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Postpartum Depression (PPD)

Definition

Being a new parent is tough regardless of how old you are, how you came to be a parent or what your family situation is. Even when you’re happy and excited to become a parent, it is a life-changing event that can be unexpectedly and profoundly stressful.

Becoming a parent, whether or not it’s your first child, can put pressure/strain on your relationships, emotions, time, energy, and physical health. It can be wonderful and the best thing to ever happen to you, but it is a lot to take on and changes your life forever. To add to this, there can be an expectation to do everything “right” while also being happy, grateful and cheerful on top of fully caring for a person 24/7.

The reality is that new parents, in particular new moms who have given birth to a baby, often struggle with the “baby blues” - a form of (usually temporary) depression which feels like low mood, sadness, irritability, low energy and apathy. Others may experience a form of heightened anxiety - extreme worry that can interfere with sleep, eating, and generally living life. Usually, these feelings subside as people adjust to their role as a parent and postpartum hormonal changes adjust and balance out.

Any parent might experience these things. Even adoptive parents and other caregivers who didn’t physically give birth to a child can experience a form of low mood or anxiety in the days after becoming a parent.

However, when these feelings are extreme, ongoing and affecting someone’s ability to live their life and/or care for their child, it might be a sign of Postpartum Depression.

Postpartum Depression is treatable, but left untreated can complicate a person’s mental health ongoing and interfere with their life and ability to parent. In extreme cases, it can cause psychosis, neglect or abuse of children and thoughts/actions of harming one’s self or others.

It is not: 

  • “Just a phase” or something someone can “snap out of”.
  • A sign or result of low intelligence or weakness.
  • Always caused by an event or definitive “reason”.
Causes

Like any mental illness, there’s usually a number of factors working together to explain why some people seem to bounce back from giving birth and becoming a parent while other struggle with serious anxiety or depression issues.

There is no single cause of depression (and therefore PPD). Physical, hormonal, social, psychological and emotional factors may all play a part in triggering the illness. The factors that trigger PPD vary from one woman to another. For example, sleep deprivation resulting from having a new baby can make a woman vulnerable to other factors that trigger depression.

Risk factors:

  • Personal history of depression
  • History of depression with a previous pregnancy
  • Family history of depression
Signs and Symptoms

The following are some signs and symptoms for Postpartum Depression.

You'll notice that many of these signs and symptoms could be explained by any number of other health issues, or even be just the result of the life changes associated with having a new child (lack of sleep, changes in relationships, energy, time, etc.). Many of the thoughts, behaviours and feelings described here could be caused by the pressure and added worries of being a new parent. It can be hard to tell the difference between what is just regular new parent “stuff” and what is developing into a mental health concern.

Below is a list of signs and symptoms for the “baby blues”, which are very common and are temporary :

  • Mood swings
  • Anxiety
  • Sadness
  • Irritability
  • Feeling overwhelmed
  • Crying
  • Reduced concentration
  • Appetite problems
  • Trouble sleeping

Postpartum Depression may be mistaken for baby blues at first — but the signs and symptoms are more intense and last longer, eventually interfering with your ability to care for your child and handle other daily tasks. Postpartum Depression requires treatment. Without it, it can last for months or longer and develop into more complicated and ongoing mental health issues:

  • Depressed mood or severe mood swings
  • Excessive crying
  • Difficulty bonding with your baby
  • Withdrawing from family and friends
  • Loss of appetite or eating much more than usual
  • Inability to sleep (insomnia) or sleeping too much
  • Overwhelming fatigue or loss of energy
  • Reduced interest and pleasure in activities you used to enjoy
  • Intense irritability and anger
  • Fear that you're not a good parent
  • Feelings of worthlessness, shame, guilt or feeling like you’re not “good enough”
  • Hard to think clearly, concentrate or make decisions
  • Severe anxiety and panic attacks
  • Intrusive or alarming thoughts of harming yourself or your baby
  • Repeated and intrusive thoughts of death or suicide

Postpartum Psychosis is fairly rare, but is a serious mental illness that requires immediate medical attention:

  • Confusion and disorientation
  • Obsessive thoughts about your baby
  • Hallucinations (seeing or hearing things that aren’t real) and delusions (believing things that are not true)
  • Sleep disturbances
  • Paranoia
  • Attempts to harm yourself or your baby

Postpartum Depression is treatable. For these or any other mental health concerns, if signs or symptoms are interfering with your life in any way, or you’re just feeling like you are in distress or feeling low, it’s time to seek help. You don’t need to wait until things get really “bad” before you seek help.

For instance, if sleep patterns, eating, relationships, enjoyment of life or your ability to care for your child are being affected, it’s a good idea to talk to someone. That someone could be a partner, friend you trust, a teacher, your family doctor, a crisis line, or counselor.

If it is your partner or friend you are concerned about, they may resist help or not even recognize that they need it. They might need you to make the first step. With Postpartum mental health concerns, a new parent may not want to admit they are struggling because of stigma and the high expectation to be happy and capable.

As always, if you feel like your friend might hurt themselves or someone else, it’s time to call emergency services.

Visit our Help Section to find out how to get help for yourself or a friend.

Like other mental health issues, Postpartum Depression will differ from person to person. Because each case is unique, the treatment will likely be unique for each individual.  In most cases, postpartum depression and anxiety are very treatable.

Treatment for Postpartum Depression may include a combination of strategies. Most often, a treatment strategy will include trying medication paired with psychotherapy. Cognitive Behavioural Therapy is one type that can be helpful.

Support groups can be tremendously helpful for parents in general, but especially those struggling with Postpartum mental health issues.

Sometimes, while a person is living with mental health issues like depression or anxiety, part of the treatment might be about treating individual symptoms on a temporary or ongoing basis to make someone feel more comfortable while they try to get better. For instance, if someone is having trouble sleeping, a doctor might suggest treatment strategies to help that person get some sleep.

It is very important that new parents have a network of support. This includes supportive, reassuring and non-judgemental partners, family members or friends. Having people around that can help with caring for a new child, taking care of chores or just checking in can make a huge difference.

A person living with Postpartum Depression, like any other person, will benefit from maintaining wellness and having good supports in their life.

Myths

Many people feel there is stigma attached to having Postpartum Depression and/or Anxiety. Having a child is supposed to be a joyful event and so people feel pressure to be happy. Having a child is also a big life change, so many brush off symptoms as being a normal part of being a new parent.

Myth: Feeling depressed or anxious after having a baby is normal. Postpartum mental illnesses aren’t really “illnesses”.

Fact: Becoming a new parent is a major life event. When you pair that with lack of sleep, high expectations, massive hormonal changes and anxiety, feeling sad, lonely and overwhelmed can happen to anyone (whether you’re a mom or a dad). However, for many new parents, these “baby blues” can progress into a serious mental illness that requires support and treatment. Postpartum Depression and Anxiety are nothing to be ashamed of and are real health issues that are generally very treatable. 

Myth: People experiencing Postpartum Depression or Anxiety are sad and cry a lot.

Fact: Like many mental health issues, how people behave or experience symptoms when they are struggling can be really different for each individual. Some who are struggling with Postpartum mental illness are sad and cry a lot. Others feel and behave in a way that is angry or irritable. Many new parents are calm and behave “normally” - even seeming to “have it all together” - in an effort to cope with or hide how they are feeling for fear of being judged.

Myth: Postpartum Depression will occur within the first few weeks of childbirth. After that, you’re in the clear.

Fact: Postpartum depression may not surface or become obvious right after having a child. It can develop or become evident anytime within the first year of becoming a parent.

Myth: Postpartum Depression or Anxiety will go away by themselves with time.

Fact: Many new parents experience the “baby blues” - low mood or anxiety following the birth of a new child. Often that resolves on its own. Postpartum Depression or Anxiety are different. These are serious illnesses that can get in the way of living a full life and can be treated effectively. It’s important to seek actual medical help to get the treatment process started. Support and medical help is needed to recover from these.

Myth: People who “have it all” (a supportive family, wealth, power, etc.) are not likely to develop Postpartum mental health issues.

Fact: Though poverty or family issues may be contributing factors for Postpartum Depression or Anxiety, these illnesses can happen to people across all social and economic levels. Many rich and famous people have been known to have Postpartum Depression and/or Anxiety. The causes vary, and can have nothing to do with how much money you have or how great your family is.

Supporting someone with any type of serious illness can be challenging. Ways to help and support a friend or loved one who is living with depression:

  • Know the signs and symptoms of Postpartum Depression and Anxiety
  • Encourage professional help for your friend when needed (see Help Section)
  • Make sure your own expectations of your loved one are realistic. Example: expecting someone who is coping with a new baby to be up, dressed and living in a spotless house is unrealistic at the best of times, let alone for someone who is struggling with an illness.
  • There are many different ways to be a parent. If your friend is not doing things the way you would, it doesn't mean that it’s wrong. Unless you fear for the safety or wellbeing of the children, avoid the temptation to judge someone or intervene in another person’s parenting style.
  • Try to be reassuring and calm if your friend is feeling particularly anxious about something, even if the worry seems out of proportion to reality. Trying to apply logic or talk someone out of their anxiety isn’t always effective or helpful.
  • Offer real help with daily responsibilities. Sometimes lots of people offer to visit, bring food etc. in the early days and weeks after a new child has arrived, but then that help disappears when it might be needed most in later months. Make specific offers for things you can do to help out, like household cleaning, folding and putting away laundry, taking the garbage out, bringing over coffee or a hot meal, taking baby out for a walk etc.
  • Give genuine praise to your loved one when you see them doing things to care for their child. Sometimes people can feel like they’re not doing anything “right”, and having someone notice and say something positive about their parenting skills might give them a boost.
  • Help with child care. This could mean having a standing “date” to take the baby for a walk once a week, spending the night to help with nighttime feedings or looking after the baby for an evening to give parents a break. Having time to yourself is good for anyone, especially a new parent. It can make a world of difference.
  • Help your loved one connect to community and health resources. Support groups, parent and baby drop-ins, public health nurse visits, etc. are helpful, and someone who is struggling may not be in the right frame of mind to research these things for themselves.
  • Treatment is a process. Medications and therapy can take time to help. Be aware of this and try to be supportive as your friend adjusts.
  • Stay calm and don’t take things personally. Sometimes mental illness can really distort how someone perceives conversations or situations. How someone reacts or communicates when they have Depression or anxiety may be confusing, distressing or even hurtful at times. They may be feeling overwhelmed and acting out, and it’s probably not about you.
  • Set some boundaries for yourself, and take care. You can’t help someone if you’re feeling overwhelmed yourself.
Resources

The information on this page is a simple overview of a complicated health issue. The content has been taken from CAMH and CAMH Documents.

For more in-depth information, please visit these sources or speak to a medical professional.

Contact your local Public Health Centre. Public Health professionals often have well baby checks, breastfeeding support and other postpartum resources that can be really helpful.

Ontario – Call Connex Ontario to find out where there are mental health supports in your community.

Crisis – In any situation where someone is at risk of hurting themselves or others, call 911 or a local crisis line.

Please see the Help Section for more information on how to seek help.