Postpartum Depression Symptoms - When and How to Get Help

A variety of emotions comes with being a new parent or finding out you’re pregnant. It’s an exciting time. Yet, feelings of anxiety and fear can also creep in.

Many birthing people experience significant mood changes after childbirth. It’s estimated between 50 and 85% of new birthing parents experience a brief postpartum period often termed “baby blues” — feelings of sadness, tearfulness, or emptiness — a few short days after giving birth.

There are three categories of postpartum mood disorders, which include postpartum blues (mildest symptoms), postpartum depression, and postpartum psychosis (most severe).

Postpartum Blues

“’Postpartum blues’ or ‘baby blues’ are mild mood symptoms that affect up to 85% of postpartum people, typically beginning within two to three days after delivery. They usually resolve within two weeks of starting and without any treatment,” said Dr. Valerie C. Sharpe, psychiatrist, Baystate Health. The postpartum blues symptoms are:

• Mood swings
• Sadness
• Crying, often for no apparent reason
• Anxiety
• Irritability
• Feeling overwhelmed
• Fatigue
• Insomnia
• Impaired concentration

Understanding the difference between postpartum blues and postpartum depression is essential. Postpartum depression is a serious mental health illness that affects behavior and physical health. It is a treatable condition that affects approximately one in seven birthing people. “In most cases, postpartum depression begins prior to conception or during pregnancy and persists into the postpartum period, if not adequately treated. Identifying and treating depression prior to delivery can significantly reduce the risk of developing postpartum depression,” said Dr. Sharpe.

Postpartum Depression

Postpartum depression most commonly occurs within two to three months after delivery but can occur up to a year later. Multiple symptoms of depression are present almost every day for at least two weeks and can last for several months without treatment. This is associated with significant distress or difficulty with functioning (caring for oneself or one’s family, working). Postpartum depression symptoms include:

• Depressed or sad mood
• Loss of interest in usual activities (may have difficulty connecting with baby, family, or friends)
• Decreased pleasure
• Insomnia or sleeping more than usual
• Restlessness
• Slowed speech, thinking, or movements
• Impaired concentration, difficulty making decisions
• Change in appetite
• Fatigue
• Excessive feelings of guilt or worthlessness (often around parenting, breastfeeding or delivery complications, or for feeling this way when it “should be the happiest time of my life”)
• Suicidal thoughts (wanting to die or thinking “my family would be better off without me,” thinking about self-harm or planning to harm self)

Risk Factors for Postpartum Depression

The #1 risk factor is a personal history of depression. Risk factors include:

• History of anxiety
• History of significant mood changes secondary to hormonal changes (with birth control, prior pregnancies, PMS or premenstrual dysphoric disorder)
• Family history of postpartum depression
• Inadequate social support
• Financial stressors
• Relationship stressors
• Stressful life events such as job change or moving
• Domestic violence
• History of trauma
• Medical conditions, such as hypothyroidism or diabetes
• Younger-age pregnancies
• Having multiples, such as twins
• Substance use
• Complications in pregnancy, birth, or breastfeeding
• Racism
• Gender-related psychological distress
• Discrimination
• Microaggressions

Postpartum Psychosis

Postpartum psychosis is the most severe and rarest form of postpartum psychiatric illness, occurring in one to two new birthing people out of every 1,000 births.

This is a treatable condition that requires emergency psychiatric treatment, as it is associated with about a 4% rate of infanticide and 5% rate of suicide.

“Mothers experiencing this have a distorted sense of reality and their judgment may be severely impaired. They may have delusional beliefs that their baby or other loved ones are going to endure intense suffering and that they need to end their lives humanely to spare them from this suffering,” said Jain A. Lattes, certified nurse midwife, certified nurse practitioner, Baystate Health.

Patients with bipolar disorder or family history of bipolar disorder or personal or family history of a psychotic episode have a higher risk of postpartum psychosis.

Postpartum psychosis can begin within the first 72 hours after delivery and most often within the first two weeks postpartum. The earliest signs usually include restlessness, irritability and decreased need for sleep. Symptoms of postpartum psychosis include:

• Rapidly shifting moods such as depressed, irritable, euphoric
• Delusions or strange beliefs
• Hallucinations that may involve commands to harm self or others
• Disorientation
• Confusion
• Erratic behaviors
• Hyperactivity
• Difficulty communicating

Postpartum Psychiatric Disorders are Treatable

“Postpartum depression, psychosis and other postpartum psychiatric disorders are treatable. Early recognition and treatment can significantly reduce suffering for women and their families. Those who experience milder symptoms often benefit from non-pharmacological options, such as individual or group therapy, mindfulness, meditation, yoga, or exercise. Those who experience more severe symptoms often require medication to achieve more rapid or significant improvement,” shared Lattes.

Unfortunately, many birthing people think that they have to stop their psychiatric medication during pregnancy or while nursing after receiving the message that these medication exposures are unsafe to the exposed embryo, fetus, or infant.

“While there is no medication that is completely risk-free, there are many psychiatric medication options that are relatively low risk in pregnancy based on multiple studies. It is important to weigh the potential risks of taking psychiatric medication against the risk of not taking it, just as one would with a medication for diabetes, epilepsy, or hypertension,” said Dr. Sharpe. “If you are struggling with a mental health condition, please know that it is not a sign of weakness, you are not a bad person for feeling this way, and you are not alone. Reaching out for help is a sign of good judgment and will likely provide significant relief not only for you but also for your loved ones.”

Options for Support with Postpartum Depression

Speak with your primary care physician, OB, midwife, or doula about how you’re feeling. They may work with a social worker or other mental health clinician who can provide further support.

There are several community mental health clinics in the Baystate Health service area that offer therapy and psychiatric treatment.

1. MCPAP (Massachusetts Child Psychiatry Access Program) for Moms offers support groups for mothers and expectant mothers, resources for pregnant and postpartum women, and more.
2. Postpartum Support International (PSI) and the PSI Help Line at 1-800-944-4773 offers online support groups for parents and families and provider directories to find local support.
3. National Maternal Mental Health Hotline at 1-833-943-5746 (1-833-9-HELP4MOMS) is a 24/7 free, confidential support line before, during, and after pregnancy.

Emergency and Crisis Services for Postpartum Depression

If you or someone you know is feeling unsafe, threatening immediate harm to self or others, is out of touch with reality, or engaging in other concerning behaviors that could put them or others at risk of harm:

• Call 911
• Go to the nearest Emergency Department (if this can be done safely)
• Call Behavioral Health Network (BHN) Crisis at 413-733-6661 for Springfield and surrounding areas