Condition Basics

What is postpartum depression?

Postpartum depression is a serious illness that can happen in the first few months after childbirth. It also can happen after miscarriage or stillbirth. It can make you feel very sad, hopeless, and worthless. You may have trouble caring for and bonding with your baby.

Postpartum depression is not the "baby blues," which usually go away within a couple of weeks. The symptoms of postpartum depression can last for months.

In rare cases, a woman may have a severe form of depression called postpartum psychosis. This is an emergency because it can quickly get worse and put her or others in danger.

It's very important to get treatment for depression. The sooner you get treated, the sooner you'll feel better and enjoy your baby.

What causes it?

Postpartum depression seems to be brought on by the changes in hormone levels that happen after pregnancy. Some things can increase your chances of getting it, such as having depression in the past, not having good support, or having a lot of other stress.

What are the symptoms?

The most common symptoms of postpartum depression are feeling very sad or hopeless and losing pleasure in life. Other symptoms may include trouble sleeping or poor appetite. Symptoms can happen in the first day or two after the birth or a couple of weeks after the birth. They can sometimes last for months.

How is it diagnosed?

Your doctor will do a physical examination and ask about your mood and your symptoms. Be sure to tell your doctor about any feelings of "baby blues" at your first checkup after the baby is born. Your doctor will want to follow up with you to see how you are feeling.

How is postpartum depression treated?

Postpartum depression is treated with counselling and antidepressant medicines. Women with milder depression may get better with counselling alone. But many women need both. To help yourself get better, try to eat well, get exercise every day, and get as much sleep as possible. Get support from family and friends if you can.

What Increases Your Risk

A risk factor is anything that increases your chances of having a certain problem. Risk factors for postpartum depression include:

• A history of postpartum depression. This puts you at high risk of having it again.
• Poor support from family, partner, and friends.
• High life stress, such as a sick or colicky newborn, financial troubles, or family problems.
• Physical limitations or problems after childbirth.
• Depression during a current pregnancy.
• Previous depression.
• Bipolar disorder, also known as manic depression.
• A family history of depression or bipolar disorder.
• Previous premenstrual dysphoric disorder (PMDD), which is the severe type of premenstrual syndrome (PMS).

Risk factors for postpartum psychosis include:

• A personal or family history of bipolar disorder.
• Previous postpartum psychosis.

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Lowering Your Risk

If you have a history of depression or postpartum depression or if you're having symptoms of depression, be sure to tell your doctor. Counselling may help lower your risk for postpartum depression. In some cases, your doctor may recommend that you start taking an antidepressant.

Many new moms feel down, anxious, or grumpy in the weeks after giving birth. For some, these feelings last longer and are more intense. If you or your loved ones are worried about how you're feeling, talk to your doctor right away.

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Symptoms

The two most common symptoms of depression are:

• Feeling sad or hopeless nearly every day.
• Losing interest in or not getting pleasure from most daily activities, and feeling this way nearly every day.

Nearly every day, you may also:

• Lose or gain weight. You may also feel like eating more or less than usual.
• Sleep too much or not enough. You may also have trouble sleeping, even when your baby is sleeping.
• Feel restless and not be able to sit still, or you may sit quietly and feel that moving takes great effort. Others can easily see this behaviour.
• Feel unusually tired or as if you have no energy.
• Feel unworthy or guilty. You may have low self-esteem and worry that people don't like you.
• Find it hard to focus, remember things, or make decisions. You may feel anxious or worried about things.

An especially serious symptom of depression is thinking about death and suicide. Some women with postpartum depression have fleeting, frightening thoughts of harming their babies.

Are you depressed?

If you have at least five of the above symptoms for 2 weeks or longer, and one of the symptoms is either sadness or loss of interest, you may have depression and may need treatment.

Even if you have fewer symptoms, you may still be depressed and may benefit from treatment. No matter how many symptoms you have, it's important to see your doctor. The sooner you get treatment, the better your chance for a quick and full recovery.

Postpartum psychosis

Postpartum psychosis is a rare, severe, and dangerous form of postpartum depression. This condition is most likely to affect women who have bipolar disorder or a history of postpartum psychosis. Symptoms usually start during the first 3 weeks (as soon as 1 to 2 days) after childbirth. Symptoms can include:

• Feeling removed from your baby, other people, and your surroundings (depersonalization).
• Disturbed sleep, even when your baby is sleeping.
• Extremely confused and disorganized thinking, increasing your risk of harming yourself, your baby, or another person.
• Extreme mood changes and strange behaviour.
• Extreme agitation or restlessness.
• Hallucinations. These often involve sight, smell, hearing, or touch.
• Delusional thinking that isn't based in reality.

Postpartum psychosis is considered an emergency that requires immediate medical treatment.

If you have any psychotic symptoms, seek emergency help right away. Until you tell your doctor and get treatment, you are at high risk of suddenly harming yourself or your baby.

What Happens

Symptoms of postpartum depression start in the weeks to months after childbirth, miscarriage, or stillbirth. Postpartum depression makes it hard for you to function well. This includes caring for and bonding with your baby. Early diagnosis and treatment are important. In rare cases, dangerous postpartum psychosis can occur.

When to Call a Doctor

Call 9-1-1 or other emergency services immediately if:

• You or someone you know is thinking seriously of suicide or has recently tried suicide. Serious signs include these thoughts:
  • You have decided how to kill yourself, such as with a weapon or medicines.
  • You have set a time and place to do it.
  • You think there is no other way to solve the problem or end the pain.
• You feel you can't stop from hurting yourself, your baby, or someone else.

Where to get help 24 hours a day, 7 days a week

If you or someone you know talks about suicide, self-harm, a mental health crisis, a substance use crisis, or any other kind of emotional distress, get help right away.

• Call Talk Suicide Canada: 1-833-456-4566 or text 45645 (4 p.m. to midnight ET).
• Kids or teens can call Kids Help Phone: 1-800-668-6868 or text CONNECT to 686868.
• Go to the Talk Suicide Canada website at https://talksuicide.ca or the Kids Help Phone website at https://kidshelpphone.ca for more information.

Consider saving these numbers in your phone.

Call a doctor now if:

• You hear voices.
• You have been thinking about death or suicide a lot, but you don't have a suicide plan.
• You are worried that your feelings of depression or thoughts of suicide aren't going away.

Seek care soon if:

• You have symptoms of depression, such as:
  • Feeling sad or hopeless.
  • Not enjoying anything.
  • Having trouble with sleep.
  • Feeling guilty.
  • Feeling anxious or worried.
• You have been treated for depression for more than 3 weeks, but you aren't getting better.

Your pregnancy health professional may be the first person to note and diagnose postpartum depression. This is one of many reasons why it's important to have a medical check 3 to 6 weeks after childbirth.

Examinations and Tests

As part of your postpartum checkup, your doctor will do a physical examination and ask about your moods and emotions. Be sure to tell your doctor about any feelings of "baby blues" at your first checkup after the baby is born. Your doctor will want to follow up with you to see how you are feeling.

Your doctor may check your thyroid-stimulating hormone (TSH) levels. This helps make sure a thyroid problem isn't causing any depression symptoms.

Ask your doctor and family members to watch you closely if you're at higher risk for postpartum depression. For example, you may be at higher risk if:

If you have an increased risk for postpartum depression, follow up with your doctor or midwife 1 to 3 weeks after you give birth.

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Treatment Overview

Treatment choices include:

Counselling.

It can give you emotional support and help with problem solving and goal setting. Others in your family may also benefit from counselling.

• Cognitive behavioural therapy helps you take charge of the way you think and feel.
• Interpersonal counselling provides emotional support and help with problem solving and goal setting.

Antidepressant medicine.

It relieves symptoms for most people. Antidepressants are typically used for 6 months or longer. They're taken first to treat postpartum depression and then to prevent symptoms from coming back. Your doctor may recommend that you take medicine for up to a year before you think about stopping it. If you've had several bouts of depression, you may need to take medicine for a long time.

Doctors recommend that people with moderate to severe postpartum depression combine counselling with medicine. Those with mild depression may get better from counselling alone. Your doctor may recommend a licensed counsellor who specializes in treating postpartum depression. To effectively treat depression, it's important that you and your counsellor have a comfortable relationship.

Getting regular exercise, eating well, and getting enough sleep may also help you feel better. Support from family or other mothers may also help.

Some people with postpartum depression may try complementary and alternative treatments (CAM), like natural health products, to help with symptoms. Talk to your doctor if you are thinking about trying a CAM treatment.

Antidepressants and breastfeeding

You can still breastfeed while taking certain antidepressants.

Treating depression is very important for you and your baby. And breastfeeding is good for your baby's health. It's also good for your baby's bond with you.

If you are worried about taking an antidepressant while breastfeeding, talk to your doctor about the risks and benefits. Antidepressants can be helpful and generally have little risk for your baby while breastfeeding.

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Self-Care

Here are some tips for taking good care of yourself when you have postpartum depression.

• Schedule outings and visits with friends and family.

  Ask them to call you often. Isolation can make depression worse, especially when it's combined with the stress of caring for a newborn.

• Get as much sunlight as you can.

  Keep your shades and curtains open. And get outside as much as you can.

• Eat a balanced diet.

  Avoid alcohol and caffeine. If you don't feel hungry, eat small snacks throughout the day.

• Get some exercise every day, such as outdoor stroller walks.

  Exercise helps improve mood.

• Ask for help with preparing food and doing other daily tasks.

  Family and friends are often happy to help a mother with a newborn.

• Don't overdo it.

  And get as much rest and sleep as you can. Fatigue can increase depression.

• Join a support group of moms with new babies.

  To find a support group in your area, talk to your doctor. Or go to the web page of Postpartum Support International at www.postpartum.net/get-help/ for more information.

• Play upbeat music throughout your day and soothing music at night.

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