What is postpartum depression (PPD)?

Approximately 15% of women experience depression following childbirth. Even though postpartum depression is a common and treatable condition, far from everyone seek the help that they need. This article helps you recognise postpartum depression and offers advice on what you can do to manage it. Additionally, it aims to reduce the stigma surrounding PPD, which still prevents new parents from sharing their experiences of depression.

What is postpartum depression (PPD)?

Postpartum depression is a form of depression that occurs in connection with having a child. According to PPD researchers Dr Lisa S. Segre and Dr Wendy N. Davis from Postpartum Support International, the onset of postpartum depression can occur during pregnancy or within the first year of childbirth. 

Depression can have a huge impact on any person’s daily function and wellbeing, but when the symptoms arrive at the same time as a newborn baby, it’s not difficult to realize what an extreme challenge life can become for new parents. The depressive symptoms are presented in more detail below and include low mood and sadness, a loss of interest or pleasure in activities (sometimes in the new baby), changed appetite, sleep disturbance (not caused by the baby), strong feelings of guilt and shame, and sometimes thinking about harming oneself or the baby. Usually, the first depressive symptoms appear during delivery or 6-8 weeks afterwards.

Having a child is a big deal and this major change in life can trigger depressive symptoms in both mothers and fathers. This article will primarily focus on womens’ experiences of postpartum depression because of the social stigma surrounding motherhood and the physical changes that most new mothers go through.

It's more than just the Baby Blues

Up to 80% of women experience the so-called ‘baby blues’ during the first 1-2 weeks after childbirth. It’s common to burst into tears in situations where you normally wouldn’t and to feel unusually irritated, restless or anxious. You may experience extreme happiness one minute and the crushing responsibility of taking care of a child the next. 

The biggest difference between the baby blues and postpartum depression is that the baby blues resolve on their own without treatment, whereas depression lingers and the symptoms usually get more intense with time. Postpartum depression doesn’t happen overnight and the symptoms sneak on gradually. A common scenario is that the baby blues slowly turn into a mild depression and you experience a lower mood. The depressive mood triggers more negative thoughts and the feeling of not being able to live up to expectations. You may worry about not being able to act and feel as a parent is ‘supposed to’ act and feel. Also, you may worry about what others think of you as a parent or you may be convinced that others would judge you if they knew what a bad parent you are. These negative thoughts trigger feelings of shame and guilt, which, in turn, increase the risk of maintaining the depression. To help you recognize what postpartum depression may sound like from the inside, this list includes common thoughts from depressed mothers:

“Everybody else thinks it’s so wonderful to have a baby, but not me. There must be something wrong with me.”

“I don’t know how to soothe my own child. It means I’m a bad mother.”

“My baby doesn’t like me.”

“I can’t even breastfeed my child, even though it’s the most natural thing in the world. I’m so bad.”

“This is what it feels like to have a baby. I will feel this bad for 18 years.” 

“I know it’s crazy, but every time my child screams, it feels like she is criticizing me, saying I’m a bad mother.”

If you recognise any of these thoughts or have similar thoughts about yourself, remember, that’s depression talking. Negative thoughts are rarely a reflection of reality or what other people actually think of you. Depression is a treatable condition and this may be the time to seek help from a professional.

Distancing yourself from friends, family or a partner can be one of the first signs that the baby blues are developing into postpartum depression. New parents may instinctively hide their depressive symptoms because of all the expectations connected to the idea of what it’s supposed to be like to have a child. Some depressed mothers avoid seeing their friends or family, while others behave exactly as they’re ‘expected to’, but hide their true feelings from the people around them. Even though it’s challenging, the best you can do in this situation is to share your thoughts and feelings with others. Let them know that something is wrong and let them help you seek counseling. It’s usually the best way to prevent depressive symptoms from worsening (read more about the difficulties of seeking help when going through postpartum depression under the headline Is postpartum depression different from other forms of depression?). In the next section, you’ll find a detailed description of the symptoms of postpartum depression.

What does postpartum depression look like?

Before we have a closer look at the definition of depression, let’s make two things perfectly clear:

1. Postpartum depression has nothing to do with how much you love your child. 
2. Postpartum depression has nothing to do with being a bad or a good parent.

The reason behind this clarification is that common symptoms of postpartum depression include feeling excessively guilty and/or ashamed and obsessing over not being a good enough parent. Remember, depression can do that to your mind, but it doesn’t make it true. Other symptoms of depression include:

• Feeling sad most of the day and/or crying more than usual
• Loss of interest and/or pleasure in activities
• Changed appetite or weight (eating more or less than usual)
• Sleep disturbance (even when your child actually lets you sleep)
• Moving more slowly than usual or making meaningless movements due to anxiety
• Feeling exhausted nearly every day
• Having difficulty concentrating and/or making decisions
• Feeling excessively guilty and/or worthless
• Suicidal thoughts or thoughts of self-harm (in the case of postpartum depression, thoughts about harming the child may occur)

If you have experienced five of the symptoms above for at least two weeks, you may be diagnosed with depression. In the case of postpartum depression, it’s common to also feel irritated or angry, to have strong feelings of anxiety and experiencing a lack of interest in the baby.

There is good reason to contact a healthcare professional if:

• You recognize several of the symptoms above.
• The ‘baby blues’ persist for more than two weeks and don’t seem to pass.
• You experience strong anxiety.
• You’re having trouble with daily tasks or taking care of your child. 
• You’re having trouble bonding with your baby (remember, you’re not the only one)
• You have thoughts about harming yourself or your child.

If you want more information about depressive symptoms in general, read Am I depressed? Or if you want to know more about anxiety, read 4 at-home remedies for anxiety and depression

What causes postpartum depression?

Having a baby brings hormonal changes, other physical changes, emotional changes and, of course, social changes. Navigating through all of these changes while taking care of a newborn can be overwhelming to say the least, and all of these factors contribute to the increased risk of depression after childbirth. So, postpartum depression is a complex disorder and we don’t know exactly what causes it. But we do know one thing for sure: it’s not your fault. There are a few risk factors for developing postpartum depression (see below), though PPD can affect parents with ‘perfect’ homes, ‘perfect’ relationships and no prior history of mental illnesses. The most important thing to remember is that postpartum depression can happen to any parent no matter their situation and it’s a treatable condition. That’s why it’s important to recognise the signs of postpartum depression so that you can seek help at an early stage. 

The factors listed below puts you at a higher risk for developing postpartum depression. It’s a good idea to discuss these risk factors with your healthcare provider so that you can plan ahead for care if you need it.

Risk factors

• A history (or family history) of depression, postpartum depression or anxiety.
• Financial problems.
• Problems in your marriage or with your partner.
• Complications with pregnancy, birth or breastfeeding. 
• Having had infertility treatment.
• A recent major change in life, such as losing your job or moving to a new house.
• Having diabetes or thyroid imbalance.

Is postpartum depression different from other forms of depression?

To say that postpartum depression is like ‘regular’ depression but in the presence of a newborn, would be to grossly oversimplify a very complex matter. There are other things that make postpartum depression differ from ‘regular’ depression and the next few sections will tell you more about that.

Your body is different from before

We live in a time obsessed with physical appearance. After giving birth to a child, the body feels and looks different from before. Organs, belly, thighs and breasts are not necessarily located at the same places as you’re used to and it can take a long while before a woman feels comfortable in her body after having a child. Additionally, vaginal birth may bring physical pain, urine leakage, vaginal discharge and pain during intercourse for weeks or months after the delivery.

A cesarean section may make it difficult to stand up for weeks and you’re not allowed to carry more than your own baby. When going through postpartum depression, these pain signals from the body may trigger negative thoughts, such as “I’m ugly”, “I’m worthless”, “my partner will never find me attractive again”, “I have destroyed my body”, or “I will be in pain for the rest of my life.”

Postpartum depression makes it more difficult for new mothers to feel pride and wonder in relation to what the body has accomplished – namely brought new life into this world.

There is a social stigma surrounding motherhood

Another thing that makes postpartum depression extra challenging is the expectations and social myths telling us that the time after pregnancy and childbirth is supposed to be the happiest of your life. The social stigma surrounding motherhood and the intense feelings of guilt that it feeds, prevents mothers from seeking treatment for their postpartum depression. PPD researchers Emily Cacciola and Elia Psouni at Lund University in Sweden conducted interviews with women who never sought help for their postpartum depression. Cacciola & Psouni found three main reasons which prevented depressed mothers from contacting a healthcare professional, or even from telling their closest friends and family what they were going through.

1. Social myths and expectations: Some mothers believed they had failed to live up to expectations or specific beliefs about what motherhood should be like and felt so guilty and ashamed that they didn’t want to seek help. This is how some of the women in the study expressed their experiences: 
   “I mean, if someone asks, “How are you?” when you have a little baby, and I say, “It’s completely horrible, it sucks.” I would flinch… I really would. Now is the time to be happy, I am supposed to be happy that I have a baby. That is not the time to tell how hard it is, how terrible you feel or that you changed your mind.”
   “I’m your typical “good-girl”, you know, making sure everyone has a good time. It’s always important that it’s nice and happy. Yes, I think it’s because I’m always supposed to… everything must look so successful.”
   
   
2. Lack of knowledge: Some mothers in the study had no prior knowledge of postpartum depression and didn’t know that their symptoms could be treated. Some mothers didn’t think their symptoms were unnatural or sufficiently severe and some were told by loved ones or healthcare professionals that their experience was “normal”. This is how some of the women expressed their experiences: 
   “I never understood what was wrong with me, until now; I thought my sadness meant I didn’t want to be a mother. I didn’t realize how bad I was feeling. This is what it’s like to be a parent everyone around me kept telling me, and I didn’t know, you’re not supposed to feel that horrible.”
   “Well… It’s hard to seek help when you don’t realize you have a problem. I had no idea what it’s like to have a baby… I think that if I had understood that I could be helped I would have spoken. But I didn’t understand, and everyone was telling me it was normal, so I believed it.”
   
   
3. Inability or reluctance to disclose symptoms: Some mothers didn’t want to tell anyone about their postpartum depression because they had negative, past experiences of seeking help. Other mothers didn’t want to share their thoughts and feelings because it was important to them to handle the situation on their own. To them, seeking help felt like a weakness or failure. This is how some of the women in the study expressed their experiences: 
   “I feel… if I can care for my child and still manage to stay alive then it’s not that big of a problem that I should seek help for it. That is how I think. Handle things yourself. I am supposed to handle things myself, anyways.”
   “I am a person who likes to do things myself, I am strong. I perceive myself as strong and capable. That I have things under control… so yes, that is definitely part of it.”

Do you recognize any of these experiences? The next section offers you advice on how to treat postpartum depression.

What can you do to treat postpartum depression?

Postpartum depression is a treatable condition and the sooner you seek help, the better. Below, you’ll find advice on how to manage your depressive symptoms.

Talk about your depression

A deeply problematic thing about postpartum depression is that the thoughts and feelings that come with the disorder could make you want to hide your condition. The best way to diminish the power that depression holds over you is to do the exact opposite, that is, to talk about it. It can be especially powerful to seek out older women with experience of having children. They know that it’s normal not to be able to live up to expectations and that no mother is perfect. So, share your feelings and your troubles with the people closest to you and, preferably, with a healthcare professional. Talking about your condition may require a whole lot of courage, but it will make postpartum depression gain less power over your life. 

There are some clinics who provide remote consultations with healthcare professionals via video messaging through their apps. It means that you can receive the first consultation at home, without having to visit a clinic. Here are two of the most popular online clinics:

• For people living in the UK – contact Babylon.
• For people living in Sweden – contact Kry.

Check out online support

Search the web for support groups for people with postpartum depression. It can be very helpful to share your story with others who are going through something similar. Being part of an online community could help you realise that you’re definitely not alone in this. 

Take care of your basic needs

Your child needs to sleep, eat, be touched, feel safe and warm. And so do you. Use your child as a source of inspiration and make sure to drink when your child drinks, sleep when your child sleeps and so on. Surround yourself with people who make you feel safe and who will get you a blanket when you’re cold. Also, take a minute to reflect on what you really need to feel as good as possible during this time and what activities can get a lower priority in your life. Ask yourself these questions:

• What are the most important things for my well being (nutritious food, sunlight on my face, hugs, daily showers, meditation, a morning walk, an extra hour of sleep, a phone call to grandmother etc.)?
• What things/activities can I live without during the first year of my child’s life?

If you want more information on how to make lifestyle changes that significantly decrease depressive symptoms with the help from a virtual therapist, you can download the depression app from Flow Neuroscience (100% free). It includes over 50 sessions with behaviour therapy focusing on antidepressant activities and habits.

What can partners do to help?

It’s a good idea to bring a partner when you seek medical or other forms of professional help for postpartum depression. Sometimes it’s easier for a non-depressed partner to explain your situation and to stand up for your needs. 

If you’re living with someone who may have postpartum depression, ask her how she’s feeling and what you can do to help. Even though she says that everything is alright, keep asking. Remember, parents with postpartum depression may try to hide their condition, so it can be important to ask repeatedly. Maybe say:

“This whole situation is completely new for us. You’re allowed to feel whatever you’re feeling.”

If you want more advice on how to help a depressed person, you get loads of practical strategies in this article: How to help someone with depression.

In conclusion

Postpartum depression affects around 15% of mothers and usually brings lower mood, a lack of interest in activities, strong feelings of guilt or shame and worry about not being a good enough parent. Even though postpartum depression is a treatable condition, far from everyone seek the help that they need. The thoughts and feelings that come with the disorder could make you want to hide your condition and the best way to diminish the power that depression holds over you is to talk about it. Sharing your experience with a healthcare professional or an online community may require a whole lot of courage, but it will make postpartum depression gain less power over your life. 

Thank you for your attention!