Postpartum depression (PPD), also known as perinatal depression, is a mood disorder which may be experienced by pregnant or postpartum women. Symptoms include extreme sadness, low energy, anxiety, crying episodes, irritability, and extreme changes in sleeping or eating patterns. PPD can also negatively affect the newborn child. Although the exact cause of PPD is unclear, it is believed to be due to a combination of physical, emotional, genetic, and social factors such as hormone imbalances and sleep deprivation. Risk factors include prior episodes of postpartum depression, bipolar disorder, a family history of depression, psychological stress, complications of childbirth, lack of support, or a drug use disorder. Diagnosis is based on a person's symptoms. While most women experience a brief period of worry or unhappiness after delivery, postpartum depression should be suspected when symptoms are severe and last over two weeks. Among those at risk, providing psychosocial support may be protective in preventing PPD. This may include community support such as food, household chores, mother care, and companionship. Treatment for PPD may include counseling or medications. Types of counseling that are effective include interpersonal psychotherapy (IPT), cognitive behavioral therapy (CBT), and psychodynamic therapy. Tentative evidence supports the use of selective serotonin reuptake inhibitors (SSRIs). Depression occurs in roughly 10 to 20% of postpartum women. Postpartum depression commonly affects mothers who have experienced stillbirth, mothers who live in urban areas, and adolescent mothers. Moreover, this mood disorder is estimated to affect 1% to 26% of new fathers. A different kind of postpartum mood disorder is postpartum psychosis, which is more severe and occurs in about 1 to 2 per 1,000 women following childbirth. Postpartum psychosis is one of the leading causes of the murder of children less than one year of age, which occurs in about 8 per 100,000 births in the United States.
Signs and symptoms Symptoms of PPD can occur at any time in the first year postpartum. Typically, a diagnosis of postpartum depression is considered after signs and symptoms persist for at least two weeks.
Emotional Persistent sadness, anxiousness, or "empty" mood Severe mood swings Frustration, irritability, restlessness, anger Feelings of hopelessness or helplessness Guilt, shame, worthlessness Low self-esteem Numbness, emptiness Exhaustion Inability to be comforted Trouble bonding with the baby Feeling inadequate in taking care of the baby Thoughts of self-harm or suicide
Behavioral Lack of interest or pleasure in usual activities Low libido Changes in appetite Fatigue, decreased energy and motivation Poor self-care Social withdrawal Insomnia or excessive sleep Worry about harming self, baby, or partner
Neurobiology fMRI studies indicate differences in brain activity between mothers with postpartum depression and those without. Mothers diagnosed with PPD tend to have less activity in the left frontal lobe and increased activity in the right frontal lobe when compared with healthy controls. They also exhibit decreased connectivity between vital brain structures, including the anterior cingulate cortex, dorsal lateral prefrontal cortex, amygdala, and hippocampus. Brain activation differences between depressed and nondepressed mothers are more pronounced when stimulated by non-infant emotional cues. Depressed mothers show greater neural activity in the right amygdala toward non-infant emotional cues as well as reduced connectivity between the amygdala and right insular cortex. Recent findings have also identified blunted activity in the anterior cingulate cortex, striatum, orbitofrontal cortex, and insula in mothers with PPD when viewing images of their infants. More robust studies on neural activation regarding PPD have been conducted with rodents than humans. These studies have allowed for greater isolation of specific brain regions, neurotransmitters, hormones, and steroids.
Onset and duration Postpartum depression onset usually begins between two weeks to a month after delivery. A study done at an inner-city mental health clinic has shown that 50% of postpartum depressive episodes began before delivery. In the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) PPD is not recognized as a distinct condition but rather a specific type of a major depressive episode. In the DSM-5, the specifier "with peripartum onset" can be applied to a major depressive episode if the onset occurred either during pregnancy or within the four weeks following delivery. The prevalence of postpartum depression differs across different months after childbirth. Studies done on postpartum depression amongst women in the Middle East show that the prevalence in the first three months of postpartum was 31%, while the prevalence from the fourth to twelfth months of postpartum was 19%. PPD may last several months or even a year.
Consequences on maternal and child health Postpartum depression can interfere with normal maternal-infant bonding and adversely affect acute and long-term child development. Infants of mothers with PPD have higher incidences of excess crying, temperamental symptoms, and sleeping difficulties. Problems with sleeping in infants may exacerbate or be exacerbated by concurrent PPD in mothers. Maternal outcomes of PPD include withdrawal, disengagement, and hostility. Additional patterns observed in mothers with PPD include lower rates of initiation and maintenance of breastfeeding. Children and infants of PPD-affected mothers experience negative long-term impacts on their cognitive functioning, inhibitory control, and emotional regulation. In cases of untreated PPD, violent behaviors and psychiatric and medical conditions in adolescence have been observed. Suicide rates of women with PPD are lower than those outside of the perinatal period. Fetal or infant death in the first year postpartum has been associated with a higher risk of suicide attempt and higher inpatient psychiatric admissions.
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