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Understanding Postpartum Depression And Anxiety

John Schaffer, LPCC

Medically reviewed by

John Schaffer, LPCC

February 11, 2019

Postpartum depression is defined by the U.S. National Library of Medicine as existing when “baby blues do not fade away or when signs of depression start one or more months after childbirth.”

According to the National Center for Health Statistics, there are more than 3.9 million baby girls and boys born in the U.S. every year. While giving birth to the newest member of the family is typically considered a happy occasion, the American Psychological Association reports that one in every seven new mothers experience a not-so-joyful mood-related response to giving birth: postpartum depression.

Postpartum Depression Defined

Postpartum depression is defined by the U.S. National Library of Medicine as existing when “baby blues do not fade away or when signs of depression start one or more months after childbirth.” This long-term distinction is important because experiencing some level of depression or anxiety is rather commonplace within the first couple of weeks of giving birth.

However, postpartum depression occurs when these “blues” don’t go away or appear more than 30 days after the birthing experience. Additionally, new mothers aren’t the only ones who are at risk of developing some type of postpartum depression, either. This particular condition can affect men, too.

Postpartum Depression and Men

For example, in May 2010, a meta-analysis was published in The Journal of the American Medical Association (JAMA) showing how men can develop postpartum depression. In this case, researchers looked at 43 different studies involving more than 28,000 men, each of which set out to determine the extent to which depression occurred in new fathers and fathers-to-be.

Upon evaluation of the data, researchers concluded that approximately 10 percent of the men studied felt some level of either prenatal or postpartum depression, with a higher incidence of this condition existing between three and six months post-delivery. Additionally, the men’s likelihood of postpartum depression—or “paternal depression” as the researchers referred to it—increased if the new mother experienced postpartum depression herself.

Potential Signs of Postpartum Depression

Signs of postpartum depression are similar to other types of depression, other than the fact that they occur specifically after giving birth. They include:

  • Feeling sad most or all of the time
  • Crying nonstop or for no reason, being tearful on and off throughout the day
  • Excessive fatigue, lack of energy
  • Restlessness
  • Feeling irritable
  • Emotional withdrawal, detachment from those around them
  • Feelings of guilt or worthlessness
  • Loss of interest in activities once enjoyed
  • Experiencing increased levels of anxiety
  • Difficulty sleeping, changes in sleep patterns (which can be difficult to differentiate because having a newborn means changed sleep patterns on its own)
  • Decreased sex drive
  • Increase or decrease of appetite
  • Trouble focusing
  • Difficulty making decisions
  • In extreme cases, thoughts of suicide or death

Postpartum Depression and the Baby

In some instances, postpartum depression extends beyond the parents, having a greater impact on the new baby. For example, postpartum depression can render a new parent incapable of taking care of the newborn child, either from a lack of interest in doing so or by worrying so much about the baby and the experience that it almost paralyzes one from taking action.

Postpartum depression can also impact the parent-child relationship when the new mother fears being left alone with the infant, either due to negative feelings toward the child or because of thoughts of harm. However scary both of these situations can be, the U.S. National Library of Medicine points out that it’s important to realize that these types of feelings “are almost never acted on.”

However, they are worth sharing with your doctor, so be sure to tell your practitioner if you’re feeling this way. Easing these thoughts and concerns may be a simple fix, but you won’t know unless you’re open and honest about having them first.

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Causes of Postpartum Depression

One of the most-asked questions when it comes to postpartum depression is: What causes it? Why do some mothers seem to get this particular condition whereas others do not?

The National Institute of Mental Health sheds some light on this often complex topic, sharing that no one thing is thought to cause postpartum depression. Instead, they state that it is a “combination of physical and emotional factors.”

For example, new parents are generally quite sleep deprived. This increased level of sleeplessness can increase a person’s risk of depression by as much as ten times over someone who has no sleep-related issues, says the National Sleep Foundation. So, physical changes like a changed sleep schedule can contribute to a depressive response.

That’s not to mention the amount of hormonal changes a new mother experiences after giving birth. Post-delivery, both estrogen and progesterone drop, each of which can have a negative impact on mood. Research conducted by Harvard University and Emory University found that lower estrogen levels can result in increased levels of depression and anxiety, even to the point of inciting the appearance of symptoms typically associated with post-traumatic stress disorder (PTSD).

Postpartum Depression Risk Factors

While the exact cause of postpartum depression is unknown, there are certain factors that, when present, can increase your risk of developing this condition after giving birth. These factors include:

  •  Feeling depressed during the pregnancy, or at any time previous to the pregnancy
  • Experiencing postpartum depression after previous childbirths
  • Family history of depression or other related mental illnesses
  • Having medical complications during the delivery or a premature birth
  • Enduring increased stress right before or after the birth due to a traumatic personal instance, such as: an unforeseen change in employment status, the death of a close friend or family member, or being the victim of a crime
  • Lack of support from family and friends
  • Issues with drugs and/or alcohol dependency or abuse

Postpartum Depression and Substance Abuse

A literature review published in the journal Women’s Health found that as many as one-third to one-half of women with postpartum depression use alcohol and between 5 and 10 percent use drugs. It also found that the highest level of use was among low-income women with a lower level of education.

Additionally, the correlation goes the other way, too. Women with a history of substance use have an approximately one in five chance of developing postpartum depression. This review further found that issues that often compounded the depression and substance use include loss of a job, not being married, and smoking cigarettes.

Information presented by doctors with the Kansas Health Institute and Duke University Medical Center suggests that the reasons some new mothers may decide to use drugs or alcohol during this time include wanting a better mood, less stress and tension, and an easier time falling asleep. Plus, she may be suffering from some type of mental health issue, which tends to be “overlooked during pregnancy and in the postpartum period.”

These statistics are critical, according to the researchers from the literature review, because use of alcohol and drugs after giving birth “can limit a mother’s ability to stay emotionally connected to her infant, adjust to his or her rhythms and behaviors, and anticipate or follow his or her development.”

There are possible consequences for the family unit, too. Some of the most severe consequences are charges of neglect or abuse on the depressive parent who is using drugs or alcohol, sometimes resulting in the child being placed in foster care.

Another issue that can affect new mothers both pre- and post-delivery is anxiety. According to Postpartum Support International, nervousness and worry affects roughly 6 percent of women prior to giving birth and 10 percent after delivery.

This type of anxiety is characterized by constant worries, fear that something bad will happen, changes in sleep and appetite, restlessness, and even physical symptoms such as feeling dizzy, experiencing hot flashes, and being nauseous.

In more severe cases, the new mother can even develop Postpartum Panic Disorder. In this instance, panic attacks occur with some sort of regularity. They cause the new mom to experience trouble breathing, chest pains, dizziness, and numbness or tingling in fingers and toes.

Postpartum Obsessive-Compulsive Disorder

Sometimes, postpartum anxiety manifests itself in the form of Postpartum Obsessive-Compulsive Disorder (OCD). Postpartum Support International indicates that this condition “is the most misunderstood and misdiagnosed of the perinatal disorders,” yet it still affects somewhere between 3 and 5 percent of new parents.

Postpartum OCD has a higher prevalence in individuals with family histories of anxiety or OCD. It’s typically characterized by repetitive thoughts or images related to the newborn, doing certain actions repeatedly (like cleaning or checking on the infant while sleeping), experiencing fear over being left alone with the baby, and being overprotective.

Effective Ways to Reduce Postpartum Depression and Anxiety At Home

If you are experiencing postpartum depression or anxiety, there are several things you can do at home that can help ease its effects. These include:

  • Asking family and friends for help to take care of your infant, your home, and all of your other obligations and responsibilities
  • Talking openly about how you feel, sharing with others the role the depression or anxiety is playing in your life
  • Keep major decisions to a minimum when you feel depressed or anxious
  • Let go of the need to be perfect
  • Set aside time to do things for just you, arranging childcare every so often so you can do things you enjoy or spend time alone with the people or hobbies you love
  • Get as much rest as you can, reducing the effects of sleep deprivation
  • Do some light physical activity, such as going for a quick walk or stretching
  • Make sure you eat regularly, meeting your own nutritional needs in addition to those of your baby if you are breastfeeding
  • Spend some time outdoors in natural sunlight; 10-15 minutes is often enough
  • Use your baby’s nap time to meditate or engage in other activities that bring you peace
  • Check out area support groups so you can connect with other new parents who feel like you do

Breastfeeding and Postpartum Depression or Anxiety

Some studies have found a correlation between breastfeeding and postpartum depression. A number of them conclude that breastfeeding offers a preventative effect when it comes to postpartum depression and anxiety.

However, in an article published by Massachusetts General Hospital Center for Women’s Mental Health, they share that, while many studies have been conducted in this area, the results are “somewhat difficult to interpret,” largely because of the small number of women being studied. Another factor that muddies the results is no control of or accounting for outside factors, such as family history of depression or the presence of any other mental or physical conditions in the person being studied.

Furthermore, new mothers who are breastfeeding are often hesitant to seek help for their depression or anxiety because they fear that they will be put on medication. If this happens, they’ll either have to quit breastfeeding or risk passing the medication on to the nursing child.

That’s partially why experts like BabyCenter stress that this is “a complicated decision, and every case is different.” However, they also reinforce that you should discuss your situation and options with your doctor, because you have several remedies available when it comes to using medication as a form of treatment while breastfeeding.

To that end, the site provides a Drugs and Breast Milk Interactions Chart that was created after discussions with Philip Anderson, pharmacist and editor of LactMed, the U.S. National Library of Medicine’s database of drugs and how they affect lactation. The chart provides a list of drugs that are “most likely safe in typical doses.” These include many different common and effective mood-related medications like:

  • Depakote
  • Dilantin
  • Wellbutrin
  • Ativan
  • Serax
  • Paxil
  • Zoloft
  • Trazodone

Of course, you should always consult with your physician first, but this information provides hope that help may be available for your depression or anxiety, even if you choose to feed your baby using breast milk.

How to Help a Loved One with Postpartum Depression or Anxiety

What happens when you’re not the one with postpartum depression or anxiety? Maybe it’s your spouse, partner, child, sibling, other family, or friend. What can you do to help them overcome this sometimes debilitating condition?, a site backed by a team of medical doctors and psychologists that provides information they hope “empowers people to help themselves create better mental health,” suggests that you do the following:

  • Get the new mother to share her feelings and, when she does, listen without giving advice or input as to how to “fix” how she feels
  • Help with responsibilities related to the house or the newborn baby without her having to ask
  • Encourage her to take care of herself by getting enough rest and engaging in activities that lower her stress levels and make her feel better (eating right, getting time alone, etc.)
  • Offer to engage in low-impact physical activity with her; research has linked exercise with reduced levels of depression both short and long-term by releasing natural mood enhancers called endorphins

If you have postpartum depression or think you have it but have not been diagnosed, help IS available. And it’s available whether you’ve tried to find relief on your own and can’t or you’re taking positive actions and simply want additional assistance so that you feel better, enabling you to be the best parent to your newborn that you can be.

Here at Rehab Center, our professional and compassionate staff is here to answer your questions 24/7, connecting you with the best treatment option for you, your situation, and your concerns. It’s all part of our confidential, no-obligation consultation. - Postpartum Depression and the Baby Blues

Harvard Health Publishing - Exercise is an all-natural treatment to fight depression

BabyCenter - Taking medicine while breastfeeding

BabyCenter - Are postpartum depression medications safe for nursing moms?

MGH Center for Women’s Mental Health - Breastfeeding and Postpartum Depression: Further Insights Into a Complicated Relationship

Postpartum Support International - Pregnancy or Postpartum Obsessive Symptoms

Postpartum Support International - Anxiety During Pregnancy & Postpartum

Duke University Medical Center - Substance Use and Depression in Postpartum Women

US National Library of Medicine - Postpartum Substance Use and Depressive Symptoms: A Review

Harvard Gazette - Estrogen and Female Anxiety

National Sleep Foundation - DEPRESSION AND SLEEP

National Institute of Mental Health (NIMH) - Postpartum Depression Facts

MedlinePlus - Postpartum Depression

JAMA Network - Prenatal and Postpartum Depression in Fathers and Its Association With Maternal Depression

American Psychological Association - What is postpartum depression & anxiety?

Centers for Disease Control and Prevention - Births and Natality

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