Postpartum Depression Causes, Risk Factors, and Prevention Strategies

After giving birth, about 80 percent of new mothers experience sadness and mood swings known as the “baby blues.” These symptoms usually last days or weeks after birth—but occasionally they develop into more severe postpartum depression (PPD).

Postpartum depression affects one in nine new mothers, according to the Centers for Disease Control and Prevention (CDC), and symptoms can appear up to one year after giving birth. Signs of PPD include persistent sadness or emptiness, hopelessness, guilt, insomnia, weight loss, decreased energy, difficulty concentrating, loss of interest in previously enjoyed activities, and more. Doctors normally treat PPD with antidepressant medication, counseling, or both.

Anyone can develop postpartum depression, but certain factors may increase your risk. Here’s everything you need to know about the causes and risk factors of postpartum depression.

What Causes Postpartum Depression?

Doctors have traditionally blamed postpartum depression on the dramatic drop in hormones (estrogen and progesterone) that occurs after giving birth. These hormonal changes alter the chemical balance in your brain. However, hormones can’t explain everything; otherwise, all new mothers would plummet into depression.

According to the latest research, women who suffer from PPD show clear warning signs during pregnancy; many have risk factors, such as a history of depression. PPD may also be associated with sleep deprivation, feelings of loneliness associated with new motherhood, the physical changes of pregnancy, breastfeeding difficulties, and more.

Always tell your doctor if you experience symptoms of PPD, or if you think you’re at risk for developing it. "Doctors can detect the most vulnerable women early and prevent illness before it strikes," says lead researcher Zachary Stowe, M.D., director of the Pregnancy and Postpartum Mood Disorders Program at Emory University in Atlanta.

Risk Factors for Postpartum Depression

Postpartum depression can happen to anyone, whether it’s your first child or fifth. But factors that may raise your risk include:

History of depression or bipolar disorder: Women who have previously had clinical depression are much more likely to develop PPD. Keep in mind that you may not have necessarily been aware of, or treated for, past episodes of depression. It's important to look at your life carefully—your adolescence, your young adulthood, previous postpartum experiences—and assess whether you have had any significant episodes of anxiety or depression that have hindered your ability to function.

Severe PMS: Because postpartum depression seems partly triggered by hormonal changes after childbirth (and possibly after weaning), many experts believe that previous hormonal sensitivity raises a red flag. PPD risk may increase in women with a history of severe PMS, or in women who experienced negative mood changes while taking birth control pills.

A perfectionist personality: Many women with PPD are perfectionists, says Joyce A. Venis, a psychiatric nurse and president of Depression After Delivery Inc., a self-help group based in Raritan, New Jersey. "They feel guilty if they can't do everything right and presume that every other mother is doing a better job," she says. "As a result, they impose unrealistic expectations upon themselves."

Difficulties during pregnancy: Significant upheavals while expecting—such as moving to a new home, a death or illness in the family, or marital stress—can make you more vulnerable to PPD. A growing body of evidence also shows that women may begin to present symptoms of depression while pregnant.

If you’re at risk for developing PPD, share as much information as possible with your partner (or a close friend). Help him learn the symptoms of postpartum depression, and ask him to be on the lookout. The biggest signs include trouble sleeping, feelings of hopelessness and guilt, loss of interest in daily activities, and having thoughts of harming yourself or your baby. It's common for all women to feel some type of “baby blues” in the first few weeks after giving birth, but postpartum depression is longer lasting and more severe.

It's also wise to reach out to a therapist while you're still pregnant. That way, you won't have to waste time looking for treatment if you develop PPD.

How to Prevent Postpartum Depression

Getting educated about this once-taboo topic allows you to create an environment that prevents or lessens the severity of postpartum depression. In fact, whether you're at risk for PPD or not, the following strategies will make the transition to motherhood easier.

Join a support group. Isolation breeds anxiety. Just knowing that others are experiencing the same mix of joy and frustration will put your mind at ease. New-mommy support groups offered by community organizations and hospitals provide relief from the social isolation that comes with having a new baby, as well as perspective, notes Meg Spinelli, M.D., director of the maternal health program at the New York State Psychiatric Institute at Columbia University. There are also numerous websites that connect you with other new mothers; check out postpartum.net for starters.

Talk to your pediatrician and OB-GYN. Because these healthcare providers have frequent contact with new and expectant mothers, they may help detect symptoms of PPD. It's important that you choose people you can talk to, and who are interested in your welfare as well as the baby's, points out Karen Kleiman, author of This Isn't What I Expected: Overcoming Postpartum Depression (Bantam, 1994).

Get help at home. Accept household help from your partner, friends, family members, or neighbors. "If you feel overwhelmed or resentful, you need to give yourself permission to ask for help rather than wait for others to offer," says Diane Sanford, Ph.D., author of Postpartum Survival Guide.

Make time to exercise. A study of more than 1,000 mothers found that those who exercised before and after the birth of their baby tended to feel better emotionally and were more social than women who didn't. "Taking a brisk walk, getting fresh air, and enjoying nature can improve your outlook," says Karen Rosenthal, Ph.D., a psychologist in Westport, Connecticut. Don't push yourself to do strenuous aerobics, though; this is more about getting your blood flowing than burning calories or tightening your abdominal muscles.

Put everything into perspective. Between hormonal swings and all the changes in your life, it will be a challenge to feel confident sometimes—especially if you assume this is supposed to be the best time of your life. Focus on the light at the end of the tunnel: Soon your baby will settle into a schedule, breastfeeding will be second nature, and your diaper bag will be stocked so you can get out of the house quickly. You have years of best times ahead; don't convince yourself that they need to be the first weeks or months of motherhood.