Postpartum Depression: When It Is More Than Just the “Baby Blues”

Audrey Howitt

Licensed psychotherapist

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    It is estimated that postpartum depression (PPD)  affects as many as one out of every even women according to the American Psychological Association.  The vast majority of women never report symptoms and it is a huge public health problem. Unfortunately, its causes are complex and not fully understood.

    Postpartum depression can be defined as symptoms of major depression developing within the first month after delivery, but the risk can persist for much longer. It is differentiated from the “baby blues” by duration and severity of symptoms.  It is thought that a complex web of physical, emotional and identity changes in a new mother contribute to postpartum depression at least in some part. Fluctuating hormonal levels, an absence of sleep, feelings of anxiety about motherhood, and feelings that you are less attractive and have lost control of your life may predominate.

    New research is shedding light on the role of emotional fluctuations  that may increase a woman’s likelihood of developing PPD post delivery.  Emotional fluctuations, swinging from anxiety, tearfulness, joy and back again are one of the hallmarks of PPD.  What is often less clear, is that for many women, these mood swings begin during the pregnancy itself.

    For many women, pregnancy itself can be a time of great changes physically, emotionally and in terms of self esteem, especially during the second and third trimesters. Research shows that fluctuations in self esteem during these critical periods, puts a woman at  higher risk for becoming depressed postpartum.

    Because it is estimated that the vast majority of women do not receive the help they need for PPD, there is important for doctors and nurses to conduct early perinatal screenings for the disorder. It is advised to conduct screenings during pregnancy, and for several months post-delivery.

    And while society portrays birth as a joyous event, it is also a highly stressful transition over a protracted period of time.  Prolonged stress can make it easy for pregnant women and new mothers to develop negative thoughts and beliefs about how they are doing as new mothers. This in turn eats away at self-esteem, leading to depression.

    So what should a mother or mother-to-be do in light of these new findings?

    • Be candid with your doctors and nurses. If they have screening tools, use them. If not, ask for them. Seek help early.
    • Know that postpartum depression varies from woman to woman. Some women tend to feel more anxiety, others feel more symptoms of depression.
    • Psychotherapy may be the answer for those who are unable to take medications during pregnancy or while breastfeeding. Cognitive behavioral therapy or mindfulness-based cognitive therapy tend to work well for postpartum depression.
    • Remember that those women who have suffered from a major depression or from bipolar disorder are more at risk for postpartum depression. Seek help early to help manage your symptoms.
    • Many women who suffer from postpartum depression have thoughts of self-harm. If you have a therapist, talk about these feelings with your therapist. Keep your local suicide hotline number handy.
    • Seek peer and partner support. Support can decrease the likelihood of depressive symptoms.

    Screening and affordable early therapeutic intervention are key in the diagnosis and treatment of postpartum depression Avoiding treatment early on can lead some to use drugs and subsequently a higher level of treatment from a drug rehab center.  Watch for changes in yourself and in your loved ones. And remember, that you are not alone.



    Erin K. Smith, Priya Gopalan, Jody B. Glance, Pierre N. Azzam. Postpartum Depression ScreeningHarvard Review of Psychiatry, 2016; 24 (3): 173 DOI: 10.1097/HRP.0000000000000103


    Identifying And Treating Maternal Depression: Strategies & Considerations for Health Plans, National Institute for Healthcare Management Foundation Issue Brief, 2010

    Int J Womens Health. 2011; 3: 1–14.; Published online 2010 Dec 30. doi:  10.2147/IJWH.S6938; PMCID: PMC3039003; Treatment of postpartum depression: clinical, psychological and pharmacological options;  Elizabeth FitelsonSarah KimAllison Scott Baker, and Kristin Leight