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What is Postpartum Depression (PPD)?
Postpartum Disorder is sometimes referred to as Postpartum Major Depression (PMD), and more recently as "peripartum depressive disorder". It is a serious mood disorder which may actually involve prominent symptoms of depression or anxiety. It usually does not resolve on its own.
Symptoms can involve loss of pleasure or interest, mood swings, depressed mood, anxiety, guilt, crying spells, agitation, fears about being left alone with the baby, panic, as well as sleep and appetite changes.
When symptoms are severe, start to feel unmanageable, impact functioning, or stick around for longer than 2 weeks, it isn’t just the baby blues – it may be Postpartum Major Depression.
Left untreated it can last several months to more than a year and can interfere with functioning.
Postpartum disorder was not technically a separate diagnosis from Major Depressive Disorder in the DSM-IV classification system of mental and nervous disorders. When onset was within 4 weeks of delivery, a coding specifier could be added to the diagnosis of Major Depressive Disorder (MDD).
In the most recent versions of APA's DSM-5 and DSM-5 TR, the disorder has been recognized as a separate diagnostic entity, now referred to as "peripartum onset depression". This was deemed to be a more appropriate term since approximately half of postpartum episodes actually start prior to delivery. The diagnostic criteria are the same as for major depressive disorder but the onset of symptoms is during the course of pregnancy or up to 4 weeks after delivery,
Postpartum Psychosis'
While very rare, postpartum psychosis, involves psychotic symptoms like delusions or hallucinations. This is a different disorder from postpartum depression.
Postpartum Depression can involve some or all of the following symptoms:
- You don’t take pleasure in
relationships, activities, or things
you used to enjoy.
- You feel sad or cry even though you may not know why.
- It feels difficult to bond with your baby.
- You have excessive anxiety or worry, often about your abilities to take care of the baby.
- Feeling guilty or worthless.
- It seems that you are more irritable or agitated than usual; you may find yourself getting angry over things that never used to bother you.
- You may feel afraid to be left alone with your baby.
- It’s hard to concentrate, focus, or make decisions.
- Your sleep and appetite levels are much higher or lower than normal.
- You’ve had thoughts about hurting yourself or your baby.
The Edinburgh Postnatal Depression Scale has been used as a screening instrument. We have provided links to the scale below. Individuals with scores above 12 or 13 should promptly consult their physician, psychiatrist or psychologist about the possibility of postpartum depression.
Disclaimer: The purpose of the questionnaires below are to help you become aware of the kinds of issues that women with postpartum depression often encounter. It is not a substitute for medical advice and is not intended to be a psychological test, psychological or professional advice. Consult with your doctor or psychologist.
Edinburgh PostNatal Depression Scale (English)
Edinburgh PostNatal Depression Scale (Spanish)
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In the movies, those first few months of motherhood look positively blissful. Mom may feel tired from childbirth, slightly worried about caring for her newborn, or too busy with all her new responsibilities to get the shower she so desperately wants. Yet her face is filled with peaceful contentment as she nurses her newborn, so in love with her little one, so satisfied with her life. The glow of pregnancy has been replaced with the sweet glow of motherhood and it looks beautifully serene. For some lucky women, this is their experience following childbirth. For an estimated 1 out of 7 women struggling with Postpartum depression, (APA) the reality feels very different. Unfortunately, many may be reluctant to seek help for fears someone may think they are a bad mother or that they are “going crazy”.
During pregnancy, the woman’s body is flooded with hormones that impact emotions. After childbirth, hormone levels drastically change, which may also trigger mood changes. As these hormones change, many women experience a form of the “baby blues”. The baby blues occur in the first two weeks following childbirth and are not always serious. The symptoms usually involve minor mood swings, sadness, crying spells, appetite/sleep disturbances, and feeling anxious or overwhelmed.
Postpartum depression does NOT mean you are a bad mom or ungrateful for your child. Postpartum depression is NOT the same as being a little tired or moody from childbirth. It is a serious condition that impacts women regardless of income, age, race, ethnicity or education level.
Celebrities who have come forth as having been diagnosed with Postpartum depression include Gwyneth Paltrow, Brooke Shields, Courtney Cox, Bryce Dallas-Howard and Lisa Rinna.
What are Some Causes and Risk Factors for Postpartum depression?
While family history of postpartum depression, previous depression and/or anxiety, and previous episodes of postpartum depression are common risk factors for Postpartum Depression, half of the women who have PPD have never had depression before.
Risk Factors:
- Hormone changes during and after pregnancy
- Social isolation (especially during maternity leave)
- Previous history or family history of anxiety or depression
- Having a child who is difficult to soothe, has special needs, or a premature birth
- Other stressors: difficulty breast feeding, financial issues, deaths in the family, illness, etc.
What Does Getting Help for Post-Partum Depression Look Like?
Many women may avoid getting help because they fear others might judge their mothering abilities or be critical because they aren’t happy during a time that is supposed to be happy. Some moms put off getting help because they are hoping it will just go away.
New medication and rights for mothers with Peripartum Depressive Disorder
In August of 2023 the Food and Drug Administration approved the first pill for postpartum depression, zuranolone, which will be sold under the brand name Zurzuva. This is a novel synthetic selective neuroactive steroid GABAA receptor positive allosteric modulator.
The medication is reported to be more quickly effective than antidepressants which can take 3-4 weeks or slightly longer to become effective. It is taken over the course of two weeks. Remarkable, clinical trials reported a response within three days and benefits lasting 6 weeks.
Forbes reported that around the same time, the Equal Employment Opportunity Commission (EEOC) proposed new rules requiring employers to provide time parents time off to treat peripartum depressive disorder, which if adopted, will make it easier for parents to seek and receive treatment.
Evidence-based Practice
The U.S. Preventive Services Task Force recommends screening pregnant and postpartum women for depression. The American Academy of Family Physicians (AAFP, 2016) recommends women with peripartum depression should be evaluated for bipolar disorder, postpartum psychosis, and suicidal risk.
Psychotherapy or selective serotonin reuptake inhibitors (SSRIs) is indicated for mild to moderate depression and a combination of medication and psychotherapy is indicated for moderate to severe depression. AAFP (2106) advised that Citalopram, escitalopram, and sertraline appear to be among the safest SSRIs during pregnancy, whereas fluvoxamine, paroxetine, and sertraline are preferred in breastfeeding women. NIMH has found that effective psychotherapeutic approaches include cognitive-behavioral therapy (CBT), Interpersonal Psychotherapy, and psychodynamic therapy.
References and Support:
Click on Postpartum Support International for their website which has articles about pregnancy and postpartum mood disorders, a list of free support groups, as well as “Warmline” a phone support service offering information and resources in English and Spanish.
Information about Postpartum Depression from the American Psychological Association.
Information on Postpartum Depression and what you can do to help yourself from the American Academy of Family Physicians.
American Academy of Family Physicians Identification and Management of Peripartum Depression
Epperson, C.N. Postpartum Depression: Detection and Treatment. Published in American Family Physician, 1999.
Fobes (2023_ Parallel Moves by FDA And EEOC Promote Postpartum Depression Treatment
NIMH Perinatal Depression
PsychDB Peripartum and Postpartum Depression
If you live in the North Central Florida area, and it is not an immediate emergency involving danger to yourself or your baby, feel free to call our office for an intake appointment (352) 336-2888.
If you are feeling like you might harm yourself or your baby, put your baby in a safe place (like a crib) and call 911 or one of the following numbers for immediate help (7 days a week, 24 hrs a day).
National Hopeline Network
1-800-SUICIDE
1-800-784-2433
National Lifeline for Suicide Prevention
1-800-273-TALK
1-800-273-8255
About the Author:
Angela Allen-Peck, Psy.D. wrote this article as a psychology resident with Clinical Psychology Associates of North Central Florida.
Clinical Psychology Associates of North Central Florida provides counseling and psychotherapy for a range of psychological issues, including depression, issues of identity, and bipolar disorder. We help adults and adolescents discover their natural resiliencies to thrive and to better cope with stress and crises.
Visit our Articles and Archives for more Educational Articles on psychology, health psychology and neuropsychology.
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