Identifying postpartum depression, or PPD, is not always simple. There are many
situations in which women develop symptoms of depression after giving birth, but
we can make two main distinctions:
1. A woman is mildly depressed or highly stressed
before she has her baby, and after delivery, the hormonal fluctuations of childbirth
and the stress of caring for a newborn push her over the edge into full-blown depression.
This is not technically PPD. This is an episode of depression that was present or
imminent before the baby’s birth and continues afterward.
2. A mother’s moods are relatively stable and upbeat
prior to giving birth but spiral downward afterwards — often within a matter of
days but sometimes over the course of months. In this case, the depression is very
clearly connected to postpartum hormone fluctuations.
The exact number of women who experience true postpartum depression is hard to know.
Many women hide their negative feelings both before and after giving birth, and
fatigue, sleep problems, pain, inflammation, and other postpartum issues can blur
the boundary line with depression. An estimated 70–85% of mothers report mild “baby
blues” within the first few weeks of birth, while just 10–20% experience the longer-lasting,
deeper PPD. A very few women develop the severest form of postpartum psychiatric
illness, known as postpartum psychosis when the mother loses touch with reality
and can deliberately or inadvertently harm herself or her child.
Baby blues, PPD, and hormonal imbalance
When trying to determine whether a mother is suffering standard, short-term baby
blues or a bout of PPD, these questions can help:
Identifiers of the baby blues
- Do your emotions seem magnified, with extreme shifts in moodiness, sadness, irritability,
- After delivery, did your emotional symptoms improve within the first two to three
- Are your symptoms just bothering you and not interfering with your ability to function
and care for your child or children?
Typically, women with more severe symptoms or symptoms lasting longer than two weeks
should be screened for PPD. That’s the time for questions like these:
Identifiers of postpartum depression
- Do you have a history of depression, with previous episodes, or did you feel depressed
- How long have you been feeling this way? Typically, PPD develops gradually over
the first three postpartum months, but symptoms can also arise very quickly.
- What are your symptoms like? Symptoms may include depressed mood and anhedonia (the
inability to experience anything pleasurable), guilt, insomnia, crying easily, fatigue,
appetite disturbance, and recurrent thoughts of death or suicide.
- Do you find yourself overly anxious about yourself and your child? Is this something
your friends and family have also observed?
- Do you have ambivalent or negative feelings towards your child?
- Are your emotions interfering with your ability to care for yourself or your child?
When a new mother says she’s depressed, it’s important to determine how she felt
before she had the baby. That can be a clue as to whether the depression is a long-standing
issue just coming to light, or is a new problem related to hormones. And this is
an important distinction because often pre-existing depression will respond to different
types of therapy than true PPD.
How a woman feels during pregnancy is also significant. A strong indication of hormone-based
PPD is when a new mother with depression tells us that pregnancy was wonderful and
she felt better than ever, and then describes a sharp contrast between the euphoria
she felt in pregnancy and the lows that came afterward. This is usually a signal
that her hormones, particularly progesterone, may be imbalanced.
Any form of depression has both physical and emotional components, and postpartum
depression is no exception. Fluctuating hormones heighten your emotions after giving
birth, and these fluctuations continue for far longer than four weeks particularly
if you breastfeed. This situation is compounded by the fatigue, discomfort, and
sleeplessness of the first days and weeks after childbirth. It can feel especially
lonely at night, when the new mom is the only one awake to care for the baby. Nights
and days as the only provider make this even more difficult for single moms.
If the baby isn’t sleeping well (or at all), has health problems, is premature,
or is prone to fussiness, it takes an even greater toll on a new mom. She may already
have conflicting emotions about her new role as a mother, particularly if her own
mother was distant, absent, or abusive. All of these factors contribute to feeling
depressed after giving birth.
The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental
Disorders —commonly known as the DSM-IV —classifies postpartum depression as Major
Depressive Disorder with Postpartum Onset. The DSM-IV also says that symptoms must
appear in the first 4-6 weeks following the birth. Unfortunately many new moms do
not experience symptoms until well after this time frame. There is also some recognition
of depression that begins during the pregnancy (peripartum-onset), holding over
into the postpartum period. Treatment recommendations can include using drugs such
as Prozac or other SSRIs that may not be effective for true PPD. Antidepressants
often just mask symptoms in women who have issues with hormonal balance.
Treating postpartum depression
There’s plenty of research into standard depression, but less for PPD, which isn’t
“just” depression that happens to occur in a new mom. PPD is different from standard
depression because the state of women’s bodies and their individual hormonal balance
after childbirth are not the same as in non-pregnant women.
When it comes to treatment, most conventional practitioners will approach PPD as
if it is standard depression, which may not be effective, leaving aside the fact
that drug therapies for depression have unknown effects on nursing babies. There
are ways to address the imbalances of PPD naturally and most of these therapies
are effective in helping women who have moved past their PPD experiences, but still
feel “off” even years after childbirth.
A natural approach
For women with PPD, natural approaches can lead to better mood and hormonal balance.
- Eat well and take either your daily prenatal multivitamin,
or another high quality multivitamin like our
Essential Nutrients, along with omega-3 essential fatty acids.
- Get as much sleep as you can. It may help to adjust
your sleep schedule to match your baby’s and ask the other parent or a helper to
take one shift at night, feeding the baby formula or pumped breast milk.
- Ask for help with the baby, and talk to friends and
relatives or a health care professional if you feel depressed right away.
- Consider herbal supplements to support hormone balance,
such as our Herbal Equilibrium
formula. You can also talk to your doctor about bioidentical progesterone therapy,
but only if you are no longer breastfeeding,
- Get outside in the sunshine daily, and try to start
doing some gentle exercise daily as well. but don’t overdo it while you’re healing.
PPD is usually resolved quickly if you get good nutrition, rest, exercise, emotional
support and, if needed, progesterone or drug therapy. The most important factor
is letting people know how you’re feeling: ask for help. Don’t become isolated —
reach out to friends, family, or social services if you’re overwhelmed by your depressed
mood. The people who care about you will want to help.
1 Nonacs, R. 2007. Postpartum depression. URL: http://www.emedicine.com/med/topic3408.htm
Mental Health America. 2006. Postpartum disorders. URL: http://www.nmha.org/go/information/get-info/depression/postpartum-disorders
ACOG. 2005. Spotlight on postpartum depression. ACOG co-sponsors National
Depression Screening Day. 2005 marks first-time focus on postpartum depression.
2 Nonacs, R. 2007.
Kendall-Tackett, K. 2005. Depression in new mothers: Causes, consequences
and treatment options. Binghamton: Haworth Press. [As cited in Kendall–Tackett,
K. 2007. A new paradigm for depression in new mothers: The central role of inflammation
and how breastfeeding and anti-inflammatory treatments protect maternal mental health.
Int. Breastfeed. J., 2, 6. URL: http://www.internationalbreastfeedingjournal.com/content/2/1/6#B1
O’Hara, M., & Swain, A. 1996. Rates and risk of postpartum depression
— a metaanalysis. Int. Rev. Psychiatry, 8, 37–54.
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