Baby Blues and Postpartum Depression

Meeting your newborn baby and getting to care for the newest family member should be a joyful time right? Well, research indicates that about 1 in 8 women experience symptoms of postpartum depression. The birth of a baby can trigger a heap of powerful emotions, which ranges from excitement and joy to fear and anxiety. But it can also result in something unexpected like depression.

Postpartum Depression (PPD) affects women who have just given birth. Giving birth brings about all sorts of new changes and emotions, and many women experience the blues, but diagnosed Postpartum depression is more intense and full-blown.

Having a baby is challenging and every woman deserves support. If you are experiencing emotional changes or think that you may be experiencing depression, it’s useful to make an appointment and talk to your health care provider. Most people get better with treatment and getting the help you deserve is the best thing you can do for you and your baby.

What Is Postpartum Depression?

Postpartum depression (PPD) is a complex mix of chemical, social, physical, emotional, and behavioral changes that happen in some women after giving birth. According to the DSM-5, PPD is a form of major depression that begins within 4 weeks after delivery. The diagnosis of postpartum depression is based not only on the length of time between delivery and onset but on the severity of the depression.

The chemical changes involve a rapid drop in hormones after delivery. The actual link between this drop and depression is still not clear. But what is known is that the levels of estrogen and progesterone, the female reproductive hormones, increase tenfold during pregnancy. Then, they drop sharply after delivery. By 3 days after a woman gives birth, the levels of these hormones drop back to what they were before pregnancy. In addition to these chemical changes, the social and psychological changes of having a baby create an increased risk of depression.

Most new mothers experience the "baby blues" after delivery. About 1 out of every 8 of these women will develop a more severe and longer-lasting depression after delivery. Postpartum "baby blues" commonly include mood swings, crying spells, anxiety and difficulty sleeping. Baby blues typically begin within the first two to three days after delivery, and may last for up to two weeks. But some new mothers experience a more severe, long-lasting form of depression. Rarely, an extreme mood disorder called postpartum psychosis may also develop after childbirth. Postpartum depression isn't a character flaw or a weakness. Sometimes it's simply a complication of giving birth.

Signs and Symptoms.

Symptoms of PPD can be hard to detect. Many women have these symptoms following childbirth:

• Trouble sleeping

• Appetite changes

• Severe fatigue

• Lower libido

• Frequent mood changes

Many women feel a bit down, tearful or anxious in the first week after giving birth. This is often called the "baby blues" and is so common that it's considered normal. The "baby blues" do not last for more than 2 weeks after giving birth.

With PPD, these come along with other symptoms of major depression, which aren’t typical after childbirth, and may include:

• Being uninterested in your baby or feeling like you’re not bonding with them

• Crying all the time, often for no reason

• Depressed mood

• Appetite and sleep disturbance

• Severe anger and crankiness

• Feelings of worthlessness, hopelessness, and helplessness

• Thoughts of death or suicide

• Feelings of guilt, shame or hopelessness

• Loss of interest, joy or pleasure in things you used to enjoy

• Possible thoughts of harming the baby or yourself

• Feelings of hopelessness or pessimism.

• Problems concentrating, recalling details, and making decisions.

• Difficulty falling asleep or sleeping too much.

Untreated PPD can be dangerous for new moms and their children. A new mom should seek professional help when:

• Symptoms persist beyond 2 weeks

• They can’t function normally

• They can't cope with everyday situations

• They have thoughts of harming themselves or their baby

• They're feeling extremely anxious, scared, and panicked most of the day

Three types?

PPD is different from the baby blues. PPD is depression that occurs after having a baby. Feelings of postpartum depression are more intense and last longer than those of “baby blues,” a term used to describe the worry, sadness, and tiredness many women experience after having a baby.

There are three terms used to describe the mood changes women can have after giving birth:

• The "baby blues" happen to as many as 70% of women in the days right after childbirth. You may have sudden mood swings, such as feeling very happy and then feeling very sad. You may cry for no reason and can feel impatient, cranky, restless, anxious, lonely, and sad. The baby blues may last only a few hours or as long as 1 to 2 weeks after delivery. Usually you don’t need treatment from a health care provider for baby blues. Often, joining a support group of new moms or talking with other moms helps.

• Postpartum depression (PPD) can happen a few days or even months after childbirth. PPD can happen after the birth of any child, not just the first child. You can have feelings similar to the baby blues -- sadness, despair, anxiety, crankiness -- but you feel them much more strongly. PPD often keeps you from doing the things you need to do every day. When your ability to function is affected, you need to see a health care provider. The practitioner can screen you for depression symptoms and come up with a treatment plan. If you don’t get treatment for PPD, symptoms can get worse.

• Postpartum psychosis is a very serious mental disorder that can affect new mothers. This illness can happen quickly, often within the first 3 months after childbirth. Women can lose touch with reality, having auditory hallucinations (hearing things that aren't actually happening, like a person talking) and delusions (strongly believing things that are clearly irrational). Visual hallucinations (seeing things that aren't there) are less common. Other symptoms include insomnia (not being able to sleep), feeling agitated and angry, pacing, restlessness, and strange feelings and behaviours. Women who have postpartum psychosis need treatment right away and almost always need medication. Sometimes women are put into the hospital because they are at risk for hurting themselves or someone else.

Baby blues symptoms

Signs and symptoms of baby blues - which last only a few days to a week or two after your baby is born - may include:

• Mood swings

• Anxiety

• Sadness

• Irritability

• Feeling overwhelmed

• Crying

• Reduced concentration

• Appetite problems

• Trouble sleeping

Postpartum depression symptoms

Postpartum depression may be mistaken for the baby blues at first - but the signs and symptoms are more intense and last longer, and may eventually interfere with your ability to care for your baby and handle other daily tasks. Symptoms usually develop within the first few weeks after giving birth, but may begin earlier (during pregnancy) or later (up to a year after birth).

Postpartum depression signs and symptoms may include:

• Depressed mood or severe mood swings

• Excessive crying

• Difficulty bonding with your baby

• Withdrawing from family and friends

• Loss of appetite or eating much more than usual

• Inability to sleep (insomnia) or sleeping too much

• Overwhelming fatigue or loss of energy

• Reduced interest and pleasure in activities you used to enjoy

• Intense irritability and anger

• Fear that you're not a good mother

• Hopelessness

• Feelings of worthlessness, shame, guilt or inadequacy

• Diminished ability to think clearly, concentrate or make decisions

• Restlessness

• Severe anxiety and panic attacks

• Thoughts of harming yourself or your baby

• Recurrent thoughts of death or suicide

Untreated, postpartum depression may last for many months or longer.

Postpartum psychosis

With postpartum psychosis - a rare condition that typically develops within the first week after delivery - the signs and symptoms are severe. Signs and symptoms may include:

• Confusion and disorientation

• Obsessive thoughts about your baby

• Hallucinations and delusions

• Sleep disturbances

• Excessive energy and agitation

• Paranoia

• Attempts to harm yourself or your baby

Postpartum psychosis may lead to life-threatening thoughts or behaviors and requires immediate treatment.

How do I know if I have baby blues or postpartum depression?

Baby blues and PPD have similar symptoms. However, symptoms of baby blues last about 10 days and are less intense. With PPD, the symptoms last weeks or months, and the symptoms are more severe.

Postpartum depression in new fathers.

New fathers aren’t immune to PPD. Research indicates that about 1 in 10 new fathers get depression during the year their child is born. They may feel sad or fatigued, be overwhelmed, experience anxiety, or have changes in their usual eating and sleeping patterns - the same symptoms mothers with postpartum depression experience. Fathers who are young, have a history of depression, experience relationship problems or are struggling financially are most at risk of postpartum depression. Postpartum depression in fathers (sometimes called paternal postpartum depression) can have the same negative effect on partner relationships and child development as postpartum depression in mothers can.

If you're a new father and are experiencing symptoms of depression or anxiety during your partner's pregnancy or in the first year after your child's birth, talk to your health care professional. Similar treatments and supports provided to mothers with postpartum depression can be beneficial in treating postpartum depression in fathers.

When to see a doctor.

If you're feeling depressed after your baby's birth, you may be reluctant or embarrassed to admit it. But if you experience any symptoms of postpartum baby blues or postpartum depression, call your doctor and schedule an appointment. If you have symptoms that suggest you may have postpartum psychosis, get help immediately.

It's important to call your doctor as soon as possible if the signs and symptoms of depression have any of these features:

• Don't fade after two weeks

• Are getting worse

• Make it hard for you to care for your baby

• Make it hard to complete everyday tasks

• Include thoughts of harming yourself or your baby

• Recurrent thoughts of death or suicide

• Depressed mood for most of the day, nearly every day for the last two weeks.

• Feeling anxious, guilty, hopeless, scared, panicked or worthless.

• Difficulty thinking, concentrating, making decisions or dealing with everyday situations.

• Loss of interest or pleasure in most activities nearly every day for the last two weeks.

Ways to cope with postpartum depression.

It's OK to feel overwhelmed.

Parenting is full of ups and downs and having a baby isn't easy. If you have depression, you don't have to suffer alone. Your healthcare provider can help find a treatment that works for you.

Here are some tips that can help you cope with bringing home a newborn:

• Ask for help. Let others know how they can help you.

• Find someone to talk to - a counsellor, psychologist, friend, family member or someone who will listen to you and help you.

• Join a support group for new parents.

• Be realistic about your expectations for yourself and baby.

• Exercise, within the limits of any restrictions your doctor may place on your level of activity; take a walk and get out of the house for a break.

• Expect some good days and some bad days.

• Follow a sensible diet; avoid alcohol and caffeine.

• Foster the relationship with your partner; make time for each other.

• Keep in touch with family and friends; don’t isolate yourself.

• Limit visitors when you first go home.

• Screen phone calls.

• Sleep or rest when your baby sleeps.

• Find time for self-care and doing things you enjoy, like reading or other hobbies.

• Get help with household chores or errands.

Recommendations from your counsellor.

There are a few things you can do at home to help cope with everyday life.

1. Exercise when you can.

Exercise may have an antidepressant effect for women with PPD. In particular, walking with baby in a stroller might be an easy way to get in some steps and breathe fresh air. In a study published in Mental Health and Physical Activity, walking was found to be a statistically significant way to ease depression. Can’t fit in a long exercise session? Try working out for 10 minutes a few times during the day.

2. Maintain a healthy diet.

Healthy eating alone won’t cure PPD. Still, getting into the habit of eating nutritious foods can help you feel better and give your body the nutrients you need. Try planning the week’s meals on the weekend and even preparing healthy snacks ahead of time. Think whole foods, such as chopped carrots and cubed cheese or apple slices and peanut butter, that are easy to grab on the go.

3. Create time for yourself.

You may feel stuck on the couch breast-feeding. Maybe you’re feeling overwhelmed by work, household responsibilities, or your older children. Instead of dealing with these stresses alone, reach out for help. Take up your mother-in-law on her offer of free babysitting. Let your partner or another trusted adult take the baby for an hour or two.

You may find it helpful to schedule some dedicated “me time” once a week. Even if you can only get out of the house between nursing sessions, you can use this time to decompress. Go on a walk, take a nap, go to a movie, or do some yoga and meditation.

4. Make time to rest.

You’ve probably been told to “sleep when the baby sleeps.” This advice may get annoying after a while, but it’s rooted in science. In the early days, your baby likely isn’t sleeping through the night. You may find it helpful to take naps or go to bed early. If you’re breast-feeding, consider pumping a bottle so your partner can take care of an overnight feeding or two.

5. Focus on fish oils.

Now is also a good time to beef up your intake of omega-3 fatty acids, like DHA. According to an article published by the Journal of Affective Disorders, women who have low levels of DHA have higher rates of postpartum depression. Seafood is an excellent dietary source of DHA. If you’re a vegetarian, flaxseed oil is another great source. You can also find supplements at your local grocery store.

6. Resist isolation.

The days may blend together, making you feel isolated at times. Talking about your feelings with others can help shift your mood. Researchers discovered that new mothers had lower levels of depression after regularly speaking with experienced mothers who had previously experienced PPD. These results extended to four weeks and then eight weeks after delivery.

Although the peer mothers in this study had specific training on how to give phone support, the power of social interaction is undeniable. Try your best to get out or at least chat with other adults and moms for support.

7. Developing a support network.

You may find comfort in confiding in a close friend or family member. If you don’t want to share your feelings with people you know, there are other places you can reach out to for support.

You can:

• Call your midwife, or another healthcare provider.

• Contact your minister or another leader in your faith community.

• Ask around about any local support groups for PPD.

• Chat online with other new moms.