Pedro ZuzartePsychiatry · Lisbon
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Postpartum depression

The birth of a child is not always experienced with the joy one expects. Postpartum depression is common, it is nobody’s fault and it is treatable.

Many mothers feel ashamed of not being well when they «should be happy». Talking about it is the first step towards getting better.

What it is

Postpartum depression is a depressive episode that begins during pregnancy or in the months after birth. It results from a combination of hormonal changes, sleep deprivation, life changes and personal factors, such as previous depressive episodes or lack of support. It can also affect the other parent.

Baby bluesFirst days, mild, improves within about two weeks.

Postpartum depressionMore intense and longer lasting, interferes with caring for oneself and the baby.

When symptoms last more than two weeks or get worse, an assessment is warranted.

Baby blues or depression?

In the first days after birth, tearfulness, emotional ups and downs and anxiety are very common. These are the so-called «baby blues», which improve spontaneously within about two weeks. In postpartum depression, symptoms are more intense, last longer and interfere with the ability to care for oneself and the baby.

Signs

  • persistent sadness, emptiness or frequent crying;
  • loss of interest and pleasure, including in the relationship with the baby;
  • intense anxiety or constant worry about the baby’s health;
  • guilt, a sense of inadequacy or of being a bad mother;
  • difficulty sleeping even when the baby sleeps;
  • frightening, intrusive thoughts about harming the baby, experienced with distress;
  • thoughts of death or that everyone would be better off without you.

When it is urgent

Call 112 or go to the emergency department if there are thoughts of suicide or of harming the baby with intent, confusion, markedly changed behaviour, strange ideas or hallucinations in the weeks after birth. These signs may indicate postpartum psychosis, which is a medical emergency.

Treatment

Treatment is tailored to severity and to the mother’s preferences. It includes psychotherapy, practical support and sleep regulation whenever possible and, when indicated, antidepressants. Some antidepressants are considered compatible with breastfeeding; the choice is made individually, weighing benefits and risks. Women who have had depression or bipolar disorder benefit from a preventive plan during pregnancy.

Related topics

Frequently asked questions

Does postpartum depression go away on its own?

The baby blues do, in the first weeks. Postpartum depression can last for months if untreated, affecting the mother, the baby and the family.

Can I breastfeed if I take antidepressants?

In many cases, yes. Some antidepressants are considered compatible with breastfeeding. The decision is made together, case by case.

Can fathers have postpartum depression too?

Yes. The other parent can also develop depressive symptoms after the birth, especially when the mother is depressed or support is limited.

References

  1. National Institute for Health and Care Excellence. Antenatal and postnatal mental health: clinical management and service guidance (CG192). 2014, updated.
  2. Stewart DE, Vigod SN. Postpartum depression. N Engl J Med. 2016;375(22):2177–2186.

This page is for information only and does not replace an individual medical assessment. Clinical review: Pedro Zuzarte, psychiatrist · Published and reviewed: .

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