Much of the reported data on postpartum depression focuses on cisgender women who identify as “moms”–but we recognize that not all postpartum parents fit into that category.
It’s only quite recently that postpartum depression is more frequently part of the pregnancy conversation, after so many generations of the condition existing largely in secret. Still, it comes with a stigma, and much misunderstanding, even though it is a known and treatable condition.
It is believed that 1 in 7 new parents experience postpartum depression–but behavioral health clinicians suspect it is far more common, with many cases going unreported. It is also more common among Black, Indigenous and parents of color, with studies showing the likelihood being almost twice that of white parents for Black and Hispanic postpartum people. It’s also important to acknowledge the additional stigma and barriers to accessing care that people of different racial or socioeconomic backgrounds may face.
As we look into recognizing the signs of postpartum depression and treating it, we also must address how to better understand it so new parents can receive the help they need.
The difference between postpartum depression and the “baby blues”
Because of how postpartum depression is talked about, it’s understandable that so many wonder if postpartum depression is the same as the baby blues. It’s not.
Baby blues is a temporary, common emotional state people experience for the first few days up to the first few weeks after childbirth, most often with symptoms of mood swings, tearfulness and irritability.
Postpartum depression is a mood disorder marked by constant, persistent feelings of sadness, anxiety, guilt and irritability about parenthood and/or the baby, alongside changes in sleep and appetite, to the point that it impacts the person’s ability to bond with their baby.
Postpartum depression vs. baby blues
Baby blues:
- Occurs in the first couple of days up to the first couple weeks after giving birth
- Common feelings include feeling overwhelmed, tearful and irritable
- Caused by the big hormonal crash after giving birth
- An expected reaction to the emotional, physical and social adjustment of becoming a parent
- Baby blues is a temporary situation that resolves on its own
Postpartum depression:
- Occurs within the first few weeks up to the first year after giving birth
- Feelings include constant and persistent sadness, irritability and guilt surrounding parenting and baby, such as “I’m not a good parent” or “People are questioning me”; lack of interest in things, specifically engagement with baby; appetite or sleep disturbance because of mood; feeling disconnected or isolated from other people; and on the most extreme end, thoughts of death
- Caused by several different factors
- While common, it’s not “expected,” so parents should seek help
- Postpartum depression is not a permanent condition; support from family, friends and healthcare providers can make a significant positive impact.
Risk factors for postpartum depression
While any birthing person can experience postpartum depression, we know of several risk factors that make some more likely to develop the condition than others. It’s also important to acknowledge there is a lot that we don’t know because we don’t have data. It has quite simply—and frustratingly—not been studied to the extent that it should be.
Risk factors:
- Personal or family history of a mental health condition, including previous postpartum depression
- Social isolation and/or lack of support
- Birth trauma or baby NICU stay
- First-time, or very young (teen) or older parents (aged 45 and older)
- Major family stressors (death, moving, divorce)
- Financial strain, especially unemployment
- Parenting a baby with special needs
- Baby feeding or sleep issues out of the norm
- Significant relationship conflicts
- Birthing parent medical conditions, such as thyroid disorder and diabetes
- Social inequity, including people of color, immigrants, queer community, those living in poverty and any marginalized group where there’s inherently a gap and lack of support
Recognizing the symptoms of postpartum depression
It’s important to acknowledge there are huge gaps in health care in general, mental health care in particular and women’s mental health care even more specifically. And there should be more done in the way of diagnosing and treating postpartum depression. Our role as providers is to offer reassurance that you are not a problem, that there is nothing wrong with you and that you will feel better.
Postpartum depression signs
Postpartum depression can be distinguished by two major factors: the persistence of the feelings and the consistent intensity of the feelings.
- Persistent feelings of sadness or emptiness
- Loss of interest or pleasure in activities
- Changes in appetite or weight caused by mood
- Sleep disturbances (insomnia or excessive sleep)
- Fatigue or loss of energy
- Feelings of worthlessness or guilt
- Difficulty concentrating or making decisions
- Irritability or anger
- Withdrawal from friends and family
- Thoughts of self-harm or harming the baby
Intense, consistent anxiety–the other side of depression–is also a common symptom and should be brought up with your provider.
Can postpartum depression affect men?
Yes, postpartum depression can affect men or the non-birthing parent. Causes and symptoms are similar to those that affect the birthing parent, such as persistent feelings of sadness, irritability and guilt. Partners should seek support if they experience these symptoms.
How is postpartum depression diagnosed?
At WHA, our behavioral health clinicians work with our OBGYN physicians and certified-nurse midwives on three-week and eight-week postpartum screening, which some have colloquially termed the “postpartum depression test.” Providers will go through the Edinburgh Postnatal Depression Scale (EPDS)—an online screening tool used to track and evaluate depressive symptoms in someone up to 12 weeks postpartum—with patients. This is a self-evaluation meant to open up a dialogue between you and your healthcare team so we can offer treatment or support.
Treatment options for postpartum depression
WHA’s behavioral services team is primarily focused on pregnant patients, postpartum patients and those who’ve experienced loss (pregnancy loss, infant loss). While we hope to start working with patients during pregnancy and follow them into postpartum, we know that’s not always possible or accessible.
For postpartum depression support, WHA provides both urgent mental healthcare and shorter-term therapy for around six months at a time, whether in-person or via telehealth. We may also refer patients to a psychiatrist, work with a patient’s primary obstetric provider to prescribe medication or connect patients to a crisis counselor.
While programs like ours are becoming more common, and we are seeing more perinatal mental health specialists enter the field, this is still a critically growing area of mental healthcare.
How to support someone with postpartum depression
Postpartum depression can be complex and nuanced, as people always assume the most severe symptoms are the only ones. Couple that with living in a culture that tells those who identify as moms how to parent and what it means to be a good parent, and people feel ashamed by the difference between their internal thoughts and what society tells them they should feel.
For those who had a vision for what parenthood would look like, saying “I’m not okay” feels like a bad thing, opening themselves up to judgment from partners, visiting family, friends or providers. Or worse, if they admit their feelings, someone may decide they should not be a parent.
For these reasons, it can be challenging to ask for help. Partners should be part of the conversation ahead of time by knowing your prenatal and postpartum resources. Also, partners should attend prenatal medical appointments to learn about what’s going to happen physically and emotionally to the birthing parent.
After the baby is born, parents should develop regular check-ins with each other about each person’s emotional health. Be intentional with that time together so you both have an opportunity to share how you are on any given day. It’s during these conversations that you can gauge changes and patterns in behaviors and seek help when you need it. Coping with postpartum depression does not need to, and should not, be permanent. There is help. You are not alone.
If you’re experiencing any symptoms of postpartum depression, make an appointment with your provider, who can connect you with WHA’s behavioral health services team.
Resources:
- Postpartum Support International
- Baby Blues Connection (503) 797-2843 or (360) 735-5571
- Postpartum Depression Helpline (800) 944-4PPD
- Multnomah County Crisis Hotline (503) 988-4888
- Washington County Crisis Hotline (503) 291-9111
- Clackamas County Crisis Hotline (503) 655-8724
