Causes & Risk Factors
There is no one particular cause of postpartum depression.
Postpartum Depression is typically caused by a combination of physical and emotional factors that occur after childbirth. It’s important to emphasize that postpartum depression doesn’t develop due to something the mother does or doesn’t do.
According to the National Institute of Mental Health, about 15% of births result in PPD.
Sudden changes in hormone levels post-birth often contribute to developing PPD. After the baby is born, a woman’s estrogen and progesterone levels drop dramatically, which can trigger the onset of depression and other PPD symptoms.
A mother’s history of depression and mental illness or a family history of depression and mental illness are other possible risk factors for postpartum depression. Research indicates that nearly two-thirds of women with PPD also had an anxiety disorder.
Other risk factors include:
- Major life events that cause severe emotional, financial, health, or relationship stress
- Giving birth to a child with special needs or health problems
- Traumatic or difficult birth experiences
- Unplanned pregnancy
- Lack of a support system
- Being under the age of 20 or over the age of 40
Many studies have explored the association between postpartum depression and maternal age. A recent Canadian study found that women in their 20s and in their 40s may have an increased risk of developing postpartum depression.
How Maternal Age Impacts Risk of Postpartum Depression
This data helps explain the relationship between maternal age and a woman's risk of postpartum depression. The numbers below represent the percentage of women with postpartum depression within the first 5 years of giving birth.
Postpartum depression symptoms vary for each affected person but generally include a mixture of side effects.
Some of the main PPD symptoms that women experience include:
- Mood swings
- Trouble sleeping
- Anger and irritability
- Feelings of worthlessness
- Moderate to major depression
- Excessive crying
- Inability to bond with their new baby
- Anxiety, worry, and/or fear
For most new moms, these feelings and symptoms develop within the first few weeks after childbirth and can last up to six months. In some cases, symptoms may develop in the months before childbirth.
If you or your loved one is struggling, there are some signs of postpartum depression to watch for, such as:
- Withdrawal from friends and family
- Loss of appetite
- Feeling lonely, guilty, and trapped
- Generally lacking motivation
- Lack of concentration
- Inability to enjoy themselves and their lives
Suppose you experience sadness or emotionlessness that lasts more than two weeks after your baby is born. In that case, The Office on Women’s Health (a division of the U.S. Department of Health & Human Services) recommends telling your primary care doctor or relevant healthcare provider.
Sometimes women can experience significant depression and suicidal thoughts. If you or a loved one is struggling with thoughts of suicide, you can call the National Suicide Prevention Lifeline at 800-273-8255. This hotline is free and is available 24/7.
The onset of symptoms and signs typically present themselves within the first few weeks after childbirth. Sometimes, however, symptoms can begin later, and symptoms may intensify initially and ease within the following months.
Postpartum depression symptoms may last up to six months after childbirth. However, if left untreated, PPD can risk becoming a chronic depressive disorder.
Postpartum Types and Variations
Several types and variations of postpartum depression exist, each with its own symptoms and primary triggers.
Postpartum Blues (or baby blues) is a milder and short-term disorder that affects roughly 30-80% of new mothers and includes symptoms of sadness, crying, tiredness, insomnia, and anxiety.
Postpartum Anxiety is an intense and chronic anxiety that can last from weeks to months and includes nervousness, fear and constant worry that something bad will happen to the baby.
Postpartum Obsessive-Compulsive Disorder (OCD)
Postpartum Obsessive-Compulsive Disorder (OCD) Occurs 4-5 months before giving birth and one month after and includes disturbing thoughts or images of harm coming to the baby or uncontrollable fear or worry of being left alone with the baby.
Postpartum Panic Disorder
Postpartum Panic Disorder is a type of postpartum anxiety that includes physical symptoms such as a racing heart, tightening chest, hyperventilation, dizziness, weakness, and other extreme symptoms.
Postpartum Post-Traumatic Stress Disorder (PTSD)
Postpartum Post-Traumatic Stress Disorder (PTSD) is a disorder that results from a trauma that occurred during childbirth or afterward. It can include incidents such as an unplanned C-section, the baby being sent to the NICU, physical childbirth complications, or a general lack of support or reassurance during delivery.
Postpartum Psychosis is a rare and severe disorder characterized by drastic changes in symptoms from agitation and anxiety to memory loss and confusion, as well as hallucinations and disinterest in one’s own baby. Women with bipolar disorder and schizoaffective disorder are at a higher risk of developing PPD than other women.
In some cases, Electroconvulsive Therapy (ECT) is recommended as an immediate treatment option for women that develop postpartum psychosis.
There are several ways that doctors diagnose postpartum depression.
They must first distinguish between other mental illness conditions. Doctors will also interpret the severity of the condition and whether it’s short-term postpartum baby blues or something more severe.
Doctors use other diagnostic tools to help, such as a postpartum depression screening questionnaire. Doctors may also order a blood test to rule out other medical conditions, such as a thyroid disorder. Doctors may also use several tests to rule out other possible medical conditions that may cause similar symptoms.
Mental health professionals will use the Diagnostic and Statistical Manual of Mental Disorders to help diagnose mental conditions such as postpartum depression.
Postpartum Depression in Men
While this mainly affects the mother, fathers may also exhibit paternal postpartum depression. This condition may occur more gradually in men within the first 12 months of a child’s life than in women who experience it sooner.
While men may cope with their symptoms differently than women do, postpartum depression in men produces similar symptoms.
The symptoms that men may experience include:
- Lack of Sleep
- Loss of interest in social or other activities
- Difficulty concentrating on tasks
- and Violent and angry behavior
Adoptive parents can also experience postpartum depression. Research has shown that this often has to do with the unmet expectations that adoptive parents place on themselves or the child when the baby or child is placed in their home.
Often, adoptive parents feel they do not get the same support from friends, family, and society as birth parents expect. All of these factors contribute to an emotional state that can become depression resembling postpartum depression.
The signs in adoptive parents are similar to those in birth parents, including irritability or changes in mood, difficulty sleeping, fatigue, guilt, shame, and uncertainty. Like birthparents, adoptive parents also lose interest in their usual social or physical activities.
The symptoms in adoptive parents not only affect the parents themselves but can also affect the child’s emotional well-being.
Postpartum depression can significantly affect relationships and marriages.
Because the moods and behaviors of those affected change drastically in weeks, it can place great concern or strain on the other partner.
Having a newborn is difficult for couples under any circumstance. But the added stress of coping with postpartum depression can create a new set of struggles many couples feel ill-equipped to handle.
Because there are still misconceptions surrounding emotional disorders like PPD, it can make it difficult in many cases for the partner to understand and empathize fully with how it has affected their loved one.
Potential marriage problems that can arise include:
- A lack of communication between the couple
- The added burden of increased responsibility toward the baby and the mother
- Decrease in sex and intimacy
- Angst about when the PPD symptoms will end
- Loss of interest in other activities and time for themselves
It’s important to understand that each couple is different. While some couples may experience marital struggles and challenges, others may not. Treatment and counseling options are available to ensure couples can work through their challenges in supportive and healthy ways.
Treatment for postpartum depression can vary based on the severity of your condition and your unique needs.
Typically, your doctor will recommend some therapy. Cognitive Behavioral Therapy (CBT), a type of psychotherapy or “talk therapy,” has shown to be highly effective in helping women during the postpartum period.
Social and family support can also be highly effective during the postpartum period. There are postpartum depression support groups (such as Postpartum Support International) that provide women with a safe environment where they can process their emotions during the active PPD period.
While talking with your partner or family members about the challenges of PPD can be helpful, a support group offers emotional support and comfort from women who are going through the same experience.
Your doctor may also prescribe medication to help relieve some symptoms of PPD, specifically depression and anxiety. SSRI medications (anti-depressants) are the most commonly prescribed medications. In recent years, a new intravenous medication called Brexanolone has changed everything. Brexanolone (Zulresso) is the first FDA-approved antidepressant medication to treat postpartum depression. Not only is it effective at countering PPD, but it is also safe to take while breastfeeding, a common complaint by women who have been on traditional antidepressant medications.
You’re Not Alone – You Can Find Home
Postpartum depression is a difficult illness that can leave new mothers feeling hopeless and alone. It can be hard to see the light at the end of the tunnel when PPD has taken over, but it is important to remember that recovery from PPD is possible. Many women can heal and feel better with the right support and treatment.
There is hope for you, and healing is possible. If you are struggling, please reach out for help. You are not alone.