What is postpartum depression and what causes it?

Some degree of emotional vulnerability is natural and expected after childbirth, and many new moms have conflicting or troublesome feelings.

The baby blues

At least 60 to 80 percent of new mothers get the baby blues, a mild form of depression that begins a few days to a week after delivery and lasts no longer than about two weeks. Moms with the blues may be weepy, anxious, irritable, and unable to sleep. Most feel better after getting some rest and help with the baby, and maybe having a good cry after all the stress and excitement of childbirth.

Postpartum depression

If your "blues" don't lift after about two weeks, it could be postpartum depression (PPD). Ten to 20 percent of new mothers develop a full-blown clinical depression, which can last from two weeks to as long as a year.

Experts have yet to come up with a precise explanation, but they agree that PPD is caused by a combination of hormonal, biochemical, environmental, psychological, and genetic factors. The precipitous drop in hormone levels immediately after childbirth may be partly to blame. Also, the emotional high of giving birth disappears quickly, to be replaced by the many new responsibilities that come with parenthood. Taking care of a newborn, while emotionally gratifying, can also be taxing and frustrating, especially for a first-time mom.

Am I at risk for PPD?

Some women are more likely than others to get PPD. You're more at risk for PPD if:

you or anyone in your family has a history of depression or anxiety, or you suffer from these conditions during pregnancy. About half of women who have depression during pregnancy go on to develop PPD. your pregnancy was not planned your spouse or partner is not supportive you're having marital difficulties you're having financial problems you've recently gone through a separation or divorce you go through a serious life change such as a big move or loss of a job at or around the time you have the baby you have severe premenstrual syndrome you have obstetric complications you were subject to early childhood trauma, have a history of abuse, or have a dysfunctional family

Remember, though, that these risk factors don't actually cause PPD. Many women with a number of risk factors never get depressed. Others with just one or even no risk factors end up with a major depression.

How will I know if I have PPD?

Your healthcare provider can best determine whether you have PPD, but you'll probably spot some symptoms yourself. Here's what to watch for:

insomnia weepiness or sadness that persists all day diminished interest in almost all activities difficulty concentrating change in appetite anxiety moodiness and irritability excessive guilt panic attacks (symptoms include racing heartbeat, dizziness, confusion, feelings of impending doom) suicidal thoughts

It's important to know the difference between normal emotional changes after childbirth and a need for further support. It's not just what you're feeling that indicates whether something may be amiss, but the frequency, intensity, and duration of your feelings. In other words, many new mothers feel sad and anxious periodically during the first few months after childbirth. But if you're crying all day long for several days in a row and having panic attacks, you should call your doctor.

Get more information about PPD, including how to cope with it and organizations you can turn to for more help.

How can I ward off PPD?

If you suffer from depression or anxiety during pregnancy, getting treated as soon as possible can dramatically reduce your chances of developing PPD. Here are a few other things you can do:

Get in the habit of taking care of yourself now so it becomes part of your routine. Plan ways to take breaks and get time off to rest once the baby comes. Talk with your partner about how you're going to divide the household responsibilities and care for each other as well as for your baby. Build a support network now (made up of friends, family members, your partner, healthcare practitioner, or therapist) so that your helpers will already be in place when the baby arrives. Start lining up help with cooking, cleaning, or baby care so you'll be able to grab some much-needed time to shower, nap, or take a walk after the baby arrives. How to prevent PPD if you've had it before

Did you develop PPD after a previous child? Once you've had PPD, the chances of getting it again are fifty-fifty, so it's best to prepare yourself for the possibility. Being prepared will give you more control of the situation, reduce the likelihood of a recurrence, and make the symptoms less severe should they arise.

According to Karen Kleiman, founder and director of the Postpartum Stress Center near Philadelphia, you can take important steps while you're pregnant to make it less likely that another episode of PPD will strike as hard:

Get in touch with all the healthcare practitioners who helped you through the previous episode. These may include your doctor, your therapist, or your psychiatrist. Discuss your options and make a plan that everyone agrees with. If your PPD was successfully treated with medication, you may want to consider taking the medication immediately after delivery. This has been documented to significantly reduce the possibility of a recurrence. Some women prefer to wait and see how they feel and start taking medication only if symptoms emerge. Once symptoms do emerge, however, the longer you feel bad, the harder it is to treat the depression. Have a talk with your mate about your concerns. Discuss what helped last time, what didn't help, and what would make things easier. Establish a support plan. Who will be there to help? Mother? Mother-in-law? Baby nurse? Doula? Other friend or family member? Take extra precautions against fatigue and stress. Make sure you rest, eat well, and exercise. Set limits. Protect yourself from overdoing it, both during your pregnancy and after. Overextending yourself can tire you out, which makes you more vulnerable to PPD than you would be if you were rested.

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