Postpartum Depression

Sadness After Childbirth: When is it more than the baby blues?

by Nadja Reilly, Ph.D, Associate Director, Freedman Center for Child and Family Development, Massachusetts School of Professional Psychology

Welcome to motherhood! Your little bundle of joy has arrived, and you may be faced with a myriad of feelings – happiness, relief, hope, as well as concerns, exhaustion, and uncertainty. Motherhood brings multiple demands and expectations. You are expected to be a good mother – one that is responsive to her child, knows how to comfort and nurture her baby. But what if you don't feel at all comfortable? What if you feel sad and exhausted and not sure about what to do for your baby? If you are feeling this way, you are definitely not alone. It is not unusual for new moms to feel sad, tired and unsure of their parenting skills. In fact, many new moms go through these feelings, and as many as 80% may experience the "baby blues." Baby blues are characterized by periods of crying for no apparent reason, anxiety, difficulty sleeping, and restlessness. Thankfully, these symptoms usually diminish approximately within 3-7 days of delivery.

For some women, however, these feelings may persist and even increase over time. This is no longer part of the "baby blues," but may signal a more serious illness, post-partum depression. Approximately 10-15% of women may experience post-partum depression after giving birth. Symptoms usually begin within the first three months after birth, but can surface anytime within a year after the baby's birth. There is a period of at least two weeks of depressed mood or loss of interest in all activities, and at least some other symptoms, including:

• Changes in appetite or weight
• Too much sleep or too little sleep
• Mood swings and irritability
• Decreased energy
• Difficulty concentrating, thinking, and making decisions
• Feeling exhausted, disorganized, overwhelmed, or hopeless
• Feeling very self-critical, and/or worring that others criticize or judge you 
• Intense feelings of sadness or anger
• It is hard to take care of yourself or the child
• A preference for being alone, or withdrawing from friends and family
• Using drugs or alcohol as a way to relieve stress, or help reduce sadness or anxiety
• Thinking about hurting yourself or your baby

While the feelings associated with post partum depression can be difficult, they do not have to be permanent. There are effective treatments for post-partum depression. If you are experiencing any of the symptoms listed above, call your doctor immediately. Do not wait to see if symptoms subside on their own. Your doctor may recommend any of the following:

Counseling: Therapy can be an effective way to address the way you are feeling, thinking, and acting. Women struggling with post-partum depression can benefit tremendously from learning new ways to cope with stress, and how to manage their feelings. Involving significant others (e.g., spouses, family) in treatment can also help improve communication and enlist their support and help during difficult times. Counseling may be done on an individual basis, or may be offered in a group through a formal group therapy program.

Medication: Antidepressants are effective in treating post-partum depression. If you are breast-feeding, you can talk to your doctor to discuss which medications are safe to use.

Support Groups: Support groups are helpful in a variety of ways, including 1) helping moms to make connections with other moms struggling with post partum depression, 2) moms may learn helpful and practical coping skills from other moms, 3) finding a source of hope and motivation.

Additional treatments: Many women respond well to supplements to their therapy and medication, such as yoga, meditation, spiritual counseling, herbal remedies, and other natural healing practices. It is always important to mention all treatments, whether prescribed or not, to your doctor, to ensure that there are no negative interactions among types of medications.