When to Seek Help for Peripartum (or Postpartum) Depression

The days and months after the birth of a baby are expected to be a joyful time. But you may also feel tired, nervous, or even a bit sad, as you adapt to the challenges of caring for a newborn, and this is called the baby blues. Baby blues are very common and occur in 50-80% of moms. But those “baby blues” typically go away after a few days as you adjust.

Most women don’t expect to feel more intense, negative emotions, such as lingering sadness, anger, or a disconnect from their baby. But some women do experience these symptoms. Formerly known as postpartum depression, it’s now called peripartum depression because it may begin during pregnancy. With peripartum depression, symptoms are more severe and last longer, and there is functional impairment associated with the symptoms. And Peripartum depression is a serious mental health condition that requires treatment to get better.

Knowing when to seek help for peripartum depression is important. Left untreated, peripartum depression could put both you and your baby’s development and life at risk.

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What Is Peripartum Depression?

If you’re a new mother and you experience negative feelings that won’t go away, you aren’t alone. Though commonly known as postpartum or peripartum depression, the medical term for what you’re feeling is major depressive disorder (MDD), with peripartum onset. It’s also now known as peripartum depression or perinatal depression. These terms apply whether the symptoms arise during of after pregnancy.

Not just the “baby blues”

Peripartum depression isn’t just the “baby blues” that your mother or best friend told you about. According to the American Psychiatric Association, up to 70% of women experience some level of fatigue, stress, anxiety, and irritability during and after pregnancy.

These symptoms don’t stop you from taking care of yourself or your baby. Usually once you get a routine going, these feelings last a week or two and then generally go away on their own.

A common — but often silent — epidemic

Peripartum depression is depression that occurs during pregnancy or after childbirth or during both times. And it affects one and eight women, according to the Centers for Disease Control and Prevention. In some states, that number is as high as one in five women.

It’s now called peripartum depression because oftentimes, the depression starts before the birth of the baby. In fact, a review in Frontiers in Neuroendocrinology found that up to one third of women who experience this type of depression will develop symptoms during pregnancy.

All too often, women with peripartum depression suffer in silence. It’s a largely undiagnosed condition. Half of all women with peripartum depression never tell their doctor or family members, according to StatPearls.

Women often don’t say anything because they don’t want others to think they are a “bad mother.” They feel guilty, ashamed, or embarrassed by what they’re feeling. You’re not a “bad mother” if you have peripartum depression, and you should not feel ashamed. Peripartum depression is not your fault and is very common. The best thing you can do for you and your baby is to seek treatment and reach out for support

When to Seek Help for Peripartum Depression

Symptoms of peripartum depression are more severe than what you feel with typical “baby blues.” These symptoms are emotionally and physically debilitating, making it hard for you from caring for yourself and your baby. And they last longer than typical “baby blues” — sometimes up to two years pospartum.

Symptoms of peripartum depression

It’s important to tell your ob-gyn or doctor if you have unusual thoughts or feelings during pregnancy or after giving birth. These include:

  • Frequent crying and sadness, often for no reason.
  • Feeling angry.
  • Feeling empty or numb.
  • Not feeling connected to your baby.
  • Thinking you’re not a good mom.
  • Withdrawing from loved ones.
  • Trouble sleeping or sleeping too much.
  • Changes in appetite.
  • Increased fatigue or loss of energy.
  • Lack of interest in activities that you once enjoyed.
  • Fear of hurting the baby or yourself.
  • Thoughts of death or suicide.

In rare cases, some mothers experience hallucinations — seeing or hearing things that aren’t there. This is known as postpartum psychosis.

When to call your doctor

Call your ob-gyn or doctor right away if:

  • You have several of the symptoms above for more than two weeks.
  • Your symptoms are getting worse.
  • You are having problems with daily activities or taking care of yourself or your baby.
  • You have thoughts of suicide or thoughts of harming your child.
  • You are experiencing hallucinations.

How to Treat Peripartum Depression

Treatment for peripartum depression can include psychotherapy, medicine, or a combination of both. Another important but often overlooked factor is level of support. Reaching out to loved ones and friends for support during this difficult time can go a long way.

Therapy

Also known as talk therapy or counseling, therapy usually involves meeting with a licensed medical professional to discuss what you’re feeling. Types of effective talk therapy include:

  • Cognitive behavioral therapy (CBT). This treatment centers around changing thoughts and behaviors to help manage a condition. CBT is often used for treating anxiety and depression.
  • Interpersonal therapy. Also common for depression treatment, interpersonal therapy focuses on social and personal relationships. It aims to help people improve communication in their relationships and develop support systems, among other goals.
  • Other therapy options. Support groups and parenting classes may also help you manage your symptoms and better care for your baby.

Daily antidepressant medicines

Your doctor may prescribe an antidepressant to treat your depression. Talk with your healthcare provider to discuss if a medication is the right choice for you. As with any medication, the risks and benefits of medication, including in pregnancy and breastfeeding need to be weighed against the risks of untreated depression and anxiety. Let your doctor know if you are pregnant and planning to breastfeed.

Brexanolone

The U.S. Food and Drug Administration has approved brexanolone as the first drug designed specifically for peripartum depression. Unlike existing antidepressants, brexanolone mimics a hormone that is naturally produced in the body.

UPMC Magee-Womens Hospital has partnered with UPMC Western Behavioral Health to now offer brexanolone as part of a comprehensive treatment program for depression that occurs during pregnancy or postpartum.

Brexanolone treatment at UPMC Magee requires a two-night stay in the hospital for intravenous infusion of the medicine that is delivered over 60 hours. Women interested in the treatment should talk to their doctor about a referral to the UPMC Western Behavioral Health perinatal psychiatry team to determine eligibility. They also can email brexanolone@UPMC.edu.

Sources

Postpartum Depression. StatPearls. Link

Pathophysiological Mechanisms Implicated in Postpartum Depression. Frontiers in Neuroendocrinology. January 2019. Link.

What is Postpartum Depression? American Psychiatric Association. Link.

Vital Signs: Postpartum Depressive Symptoms and Provider Discussions About Perinatal Depression. Morbidity and Mortality Weekly Report. May 15, 2020. Centers for Disease Control and Prevention. Link.

Depression Among Women. Centers for Disease Control and Prevention. Link.

About UPMC Magee-Womens Hospital

For more than a century, UPMC Magee-Womens Hospital has provided high-quality medical care to women at all stages of life. UPMC Magee is long-renowned for its services to women and babies but also offers a wide range of care to men as well. Our patient-first approach ensures you and your loved ones get the care you need. Nearly 10,000 babies are born each year at Magee, and our NICU is one of the largest in the country. Our network of care – from imaging centers to hospital services – provides care throughout Pennsylvania and Maryland, giving you a chance to get the expert care you need close to home. The U.S. Department of Health and Human Services recognizes UPMC Magee as a National Center of Excellence in Women’s Health, and the Magee-Womens Research Institute is the largest research institute in the U.S. devoted exclusively to women’s health and reproductive biology.

About UPMC Western Behavioral Health

UPMC Western Psychiatric Hospital is the hub of UPMC Behavioral Health, a network of community-based programs providing specialized mental health and addiction care for children, adolescents, adults, and seniors. Our mission is to provide comprehensive, compassionate care to people of all ages with mental health conditions. UPMC Western Psychiatric Hospital is a nationally recognized leader in mental health clinical care, research, and education. It is one of the nation’s foremost university-based psychiatric care facilities through its integration with the Department of Psychiatry of the University of Pittsburgh School of Medicine. We are here to help at every stage of your care and recovery.