From causes and risk factors to treatment options and support, Dr. Kathryn Lucas, OB/GYN at Virginia Physicians for Women, answers questions about this common maternal mental health condition.
As practicing OB/GYNs, we are constantly learning about how our health and bodies are impacted by the world around us. The focus on our mental health is rapidly growing, and it is about time! Our psychological well-being can greatly impact our quality of life, and poor mental health may have serious consequences for pregnant persons and babies alike.
In December 2022, the Centers for Disease Control and Prevention (CDC) published a national report highlighting that all cases of maternal mortality associated with mental health conditions were preventable. During the COVID-19 pandemic, pregnant persons were more vulnerable than ever, and screening for perinatal mental health conditions became a “vital sign” that grew to be an important aspect of comprehensive care. It is more important now more than ever that providers invite pregnant persons to engage in open conversations about mood symptoms and initiate timely interventions when indicated.
What is postpartum depression and what are the symptoms?
The criteria for diagnosis of postpartum depression as defined in the Diagnostic and Statistical Manual of Mental Disorders 5th Edition (DSM-5) is the same criteria for diagnosing depression outside of pregnancy. An individual must report five or more of the following symptoms for at least two weeks that represent a change from their norm.
Symptoms of postpartum depression:
- Depressed mood
- Decreased interest or pleasure in normal activities
- Significant unintentional changes in weight (gain or loss of at least 5% in a month) or appetite (decrease or increase)
- Alterations in sleep (too much or not enough)
- Feeling like you are reacting slower or more agitated than normal
- Fatigue
- Feelings of worthlessness or inappropriate guilt
- Difficulty concentrating
- Disruptive and recurrent thoughts of wanting to hurt yourself or others
In addition to these symptoms which make up the diagnostic criteria, other signs of postpartum depression include withdrawal from friends and family as well as difficulty bonding with your baby.
Is it the baby blues or postpartum depression?
If you ask any new (or veteran) parent, you can imagine that a lot of these symptoms can overlap with normal behaviors and responses during pregnancy and postpartum. Recognizing your symptoms can be tricky and confusing.
Postpartum depression is not just the baby blues, which is usually characterized by mild symptoms that start within a few days after delivery and resolve by two weeks postpartum. If you are experiencing moderate to severe symptoms or any symptoms that extend beyond two weeks after your baby is born, you may have postpartum depression.
How common is postpartum depression and how long do symptoms last?
More common than you think! Perinatal mental health conditions affect more than 1 in 5 people. These disorders can include pre-existing conditions prior to or any diagnosed during your pregnancy and up to the first year postpartum.
While classic definitions include symptoms up to four weeks postpartum, most experts agree that extending this to 12 months is more clinically relevant. After one year postpartum, your provider may discuss with you that there may be an alternative underlying condition present.
How is postpartum depression diagnosed?
Postpartum depression is diagnosed using a screening tool administered by your provider. One of the most commonly used tools is the Edinburgh Postnatal Depression Scale, a 10-question survey that assesses the presence and degree of significance of depressive or anxiety-related symptoms within the last seven days.
There are many excellent screening tools available in several languages, including Spanish; so please ask your provider about using one in your native language.
What are the main causes and risk factors for postpartum depression?
Expected fluctuations in important hormones active in normal pregnancy and lactation, such as estrogen, progesterone, oxytocin, dopamine, and serotonin, can lead to emotional or behavioral changes. When these fluctuations are combined with a lack of sleep, feelings of isolation, and other environmental stressors of having a newborn, we may feel like we are pushed to our emotional limits.
If you have pre-existing depression, bipolar disorder, anxiety, or have a history of trauma, you may be at higher risk of developing postpartum depression compared to those without these conditions. A diagnosis of postpartum depression in any prior pregnancies also predisposes you to having symptoms in your current or future pregnancies. Similarly, individuals who may be coping with a history of substance abuse or current addictions also are particularly at high risk for developing postpartum depression.
External stressors from our work or school, food or housing instability, or interpersonal relationships can all contribute to depressive emotions or thoughts. While we may not totally understand how our genetic make-up plays a role, mental health conditions may even run in families, and it is important that you talk with yours about their experiences, too!
What are some ways postpartum depression can be treated?
Despite the high prevalence of postpartum depression, perinatal mental health conditions are still largely undertreated – or not treated at all. While talk therapy and medications are both safe and effective to use during pregnancy and while breastfeeding, it is well known that when combined they can lead to the best possible outcomes.
In addition to medical or psychological treatments, eating well, staying active, getting outside, and sleep hygiene are also vital factors that support overall physical and emotional wellness.
How commonly are symptoms of postpartum depression treated with medications?
Very! Certain medications have been studied to be safe and effective in treating depression during pregnancy and postpartum. In fact, we know that NOT treating symptoms may be more harmful than the overall low potential risks of using medications. Untreated depression may be associated with increased risk of preeclampsia, preterm delivery, low birth weight, impaired parent-infant bonding, decreased engagement in healthcare, substance abuse, and suicide.
What types of medication are used to treat postpartum depression?
The first-line treatment for depression in pregnancy or breastfeeding are serotonin-reuptake inhibitors (SSRIs), which increase the availability of serotonin in the brain to stabilize mood. Other medications that are not specifically in this class, but have been found to be safe include Wellbutrin (bupropion) and Buspar (buspirone).
Mothertobaby.org is a great resource that provides fact sheets about safety information for common antidepressants:
- Zoloft (setraline)
- Prozac (fluoxetine)
- Celexa/Lexapro (citalopram or escitalopram)
- Wellbutrin (buproprion)
We encourage you to speak with your provider about the risks, benefits, and alternatives for treatment of depression if you are considering starting medication or before stopping any current medications.
What about therapy?
Psychotherapy can be beneficial for everyone to better equip ourselves for the physical and emotional changes of becoming a new parent – even if you yourself are not affected by postpartum depression. Regular therapy is similar to any other routine or preventative care visit with the goal to optimize your health during this new chapter in your family’s life.
Individual or couple’s sessions may be in-person or via telehealth provided by a psychiatrist, licensed therapist, or counselor, depending on your personal needs. In addition to your prenatal care provider, your baby’s pediatrician or community case-workers may also play a big role in referring you to appropriate resources.
What are some resources and support groups that may help me if I have postpartum depression?
If you are struggling, talk with your family, friends, neighbors, and other parents and be empowered by open communication – because chances are you are NOT alone!
Here are a few resources:
- Postpartum Support Virginia (free services): postpartumva.org
- Seven Starling (therapy, group therapy, community support, and medical evaluation covered by insurance): sevenstarling.com
- Postpartum Support International: postpartum.net
- Human Resources and Services Administration (HRSA) National Maternal Mental Health Hotline: 1-833-TLC-MAMA, mchb.hrsa.gov/programs-impact/national-maternal-mental-health-hotline
- March of Dimes: marchofdimes.org/find-support/topics/postpartum/postpartum-depression
- Substance Abuse and Mental Health Services Administration (SAMHSA): samhsa.gov
- National Alliance on Mental Illness (NAMI): nami.org/your-journey/maternal-new-parent-mental-health
Don’t be afraid to reach out for help.
There is a lot of pressure on parents, family members, and loved ones to be able to juggle all of the real challenges that come with welcoming a new baby. It is important to remember that postpartum depression – or any lack of your ability to “deal” with what is going on around you – is not your fault.
We encourage you to feel empowered and advocate for your mental health by speaking with your provider about your concerns. The sooner symptoms are recognized and treated, the better. Severe complications from untreated mental health conditions are, in fact, preventable. As a healthcare team, we can work together to normalize how we relate to our emotions and fight the stigma of living with mental health conditions.
Your OB/GYN care team is ALWAYS here to support you. Never be afraid to reach out if you or a loved one may be struggling with symptoms of postpartum depression.
About Dr. Lucas
Dr. Kathryn D. Lucas is an OB/GYN at Virginia Physicians for Women with expertise in comprehensive postpartum care. She sees patients at VPFW’s St. Francis and Prince George offices and delivers babies at St. Francis Medical Center.
