The Truth About Postpartum Depression Recovery
- Paul Patterson, MD, FAAP
- Apr 14, 2023
- 12 min read
Updated: Mar 1, 2024
Pregnancy and childbirth bring with you an abundance of joy, but also some unique challenges. One of those challenges is the possibility of postpartum depression, which can commence anytime after birth in both mothers and fathers.
If you’re concerned about postpartum depression, or are just interested in learning more about it, keep reading as we describe the symptoms of postpartum depression, discuss how long it may last, and set out the ways that you can get the help you might need.
In this article:
What is postpartum depression?
Postpartum depression (PPD) generally refers to depression that women can experience as a result of giving birth. Paternal postpartum depression is also common and is discussed further below.
The American Psychiatric Association (APA) refers to depression caused by pregnancy and/or birth as "peripartum depression" to emphasize that symptoms can arise both during pregnancy or after the baby is born. You might also see it referred to as "perinatal depression." There is no significant difference between these terms and they are usually used interchangeably.
For purposes of this article, we will say "postpartum depression" or PPD.
Postpartum depression symptoms
The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) used by medical professionals identifies PPD as a major depressive disorder, which are characterized by the following symptoms:
Depressed mood most of the day, nearly every day
Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day
Significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month)
Insomnia (difficulty falling or staying asleep) or hypersomnia (excessive sleepiness during the day) nearly every day
Psychomotor agitation (restlessness characterized by movements like pacing or handwringing) or retardation (slower thinking or body movements)—these must be observable by others, not merely subjective feelings of restlessness or being slowed down
Fatigue or loss of energy nearly every day
Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day
Diminished ability to think or concentrate, or indecisiveness, nearly every day
Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide
The DSM-5 specifies that these symptoms must “cause clinically significant distress or impairment in social, occupational, or other important areas of functioning” and must not be caused by another medical condition or substance.
Postpartum depression vs. "baby blues"
After giving birth, it's common for many new moms to experience an emotional condition known as "baby blues," which can involve more frequent crying and feelings of restlessness and anxiety.
The precise cause of the baby blues is not known, but it is likely some combination of hormonal changes during pregnancy and after birth, lack of sleep, adjusting to a new routine, and the rush of emotions from new parenthood.
Baby blues usually starts a few days after giving birth and lasts for a week or two. It does not interfere with baby care or other regular activities and does not require medical treatment.
PPD is not baby blues and should not be dismissed as such. PPD can continue for a year or more, involve more severe mood swings, and interfere with a mother's ability to function physically and emotionally. It's critical for a mother experiencing PPD to seek medical attention.
Postpartum depression and postpartum anxiety
As many as two-thirds of women who suffer from PPD also experience postpartum anxiety. This is characterized by intense feelings of anxiety, involving a racing heartbeat, stress and unhappiness, a sense of panic for no good reason, and blaming oneself for things that go wrong.
Postpartum depression vs. postpartum psychosis
Postpartum psychosis is a serious but extremely rare condition with symptoms that include insomnia, hearing voices, and extreme paranoia.
It occurs in approximately 0.1 to 0.2 percent of births and is more prevalent in women with a personal or family history of bipolar disorder.
Postpartum psychosis is a medical emergency and requires immediate evaluation and treatment if symptoms appear.
Who gets postpartum depression?
Prevalence
It's difficult to determine a precise prevalence for PPD, since how and whether it is diagnosed varies significantly by population. The APA estimates that one in seven new mothers suffer from PPD, while the CDC reports one in eight. Some studies have found that as many as 20% of new mothers may experience PPD.
Researchers have found that this rate increased dramatically during the early days of the Covid-19 pandemic, with as many as one third of new mothers experiencing PPD during that time.
This increase is likely the result of a number of factors, including greater isolation before and after giving birth, giving birth without a partner in the room, concerns about contracting (or the baby contracting) Covid, and reduced access to mental health and other resources that were more widely available pre-pandemic.
Risk factors for postpartum depression
Numerous factors can make it more likely that a mother will experience PPD, including:
A history of depression or anxiety
Isolation or lack of a strong support system after birth
Stressful life events, such as financial or family or relationship challenges
Pregnancy complications, such as premature birth
A history of abuse or other trauma
Certain medical conditions, such as diabetes or thyroid conditions
Sleep deprivation
Having one or more of these risk factors does not mean you will definitely develop PPD. However, being aware of the risk factors can help you be more vigilant about noticing symptoms and seeking help sooner.
Postpartum depression in dads
Having a baby can also be mentally and emotionally challenging for new dads! Paternal postpartum depression (PPPD) refers to the depression that new fathers can experience during their child's first year. It can even set in before the baby is born.
PPPD may impact as many as 25% of new fathers.
The symptoms of PPPD are largely similar to those of PPD. Fathers might experience hopelessness, irritability, lack of interest in activities, difficulties with sleep or appetite, and trouble bonding with the new baby. New fathers may also be more likely to channel their stress into work or abuse alcohol or other substances.
Healthcare providers often do not screen for PPPD in the same way as PPD. Furthermore, fathers may be less likely to be open about their mental health struggles due to a real or perceived stigma around mental health struggles for fathers.
However, PPPD can also have a negative impact on child development, so it is essential to ask for help when needed. If you or your partner is experiencing any symptoms of PPPD, be sure to check in with your healthcare provider for evaluation.
How long postpartum depression lasts
When it begins
The onset of PPD varies by person, but it generally begins within the first few weeks after the baby is born.
However, it’s possible for PPD to commence at any time during the first year. Symptoms can gradually develop or appear suddenly.
As noted above, PPD can also begin during pregnancy, including after a miscarriage.
When it typically ends
The duration of PPD varies greatly depending on the individual based on the severity of symptoms, life circumstances, and type of treatment they receive.
Untreated postpartum depression can last a year or longer.
However, seeking treatment can significantly improve symptoms and outcomes and hasten recovery from PPD.
Effects of postpartum depression
On the mother
PPD can have serious consequences for the mother's physical and mental health. These consequences can include:
Emotional effects, such as hopelessness, irritability, anxiety, guilt, and shame, which can negatively impact a mother's self-esteem and connection to her baby
Physical effects, such as decreased energy and appetite, headaches, and sleeping issues
Social and relationship issues, including withdrawing from social interactions and feelings of isolation, which can impact the mother's relationships with her partner, family, and friends
Trouble performing ordinary parenting tasks and bonding with the baby, which can cause guilt and frustration and contribute to further depression
Long-term mental health effects, including a greater risk of suffering from anxiety and depression in the future
On the child
PPD can also negatively impact multiple aspects of a baby's development. It is essential to remember that none of these consequences mean that a woman experiencing PPD is a bad mother—she is suffering from an illness and needs treatment and support.
Social and emotional development
Mothers suffering from PPD are less likely to respond effectively to their baby's cries or show them warmth and affection, which can both harm their ability to bond with their baby and have negative effects on the child's social and emotional development.
As a result of these early experiences, the child might have difficulty engaging with others, forming secure attachments, and self-regulating. They are more likely to exhibit emotional and behavioral problems, such as hyperactivity, aggression, and trouble with social interactions.
PPD can also increase the child's risk of developing depression and/or anxiety later in life.
Cognitive development
PPD can have a lasting impact on a child's brain development. A mother with PPD might not engage with her child as much or provide the types of stimulation, interaction, and communication that her child needs to learn.
As a result, her child could have language delays and may struggle with memory, attention, and problem-solving in their early years. They may even score lower on IQ tests and have learning difficulties.
Physical development
PPD can also indirectly impact the child's physical development. As a result of PPD, the mother may be too exhausted or depressed to feed her baby adequately. She may also struggle to maintain her own healthy diet, which affects her ability to provide adequate nutrition through breast milk.
This can have serious health consequences for children that can last into adulthood, including weight gain, reduced metabolism, and an increased risk of developing various chronic illnesses.
To learn more about how your child develops, see Holistic Approach to Child Development: The PROE Framework.
If you are concerned about your child's development, check out When Should You Be Concerned About Your Child's Development? and #MilestonesMatter: Don't Underestimate Developmental Monitoring.
Treatment of prenatal and postpartum depression
Screening for postpartum depression
The Edinburgh Postnatal Depression Scale (EPDS) is a screening tool designed to help healthcare providers identify potential symptoms of maternal postpartum depression. The EPDS does not diagnose PPD, but is used to identify women who should receive additional evaluation and possibly treatment.
The EPDS is widely used and simple to administer. It consists of 10 self-reported questions that ask about the mother's feelings during the previous seven days. These questions are intended to assess multiple symptoms of depression, including sadness, anxiety, and trouble sleeping.
The EPDS is included in the Survey of Well-being of Young Children (SWYC), a screening tool that assesses children's cognitive, language, motor, and social-emotional development and screens for family risk factors such as parental mental health.
You can access the EPDS online here. Regardless of your score on the screening test, consult with your doctor if you have any concerns.
Screening for paternal postpartum depression
There is no comparable patient health questionnaire designed to screen for PPPD. Studies have evaluated the possibility of using the Edinburgh Postnatal Depression Scale to screen new fathers and found that it requires an amendment of the cutoff score to be considered accurate.
Moreover, although pediatricians generally screen mothers for PPD during well child appointments during the first year, they often neglect to ask these same questions of fathers.
For these reasons, it is essential to be proactive in monitoring yourself or your partner for any symptoms of PPPD and to consult with your healthcare provider or your child's pediatrician if you have any concerns. PPPD can also have serious consequences for the entire family.
Diagnosing postpartum depression
There is no specific diagnostic test for PPD. Rather, it is usually diagnosed through a combination of physical exam, psychological evaluation, and review of the patient's medical history.
Typically, a woman is diagnosed with PPD if she is experiencing at least five of the symptoms of a major depressive disorder enumerated in the DSM-5, listed above, and these represent a change from her regular functioning.
These symptoms must arise during pregnancy or within one year following birth and persist for at least two weeks.
The healthcare provider will also account for other physical and mental health conditions and family, relationship, or other life factors that might contribute to PPD.
Just remember that PPD is a real illness and should be taken seriously. If you or someone you know is experiencing any of the symptoms of PPD, it's important to promptly discuss your concerns with your healthcare provider. They will evaluate your symptoms, rule out other physical conditions that might cause similar symptoms to PPD (such as thyroid conditions), and provide any necessary referrals to a mental health professional.
Also keep in mind that other mental health conditions can affect both new and more experienced parents! You can experience depression and anxiety at any time, not just postpartum, so don't hesitate to seek help if you are struggling.
Treating postpartum depression
Medication
PPD is often treated with antidepressant medication, most commonly a type called selective serotonin reuptake inhibitors (SSRIs).
Although medication taken while breastfeeding will pass into the mother's breast milk, most antidepressant medications carry few risks for the baby. Your doctor will talk to you about all of the risks and benefits of taking a specific medication so that you can make an informed decision.
If you are experiencing postpartum anxiety, you may also need additional medication to treat those symptoms.
If your doctor believes that medication is important in your case, do not hesitate to take it. Remember that your recovery is important for both your health and your family's well being.
Therapy
Talk therapy can also be an important part of a treatment plan for PPD. Talking to a mental health provider can help you find positive ways to deal with negative feelings and stressful situations and set realistic goals and expectations for yourself.
Support groups can also be a lifesaver for parents suffering from PPD, although they should be an addition to—not a replacement for—medical care. Talking to other moms and dads who are experiencing the same struggles can combat feelings of guilt and shame, provide strategies for addressing symptoms, and help you feel less alone.
Exercise
Don’t underestimate the value of exercise! Research has found exercise to have a positive role in reducing symptoms of PPD.
Exercise causes your body to release endorphins, a natural “feel-good” hormone that can reduce feelings of depression and anxiety. Exercise can also help you sleep better and combat the sleep issues often associated with PPD.
For the first weeks after birth try something gentle, like stroller walks with your baby so you can feel some sunshine on your face. Even small amounts of physical activity can make a big difference!
Consult with your doctor before beginning an exercise regimen to be sure your body is physically ready for the activity and to discuss how it fits with your PPD care plan.
Postpartum self-care
When you are suffering from PPD, everything can feel overwhelming. So do your best to focus only on the essentials until you are feeling more like yourself.
Take good physical care of yourself. Try to get as much sleep as possible, including napping during the day if you can. Eat as healthily as possible with a new baby. If your job allows, try to take additional time off of work or ask for a reduced workload to ease your stress and give you more time to rest.
Accept help whenever it's offered. Your most important job is to feel better, so let family members and friends help with the baby, bring food, and run errands. And let your partner take on the majority of baby care tasks if possible.
And finally, if you are suffering from PPD, give yourself grace! PPD is a common condition and many other moms and dads struggle with the same feelings. There is no shame in taking medication, accepting help, and letting non-essential tasks slide for a while. Remember that taking care of yourself now will let you take care of your baby later.
The Takeaway
No one should suffer from PPD in silence. Although it can be hard to take that first step if you are experiencing symptoms of PPD, know that you are not alone and it's okay to seek help in getting better. With guidance from a medical professional and support from loved ones, you can get through this challenging time.
So if you notice any symptoms of PPD, don't be afraid to reach out for help—the sooner the better!
Sources
Diagnostic and Statistical Manual of Mental Disorders (DSM-5). 2013. American Psychiatric Association.
Carlberg M, Edhborg M, and Lindberg L. Paternal Perinatal Depression Assessed by the Edinburgh Postnatal Depression Scale and the Gotland Male Depression Scale: Prevalence and Possible Risk Factors. Am J Mens Health. 2018 Jul; 12(4): 720–729. doi: 10.1177/1557988317749071.
Davé S1, Petersen I, Sherr L, Nazareth I. Incidence of maternal and paternal depression in primary care: a cohort study using a primary care database. Arch Pediatr Adolesc Med. 2010 Nov;164(11):1038-44.
Fairbrother, et al. Perinatal anxiety disorder prevalence and incidence. J Affect Disord. 2016 Aug; 200:148-55.
Kim P, Swain JE. Sad dads: paternal postpartum depression. Psychiatry (Edgmont). 2007 Feb;4(2):35-47.
Langan RC, Goodbred AJ. Identification and Management of Peripartum Depression. Am Fam Physician. 2016;93(10):852-858
Marconcin P, Peralta M, Gouveia ER, et al. Effects of Exercise during Pregnancy on Postpartum Depression: A Systematic Review of Meta-Analyses. Biology (Basel). 2021 Dec; 10(12): 1331. doi: 10.3390/biology10121331
Shuman, C.J., Peahl, A.F., Pareddy, N. et al. Postpartum depression and associated risk factors during the COVID-19 pandemic. BMC Res Notes 15, 102 (2022). https://doi.org/10.1186/s13104-022-05991-8
Slomian, J, Honvo G, Emonts P, et al. Consequences of maternal postpartum depression: A systematic review of maternal and infant outcomes. Womens Health (Lond). 2019; 15: 1745506519844044. doi: 10.1177/1745506519844044.
Wisner, KL, et al. Onset Timing, Thoughts of Self-harm, and Diagnoses in Postpartum Women With Screen-Positive Depression Findings. JAMA Psychiatry/ Vol. 70 (No. 5), May 2013.
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