If you’ve experienced pregnancy, you’ve likely heard the term “baby blues” thrown around. It refers to a feeling of sadness that can occur after someone has a child, often caused by hormonal changes or emotional stressors.1 But what happens when the baby blues don’t seem to be going away?
Extended and lasting feelings of sadness, anxiety, and other depression symptoms after giving birth are all signs of postpartum depression (PPD). Postpartum depression is a mood disorder that can affect parents up to one year after birth, or even near the end of pregnancy.2
Many new parents can feel ashamed to discuss or receive treatment for postpartum depression, which can lead to health issues for themselves and their baby. But PPD is a common mental health disorder; one in eight individuals surveyed in a CDC study reported experiencing symptoms.3
If you’re struggling with postpartum depression, you’re not alone. Read on to learn more about the warning signs, treatment options, and how to take care of yourself and your baby.
A note: It is common for people to refer to postpartum depression simply as “postpartum.” However, in this article, we define “postpartum” as the period after giving birth. To avoid confusion, we will use the terms “postpartum depression” or “PPD” when discussing postpartum depression.
Signs of postpartum depression
Postpartum depression (which can also be referred to as perinatal depression) is depression after childbirth or towards the end of pregnancy that lasts longer than a few weeks and has a major impact on one’s quality of life.4 It usually starts within the first few weeks after birth.5
Symptoms to look out for include:6
- Feelings of sadness and hopelessness
- Feelings of guilt
- Loss of interest in usual activities
- Extreme mood swings
- Loss of appetite or overeating
- Constant anxiety and/or worry
- Difficulty concentrating
- Constantly feeling tired
- Difficulty doing everyday tasks
- Inability to sleep or sleeping too much
- Difficulty bonding with your baby
- Suicidal thoughts
If you’re having thoughts of harming yourself and/or your baby, call 988 or contact emergency services immediately.
It’s important to note the difference between postpartum depression and the baby blues. The baby blues include changing mood, being tired, tearful, irritable, and anxious. It generally resolves within 10-14 days after delivery. Postpartum depression, on the other hand, is more severe and long-lasting.
Research suggests that those with postpartum depression are at a higher risk of suicidal behavior.7 People with untreated PPD can also struggle with other mental health disorders, suffer negative physical health effects, and have difficulty building a relationship with their child.8
PPD can also have negative effects on infants and children as they grow up. These may include emotional and behavioral problems, insecure attachment styles, difficulties with sleeping and eating, and difficulties learning.9
Untreated postpartum depression can last for months and cause health problems for both the parent and baby. It’s important to get treatment for PPD to avoid mental health issues, including suicidal thinking. Treatment can also help improve the ability to bond with your baby. It also can improve the way you relate to your baby as they grow to improve their sleeping and eating as well as their ability to learn as they get older.
Postpartum depression and substance use
People experiencing PPD may use substances to try to make themselves feel better. Substance use can provide temporary relief from the demands of caring for a newborn. Substances can also help deal with hormonal changes and lack of sleep. Because of this, people with PPD can be at risk of developing issues with substance use as a way to self-medicate.10
Additionally, people who receive substance use treatment during pregnancy often end treatment once they have given birth.11 Approximately half of parents receiving medication for opioid use disorder (MOUD) during pregnancy discontinue the medication within 6 months of delivery.12 A new parent’s focus naturally centers on their baby rather than themselves. However, this may mean that their own needs, especially for substance use treatment, may go unnoticed and unmet. The lack of a support system can make things harder. Additionally, babies exposed to substances before birth can experience withdrawal symptoms, which may make them more challenging to care for.
Treatment can also be hard to get for many new parents. Less than 13% of pregnant and 10% of new parents in need of substance use treatment receive it.13 This is particularly an issue for Black parents, who are more likely to lack access to medications to treat opioid use disorder.14 In some states, new parents lose Medicaid coverage 60 days after delivery.15 In addition, stigma and fear of losing custody often prevent them from accessing substance use treatment even if it’s available.
In general, the risk of overdose increases in the postpartum months. Anxiety and depression at delivery are associated with a higher risk of overdose within 1 year of delivery.16 Untreated postpartum depression only increases this risk.
Treating postpartum depression
Postpartum depression might seem scary, but it is treatable with the right help and support. Some treatment options include:
Therapy. Speaking with a therapist regularly can be extremely helpful for new parents. Many therapists specialize in postpartum care. Cognitive behavioral therapy (CBT) is often offered. A search on Psychology Today using the filters for pregnancy and postpartum can help you find specialists in your area.
Medications. People who are breastfeeding may be concerned about taking antidepressants because medications can enter their breast milk. Every situation is different, and you and your doctor will need to come up with a plan that best fits your needs. Medications generally considered safe to use during the postpartum period include:17
- SSRIs like sertraline (Zoloft), escitalopram (Lexapro), and fluoxetine (Prozac)
- SNRIs like duloxetine (Cymbals) and venlafaxine (Effexor XR)
- Bupropion (Wellbutrin)
Mother to Baby is a great resource for finding information about medication safety during pregnancy and while breastfeeding.
Support groups. Connecting with others who are going through similar experiences can help you feel less alone. Postpartum depression support groups are offered through many medical establishments and other treatment service hubs and can be attended in person or online. You may find some through Postpartum Support International.
A note on treatment for co-occurring disorders
While it can be difficult to access, it’s important to receive proper treatment for mental health and substance use concerns being experienced at the same time (AKA “co-occurring disorders”). It can not only help your baby’s health but reduce the increased risks that relate to postpartum substance use and depression, including overdose.
If seeking a therapist, treatment program, or support group, be sure to look for those that specifically treat co-occurring disorders as well as those who specialize in postpartum care. It’s important to note that there are not a lot of these programs, they’re not always easy to find, and many people do not have access to them. If that is the case in your area, telehealth and virtual treatment options can be helpful. Safe Locator is a search tool you can use to find treatment programs that specialize in helping pregnant and postpartum women.
Medications for opioid use disorder (MOUD) and medications for alcohol use disorder (AUD) are the gold standard for treating substance use. They are also the recommended treatment for postpartum people with substance use disorders (per the American College of Obstetricians and Gynecologists, SAMHSA, and other reputable health organizations). In fact, health professionals discourage discontinuing MOUD for some time after your baby is born – typically until they are sleeping through the night and you are no longer breastfeeding.18
At Partnership to End Addiction, our BabySTEPs Helpline offers support for individuals dealing with substance use in pregnancy and postpartum, so please reach out for confidential support in English and Spanish. Our helpline specialists will listen to your concerns, provide guidance, and direct you to other resources.
Conclusion
Postpartum depression can make a new parent feel scared, isolated, and hopeless. But no one ever has to go through it alone. Finding the right treatment and relying on your support system can help ensure a healthier future for both you and your child.