Depression: Managing Postpartum Depression

Postpartum depression is more than a temporary feeling of sadness or lack of energy. It is a medical condition that occurs sometime in the first several months after childbirth. It seems to be triggered by normal hormonal changes after pregnancy. These hormonal changes are especially likely to lead to postpartum depression if you've had depression before, are under a lot of additional stress, or have poor support from your partner, friends, or family.

You probably have postpartum depression if you've had five or more of the following symptoms (including at least one of the first two symptoms) for most of each day over the past 2 weeks:¹

1. Depressed mood—tearfulness, hopelessness, and feeling empty inside, possibly with severe anxiety
2. A significant loss of pleasure in either all or almost all of your daily activities
3. Appetite and weight change—usually a drop in your appetite and weight, but sometimes the opposite
4. Sleep problems—usually insomnia, even when your baby is sleeping
5. Noticeable changes in how you walk and talk—usually restlessness, but sometimes sluggishness
6. Extreme fatigue or loss of energy
7. Feeling worthless or having inappropriate guilt
8. Difficulty concentrating and making decisions
9. Thinking a lot about death or suicide

If you think you may have postpartum depression, take a short quiz to check your symptoms:

Interactive Tool: Are You Depressed?

Early treatment is important for both you and your baby.

Continue to Why?

Postpartum depression affects both you and your baby. It interferes with your ability to function normally, including caring for and bonding with your baby. Some babies of depressed mothers might lag behind developmentally in behavior and mental ability.

Antidepressant medicine and counseling are effective ways to treat postpartum depression. Some medicines are thought to be safe for use during breast-feeding.

Continue to How?

Depression is a medical condition that requires treatment. It's not a sign of weakness. Be honest with yourself and those who care about you. Tell them about your struggle. You, your doctor, and your friends and family can team up to treat your postpartum depression symptoms.

Talk to your doctor about your postpartum depression (PPD) symptoms, and decide what type of treatment is right for you. (You may also have your thyroid function checked, to make sure a thyroid problem isn't causing your symptoms.) Treatment options include:

• Cognitive-behavioral therapy with a supportive counselor. This is recommended for all women who have postpartum depression. It can also help prevent postpartum depression. A cognitive-behavioral counselor can also teach you skills for managing anxiety, such as deep breathing and relaxation techniques.
• Interpersonal counseling focusing on your relationships and the personal changes that come with having a new baby. This gives you emotional support and helps with problem solving and goal setting.
• Antidepressant medicine, ideally along with counseling. Because breast-feeding offers many emotional and physical benefits for both baby and mother, experts are studying which antidepressants are most safe for breast-feeding babies. So you can breast-feed while taking an antidepressant for postpartum depression. Whether or not you are breast-feeding, your doctor is likely to recommend a selective serotonin reuptake inhibitor (SSRI). Tricyclic antidepressants, excluding doxepin (Silenor, Zonalon), are also used by women who breast-feed.

Breast-feeding babies whose mothers take an antidepressant do not often have side effects. But they can. If you are taking an antidepressant while breast-feeding, talk to your doctor and your baby's doctor about what types of side effects to look for.

Home treatment measures may also be helpful.

• Schedule outings and visits with friends and family, and ask them to call you regularly. Isolation can make depression worse, especially when it's combined with the stress of caring for a newborn.
• Get as much sunlight as possible. Keep your shades and curtains open. And get outside as much as you can.
• Eat a balanced diet. Avoid alcohol and caffeine. If you have little appetite, eat small snacks throughout the day. Nutritional supplement shakes are also useful for keeping up your energy.
• Get regular daily exercise, such as outdoor stroller walks. Exercise helps improve mood.
• Ask for help with food preparation and other daily tasks. Family and friends are often happy to help a mother with newborn demands.
• Don't overdo it. And get as much rest and sleep as possible. Fatigue can increase depression.
• Join a support group of moms with new babies. An infant massage class is another great way of getting out and spending time with others whose daily lives are like yours. You will also learn new ways to bond with your baby. To find a support group in your area, talk to your doctor. Or see the website of Postpartum Support International at www.postpartum.net.
• Play stimulating music throughout your day and soothing music at night.

Continue to Where?

Now that you have read this information about postpartum depression, you can take action, work with your doctor, and ask family and friends to support you along the way.