Postpartum Depression Explained

“How could you be depressed when you have such a cute baby? Postpartum depression isn’t real; it’s all in your head, just like PMS.”

If someone said this to you, you might be tempted to hurl something in his/her way, even if you don’t have postpartum depression. You don’t even have to have a baby to be infuriated by such ignorance.

Unfortunately, this sentiment is common. Mothers themselves and even medical professionals often misunderstand postpartum depression. It could be a cultural issue as well. The U.S. society in general seems hell-bent on mothers bouncing back immediately after giving birth, whether it’s going back to work or getting their figure back.

Postpartum depression is a very real, serious condition. Mothers (or even fathers in some cases) need professional treatment for it, as it might not go away on its own.


What Exactly is Postpartum Depression?

ppd01_depressed-300x296Postpartum depression (PPD) is also known as postnatal depression. It’s a type of moderate to severe clinical depression that occurs after childbirth. It can affect both sexes, although mothers are more susceptible to it. According to American Psychological Association, some 9 to 16 percent of women experience PPD after childbirth.

When postpartum depression reaches its extreme, it can turn into postpartum psychosis. It affects 1 to 2 out of every 1,000 cases of PPD.

The causes of postpartum depression aren’t 100% understood, but there’re some risk factors, including:

  • A history of depression (yourself or family)
  • Previous miscarriage or stillbirth
  • Prenatal depression
  • Low social support
  • Smoking
  • Poor marital relationship
  • Low levels of oxytocin

These factors are not conclusive nor do they cover all potential risk factors. Any woman can get postpartum depression after childbirth, miscarriage, stillbirth, or even adoption of a child. It can happen after just one child or multiple children.

Men can experience PPD. The Journal of the American Medical Association published a report that indicated 10 percent of men worldwide had signs of depression after having a child. This is known as PPPD, or paternal postpartum depression.


History of Postpartum Depression

Is postpartum depression a recent phenomenon, or has this always happened to women after childbirth?

PPD has been around for a long time, although the term itself didn’t become mainstream until the mid-2000s. In 2005, actress Brooke Shields published Down Came the Rain, where she brilliantly compared her tears post-birth to the rain taking down the itsy-bitsy spider. The condition was further publicized in well-known verbal jabs exchanged with Tom Cruise.

Earlier literatures suggest postpartum depression has always existed, even though the term was only recognized in the fourth edition of Diagnostic and Statistical Manual in 1994. Hippocrates mentioned “wandering womb” in the fourth century B.C., referring to the uterine fluid that could flow to the head after childbirth and cause psychosis.

Jean-Etienne Esquirol was a physician from the nineteenth century who became one of the first physicians to acknowledge postpartum illnesses in detailed case reports. He reported postpartum melancholy, delirium, and mental disturbances in 92 case reports.

So PPD is nothing new; it has been around for centuries, but it was hard to acknowledge and quantify. One reason is that many women dealt with “mild” cases of postpartum depression and sought to treat it at home. Also the stigma around feeling the way they did – because all mothers are supposed to love their newborns and be happy – probably prevented them from being vocal about their condition and seeking treatment.

When not treated in time, PPD can become full-blown psychosis. Sometimes you watch the news or read about women who killed their own children. It’s highly likely that many of them were suffering from a case of postpartum psychosis.

Now that postpartum depression is better known, treatment options are being expanded and more women and men can find support networks either online or offline.



No doctor or researcher can pinpoint to one single cause that makes new parents susceptible to PPD. It’s widely thought to be a combination of physical and emotional changes.

The reason women experience it more than men is because they’re actually going through physical changes. After childbirth, there’s a dramatic drop in estrogen and progesterone. Although breastfeeding a newborn can produce oxytocin, one of the “happy” hormones, it might not be enough to balance out the lack of other hormones.

Emotional changes can be byproducts of physical issues. When you’re going through sleep-deprivation and immense overwhelm, it’s not unreasonable to think you’d have problems handling other day-to-day tasks. You might also not like your postpartum body or can’t get used to it. Top that off with confusion about your sense of identity and it’s no wonder you have depression.



Postpartum depression symptoms are highly individual and range from mild to severe. It’s important to distinguish the “baby blues” with “depression.” The baby blues are common after childbirth and only last a few days to weeks. Some of the symptoms include:

  • Anxiety
  • Crying
  • Irritability
  • Mood swings
  • Problems with appetite
  • Sadness
  • Trouble sleeping

Postpartum depression symptoms may be some or all of the above, but they’re more intense and last longer. Symptoms appear within the first few weeks after childbirth, but can also show up later – even after 6 months. If any of these symptoms persist weeks after giving birth, you might have postpartum depression:

  • Difficulty bonding with your baby
  • Excessive crying
  • Recurrent thoughts of suicide or death
  • Feelings of shame, guilt, worthlessness
  • Fear that you’re not a good mother
  • Loss of appetite
  • Eating much more than normal
  • Loss of sleep
  • Sleeping too much
  • Panic attacks or anxiety
  • Fatigue or lack or energy

When you go too long without seeking treatment for these symptoms, your PPD may develop into postpartum psychosis. This is a rare condition that develops after the first week postnatal, but the symptoms, which may include hallucinations, delusions, and paranoia, are much severe. They can be life-threatening.


Treatment Options

Can postpartum depression be treated? Or does it go away on its own?

PPD is like any other clinical depression. It can be treated with medication and psychotherapy. But as the condition is highly individual, so is the treatment plan. What works for one woman may not work for another.

In order to be treated for postpartum depression, you must first be diagnosed. Your medical professional will ask you to fill out a depression-screening questionnaire. You may be asked to undergo a blood test.

There are currently two overarching treatment options for PPD: psychotherapy and antidepressants.

Research often suggests psychotherapy should be the first line of treatment before medication. According to the in-depth report by The New York Times on postpartum depression, psychotherapy without medication should benefit patients within 8 weeks, with symptoms completely resolved by 12 weeks. If that doesn’t pan out, that’s when antidepressant drugs regimen starts.

Psychotherapy is simply a fancy word for an opportunity to talk to a counselor, psychologist, or other trained provider. Because PPD is still under-diagnosed, you may fear judgment or lack of approval from your spouse, parents, friends, or other people in your life. By just talking about your concerns and feelings, you may be on your way to feeling better.

In your therapy sessions, you should discuss any feelings of sadness, thoughts of harming yourself or committing suicide, feelings of overwhelm and disconnect from your baby, and anything else that are contributing to your depression.

If therapy alone isn’t helpful, you may want to ask your doctor to kick it up a notch and put you on antidepressant drugs. This could become a concern if you want to breastfeed your baby. But between feeling better and breastfeeding, your medical professional will urge you to take the former option.

There are two types of antidepressants: selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs). SSRIs are usually recommended first and include some famous brand names like Prozac (fluoxetine), Zoloft (sertraline), Celexa (citalopram), etc.

TCAs are an older class of antidepressants and can be used if you don’t respond well to SSRIs. Because some of them, like doxepin, aren’t safe for breastfeeding, they’re not the first recommendation.


What Can You Do Right Now?

So you know you need to be treated for postpartum depression. But what can you do personally? Your entire life won’t revolve around visiting doctors and taking antidepressants.

For one thing, it’s essential you don’t feel guilty or worthless over feeling the way you do. Contrary to the rosy picture of postnatal bliss that society paints, it’s perfectly normal and even expected you’d be overwhelmed by caring for a newborn. Postpartum depression isn’t caused by anything you do.

You can get into some lifestyle habits that promote your physical and mental well-being. These include:

Spending time in the sun: sunlight improves your mood, so get just a few minutes of sun each day.

Asking for help: sometimes your spouse can be utterly unhelpful because he doesn’t understand postpartum depression. It helps to spell out exact things for him to do, like chores, preparing for meals, and setting aside time exclusively for your relaxation.

Joining a support network: humans are naturally social beings. You may want to seek out a group of women dealing specifically with postpartum depression. It can be therapeutic to know you’re not alone in your suffering.


Postpartum Depression Myths & Facts

Although most people are familiar with postpartum depression, the condition has only become front and center recently. As such, there is a lot of myth and misunderstanding that surround PPD. Here are the facts to dispel some common myths:

Myth 1: Having postpartum depression is your fault

Fact: This is surprisingly wide in belief. After all, not all women experience it, so why do some get it? You’re the only one who can control your feelings, right?

As mentioned earlier, postpartum depression can happen to anyone, particularly to those with high risk factors. While some of those risk factors can be controlled, others like genetic disposition can’t be helped.

PPD is a result of rapid fluctuations in hormones. Some women are just luckier than others not to be predisposed to such a condition.

In short, because PPD is a real, medically diagnosable condition, you should never blame yourself for feeling depressed after giving birth.

Myth 2: Mothers with postpartum depression will kill their kids

Fact: It’s postpartum psychosis, not depression, which can lead some people to harm their own children. But even with women suffering from postpartum psychosis, the actual cases of murder are very rare.

It’s because it’s so rare that they make the news. News is supposed to be sensational; otherwise, they wouldn’t be newsworthy. It’s because of this sensationalist approach to a postpartum condition that more women can’t freely admit they suffer from it.

Myth 3: Postpartum depression will go away on its own

Fact: Just like any other type of depression, PPD is a real illness that requires medical intervention. It doesn’t necessarily have to involve medication, but seeing a mental health professional specializing in PPD is almost a certainty.

PPD doesn’t even have to happen right away in order to be diagnosed as such. It can appear anytime within the first year after giving birth. In any case, serious postpartum depression symptoms don’t resolve on their own. It’s actually dangerous to think that they’ll go away – that’s the baby blues, not PPD. Although it’s easy to confuse the two, PPD symptoms last much longer and are much more intense.

Postpartum depression is now recognized worldwide. It can happen to anyone, even men. It doesn’t discriminate; whether you’ve had a first or fifth child, it can hit you and slowly consume you.

While the condition still has a lot of familial and social stigma attached to it, it’s important to seek treatment at the first onset of prolonged symptoms. Popular treatment options are psychotherapy and antidepressants, both of which are covered by insurance in most cases.

Even though PPD is a serious condition, many women have recovered from it to thrive with their newborns. You can find hope for recovery by acknowledging that your feelings are valid and being proactive about treating your condition.