What Are The Types Of Postpartum Depression
There are three different types of postpartum mood disorders:
Postpartum blues or baby blues
The baby blues affect between 50% and 75% of people after delivery. If you’re experiencing the baby blues, you will have frequent, prolonged bouts of crying for no apparent reason, sadness and anxiety. The condition usually begins in the first week after delivery. Although the experience is unpleasant, the condition usually subsides within two weeks without treatment. The best thing you can do is find support and ask for help from friends, family or your partner.
Postpartum depression
Postpartum depression is a far more serious condition than the baby blues, affecting about 1 in 7 new parents. If you’ve had postpartum depression before, your risk increases to 30% each pregnancy. You may experience alternating highs and lows, frequent crying, irritability and fatigue, as well as feelings of guilt, anxiety and inability to care for your baby or yourself. Symptoms range from mild to severe and may appear within a week of delivery or gradually, even up to a year later. Although symptoms can last several months, treatment with psychotherapy or antidepressants is very effective.
Postpartum psychosis
Should Breastfeeding Mothers Take Antidepressants
Nursing moms who are experiencing symptoms of depression should seek treatment immediately. If you are not already seeing a therapist or a psychiatrist, ask your OB-GYN or midwife for a referral. You dont have to go through this alone.
In some cases, your provider might recommend therapy alone as a treatment for your depression. But if she thinks you need to take an antidepressant, try not to worry.
All antidepressants are excreted into breast milk, but most are found at very low or undetectable levels in infant serum, says Dr. Rebecca Berens, assistant professor of Family and Community Medicine at Baylor College of Medicine in Houston. While infants should be monitored for behavior changes and weight gain if a mother is taking antidepressants, very few side effects in infants have been observed in studies. The risks to infant and maternal health of untreated postpartum depression are significant and far outweigh the risks of taking antidepressants while breastfeeding.
That being said, its not a one-size-fits-all approach. The best antidepressant to take is the one that best controls the mothers symptoms while also taking into consideration the infant safety profile, so this decision must be individualized, Dr. Berens says.
Are Some Women More At Risk Of Postpartum Depression
Yes. You may be more at risk of postpartum depression if you:3
- Have a personal history of depression or bipolar disorder
- Have a family history of depression or bipolar disorder
- Do not have support from family and friends
- Were depressed during pregnancy
- Lose your appetite
- Have trouble sleeping
The baby blues usually go away in 3 to 5 days after they start. The symptoms of postpartum depression last longer and are more severe. Postpartum depression usually begins within the first month after childbirth, but it can begin during pregnancy or for up to a year after birth.5
Postpartum depression needs to be treated by a doctor or nurse.
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Intimate Partner Violence And Child Abuse
HCPs are ideally positioned to recognize signs of family violence, including intimate partner violence, as well as child exposure to intimate partner violence and other types of child maltreatment. These forms of violence can negatively impact the health of mother and child, and the effects can persist over time. It is important that providers be equipped to recognize and respond safely to situations involving family violence, and to ensure that their interactions or interventions do not revictimize the mother or child.
According to the Maternity Experiences Survey, about 1 in 10 women who have given birth reported experiencing one or more acts of violence in the past 2 years, most often being pushed, grabbed, or shoved in a way that could have hurt them.Footnote 215 Over half identified their partner, husband, or boyfriend as the perpetrator of this violence. One-third experienced the violence during pregnancy, and 16% reported that the violence increased after the birth of the baby, 52% that it decreased, and 32% that it stayed the same. Of those women who experienced abuse, 61% reported discussing or receiving information about what to do if they experienced abuse.Footnote 215
Provincial/territorial child welfare legislation considers exposing a child to intimate partner violence/family violence a form of maltreatment, and HCPs are required to report it.Footnote 296
How Is Postpartum Anxiety Treated
Your healthcare provider will recommend treatment based on your symptoms, health history or if you are breastfeeding. In mild cases, changes to daily activities or speaking with a counselor can help reduce symptoms. If your anxiety worsens or is interfering with your life, medication may be an option.
Cognitive behavioral therapy for postpartum anxiety
CBT is a technique used by therapists or psychologists to help identify your emotions and change your thought patterns. Through CBT, you can unlearn negative thoughts and behaviors and adopt healthier thinking patterns and habits. CBT typically takes place over several one-on-one sessions. Using a question-and-answer format in your sessions, your therapist or counselor helps you learn to respond better to stress and anxiety. In some cases, your therapist may specialize in the emotions and behaviors of the postpartum period.
Non-medicated treatments for postpartum anxiety
Medication is not always needed to treat postpartum anxiety. Some ways to treat postpartum anxiety without medication are:
- Find a support group for new parents where you can share your feelings with people in a similar situation.
- Ask for help from family or friends. For example, having someone help with chores or babysitting can take some pressure off of you.
- Try to take a walk or get exercise every day. Practicing yoga can also help with relaxation.
- Take care of yourself by eating a healthy diet and sleeping as much as you can.
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How Can I Reduce My Risk For Postpartum Anxiety
Sometimes there isn’t anything you can do to prevent postpartum anxiety. It’s not your fault and not caused by anything you did or didn’t do. If you know of specific triggers from your past or have a history of anxiety or depression, talk to someone during your pregnancy. Talking with a counselor and learning coping tools before your baby is born can reduce the intensity of your anxious thoughts during the postpartum period.
What Are The Symptoms Of Postpartum Anxiety
Anxiety is your body’s way of responding to danger or threats. If you have postpartum anxiety, you may feel like you or your baby is in constant danger. The symptoms you feel are your body’s way of reacting to this constant sense of worry or fear.
Common signs of postpartum anxiety are:
Physical symptoms
- Feeling on edge or fearful.
Behavioral symptoms
- Avoiding certain activities, people or places.
- Being overly cautious about situations that aren’t dangerous.
- Checking things over and over again.
- Being controlling.
There are certain conditions like obsessive-compulsive disorder or panic disorders that can affect you during the postpartum period. If you are suffering from either of these conditions, you may have panic attacks or obsessive thoughts.
Be honest with your healthcare providers about all the symptoms you feel. They are there to support you and recommend treatments to help.
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Exploring An Alternative Approach
Three months after giving birth and about to return to work as a dental hygienist, Ashley Reynolds suddenly lost her appetite, wasn’t able to sleep, and began having constant irrational thoughts about the safety of her two children. Ashley consulted her doctor, who recommended antidepressants , but Ashley didnt feel comfortable taking them knowing that trace amounts of medications can end up in breast milk. So, she decided to pursue an alternative approach: CBD.
Short for cannabidiol, CBD comes from the hemp plant and has been associated with reducing anxiety and used to treat post traumatic stress syndrome and chronic pain. These days, people are using CBD to treat a range of ailmentsincluding anxiety what isnt clear is whether its safe for breastfeeding women. As of now, the majority of CBD products are classified as supplementsnot medicationwhich means they arent regulated by the FDA. In general, theres still a dearth of research on the safety and efficacy of CBD, and this is only compounded for women who are pregnant or breastfeeding due to the lack of clinical trials.
How Can Postpartum Depression Affect Breastfeeding
We cannot deny the fact that a mother’s mental health is crucial when it comes to the development of her baby. A depressed or anxious mother would find it extremely challenging to provide the proper support that her baby requires. They can face difficulties with initiating or sustaining breastfeeding.
When a woman goes through postpartum depression, her doctor will try to understand what parts of her day bring happiness and peace and what are the factors that make her anxious and sad. Here they will try to determine in what category breastfeeding falls.
If the mother feels breastfeeding is helping her form a bond with her child, then the treatment for her postpartum depression will be built around protecting the breastfeeding relationship.
Treatment would usually include a combination of medications and therapy. She would be given anti-depressants that are safe to use while breastfeeding.
On the other hand, if the thought of breastfeeding is contributing to worsening her symptoms, then her doctors will suggest alternate forms of feeding.
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Monitor Yourself For Side Effects
As with any medication, you should monitor yourself for any reactions or unwanted side effects, Dr. Roshan recommends. Additionally, if you are just starting the medication, you should stay in touch with your doctor or mental health provider because you will still be dealing with mental health challenges as you wait for the medication to take effect.
Zoloft can take up to four weeks to reach a steady state in the body, meaning it can take about one month before the patient may feel relief from their symptoms, Dr. Roshan warns. It is important to communicate closely with the prescribing provider during Zoloft therapy.
What Causes Postpartum Depression
Hormonal changes may trigger symptoms of postpartum depression. When you are pregnant, levels of the female hormones estrogen and progesterone are the highest theyll ever be. In the first 24 hours after childbirth, hormone levels quickly drop back to normal, pre-pregnancy levels. Researchers think this sudden change in hormone levels may lead to depression.2 This is similar to hormone changes before a womans period but involves much more extreme swings in hormone levels.
Levels of thyroid hormones may also drop after giving birth. The thyroid is a small gland in the neck that helps regulate how your body uses and stores energy from food. Low levels of thyroid hormones can cause symptoms of depression. A simple blood test can tell whether this condition is causing your symptoms. If so, your doctor can prescribe thyroid medicine.
Other feelings may contribute to postpartum depression. Many new mothers say they feel:
- Tired after labor and delivery
- Tired from a lack of sleep or broken sleep
- Overwhelmed with a new baby
- Doubts about their ability to be a good mother
- Stress from changes in work and home routines
- An unrealistic need to be a perfect mom
- Grief about loss of who they were before having the baby
- Less attractive
- A lack of free time
These feelings are common among new mothers. But postpartum depression is a serious health condition and can be treated. Postpartum depression is not a regular or expected part of being a new mother.
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Hormones Sleep Deprivation General Life Upheaval: In The Early Days Of New Motherhood A Case Of The Baby Bluesfeeling Sad Or Anxious Postpartumis Normal Affecting 80 Percent Of New Moms In The First Few Weeks According To The National Institute Of Mental Health But For 1 In 5 New Moms Those Feelings Dont Go Away They Get Worse
Sporadic tears that become frequent bouts of crying, feeling like a bad mother or having thoughts of hurting your baby , signal its time to talk with your doctor about postpartum depression and anxiety . Counseling can help and so can medication. .
Given the limited research on how medications affect breast milk , its not surprising that many new moms can often feel stuck, wondering if they have to choose between breastfeeding and treating their PPD. The decision to take antidepressants while breastfeeding requires careful consideration of the benefits and risks with a healthcare provider. But first one needs to admit they actually need help.
Start With A Smaller Dose
One way to mitigate any unwanted side effects is to start with a smaller dose of Zoloft and gradually increase the dose as your body gets used to it. This is the method that the Academy of Breastfeeding Medicine recommends when a breastfeeding parent begins a course of Zoloft.
For example, ABM recommends starting at a dose of 25 mg, staying on this for 5-7 days, and then increasing the dose to 50 mg per day. After that, dosage can be increased if needed. Of course, dosage and timing will vary from one breastfeeding parent to another and is something for you to discuss with your healthcare provider.
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What Is Postpartum Psychosis
Postpartum psychosis is rare. It happens in up to 4 new mothers out of every 1,000 births. It usually begins in the first 2 weeks after childbirth. It is a medical emergency. Women who have bipolar disorder or another mental health condition called schizoaffective disorder have a higher risk of postpartum psychosis. Symptoms may include:
- Seeing or hearing things that arent there
- Feeling confused most of the time
- Having rapid mood swings within several minutes
- Trying to hurt yourself or your baby
- Restlessness or agitation
- Behaving recklessly or in a way that is not normal for you
What Are The Signs & Symptoms Of Postpartum Depression
Symptoms of postpartum depression can vary from woman to woman. But common signs include:
- feeling sad, hopeless, or overwhelmed
- feeling worried, scared, or panicked
- blaming yourself unnecessarily
- not feeling attached to the baby
- not wanting to do things that usually are enjoyable
Although it is very rare, some women have very serious symptoms such as:
- thoughts of hurting the baby or themselves
- hearing voices, seeing things that are not there, or feeling paranoid
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How Is It Diagnosed
Unlike other medical conditions, there isn’t a clear diagnostic tool for postpartum anxiety. There are postpartum anxiety questionnaires that your provider may ask at your appointment. You should not feel ashamed or uncomfortable sharing your symptoms. Having an open and honest conversation about your anxiety is often the best tool providers have to diagnose postpartum anxiety. They may ask you questions or use other screening tools to diagnose postpartum anxiety and determine the severity of symptoms.
How Do Doctors Screen For Postpartum Depression
It can be hard to detect mild cases of postpartum depression. Healthcare providers rely heavily on your responses to their questions.
Many healthcare providers use the Edinburgh Postnatal Depression Scale to screen for postpartum depression. It consists of 10 questions related to symptoms of depression such as feeling unhappy, anxious or guilty. You’re asked to check the response that comes closest to how you’ve felt the last seven days. A higher score indicates possible postpartum depression.
If your provider feels you have signs of postpartum depression, they will recommend an appropriate treatment.
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Can I Still Breastfeed
If youâre still nursing your baby, youâre probably wondering if itâs safe to take antidepressants. Most likely yes, depending on the medication.
Antidepressants have shown up in breast milk in very low amounts. Studies have found that neither the old or new drugs have harmful effects on babies when small amounts are passed through breast milk. But be sure to tell your doctor that youâre nursing, just to be safe.
Can I Take Zoloft While Breastfeeding
Brian Levine, MD, MS, FACOG, is board-certified in obstetrics-gynecology, as well as reproductive endocrinology and infertility . He is the director and founding partner of CCRM New York and was named a rising star by Super Doctors from 2017 to 2019.
There are many reasons why you might be considering taking an antidepressant like Zoloft while breastfeeding. You may have been taking Zoloft before you became pregnant and would like to take it again now. Or, like many new parents, you may have never taken Zoloft before, but are considering it now, as you deal with a postpartum mood disorder like postpartum depression or postpartum anxiety.
Its rarely easy to seek help for a mental health challenge, and you should be proud that you are addressing your mental health by considering taking an antidepressant. Thankfully, Zoloft is considered safe to take while breastfeeding. In fact, its generally the first antidepressant a healthcare provider recommends to a breastfeeding parent.
Of all the SSRI medications, Zoloft has the most widely recognized safety profile for breastfeeding, says Daniel Roshan, MD, a high-risk maternal-fetal OB-GYN in New York City. We would consider Zoloft generally safer than other similar medications for breastfeeding.
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How Do I Know It’s Postpartum Anxiety And Not Just Worrying
Having a baby or becoming a parent and worrying go hand in hand. Postpartum anxiety is an excessive or extreme worry that feels like it never stops. If your worrying interferes with your ability to calm down and feels like it lasts all day, you may have postpartum anxiety. Postpartum anxiety is also associated with irrational fears or constantly feeling on edge.
Some examples of postpartum anxiety could be:
- Staying awake all night because you are afraid your baby will stop breathing in their sleep.
- Being terrified to leave your baby alone for a few minutes with an adult you trust .
- Being so afraid someone will hurt you or your child that the thought of leaving your house makes your heart race.