Postpartum depression

Postpartum depression
Postpartum depression is not the same as the baby blues. What are the symptoms?



Postpartum depression is a disorder that affects many mothers, as well as fathers, following the birth of their babies. The severity of the depression varies according to the nature and intensity of the symptoms. Unlike the baby blues, postpartum depression can last for a long time, especially if not treated as early as possible.

What is postpartum depression?

Postpartum depression is depression that occurs following delivery. Also known as postnatal depression, it can occur at any time in the year following the baby’s birth. Postpartum depression is more severe than the baby blues and requires care.

Postpartum depression affects 15-20% of new mothers. Among them, about 7% will experience significant symptoms of depression in the first three months following delivery, and 19% will experience mild to moderate symptoms.

Studies have demonstrated that postnatal depression rates are generally higher three months following delivery and gradually decrease thereafter. The number of mothers with depression symptoms without postnatal depression peaks in the three to six months following the delivery (about 41%). During the postpartum period, signs of fatigue can be confused with depression symptoms.

Postpartum depression symptoms

The most common postpartum depression symptoms are as follows:

Some parents may not be aware that they are depressed. Others may not want to speak of it due to fear of what their social circle will think of them.
  • Deep sadness for no apparent reason;
  • Unexplainable frequent crying;
  • Prolonged exhaustion or sleeping problems (getting too much or not enough sleep);
  • Excessive low self-esteem or guilt (feeling like a bad parent, difficulty in bonding with their baby);
  • Irritability;
  • Extreme anxiety (especially in regard to the child’s well-being);
  • Inability to properly care for their child or refusal to spend time with them;
  • Lack of pleasure when caring for the child, if the parent is able to do so;
  • Disinterest or lack of pleasure when engaging in previously enjoyed activities;
  • Change in appetite;
  • Feeling things will never get better;
  • Tendency to isolate themselves;
  • Suicidal ideation.

If you are experiencing any of these symptoms or are feeling distressed, consult a physician or psychologist. If you are afraid that you might hurt yourself or your baby, immediately seek medical attention or go to a hospital emergency department.

For immediate assistance, call Info-Social (811) or the LigneParents, a free, confidential 24-hour response service (1-800-361-5085).

What to do if you are worried about your spouse

If you suspect that your partner or a mother in your social circle is suffering from postpartum depression, acknowledge their suffering without minimizing it to avoid making the mother feel even more guilty or incompetent. You should also listen without judgment, encourage the mother to consult a physician, and ask how you can help.

Post-traumatic stress disorder

About 4-6% of women may experience post-traumatic stress disorder following a difficult delivery, and 20% experience some symptoms of post-traumatic stress disorder, causing distress. If negative memories of childbirth are preventing you from working, affecting your relationship with your child, or preventing you from contemplating another pregnancy, it is important to seek professional help. For more information, see our fact sheet When childbirth doesn’t go as planned.

Causes of postpartum depression

Experts agree that there is no single cause for postnatal depression, but rather a combination of factors that can together play a role in triggering and sustaining it.

Postpartum depression may be partly due to physiological causes (e.g., hormonal changes, lack of sleep, exhaustion), but may also be triggered by massive life changes caused by the baby’s arrival. It can also be the result of the mother feeling overwhelmed or even submerged by constraints and a lack of balance between tasks and enjoyable activities.

There is little information to date on postnatal depression in spouses of biological mothers, as this is a recently discovered and unstudied phenomenon.

The arrival of a child, especially the first, means the mother is developing into a new role, which implies a major redefinition of identity. This change often revives childhood memories and provokes reflection on their relationship with their own mother, which can be a source of great inner upheaval. Additionally, the arrival of a child can come with feelings of grief: mourning for life before the child, for the idealized child, and for idealized motherhood.

Moreover, the arrival of a child can induce high expectations, such as reuniting a fragile couple, rebuilding the self-esteem of a vulnerable mother, or meeting an unfulfilled emotional need. In such cases, the child’s arrival can sometimes be a disappointment in the first few weeks and can then lead to significant feelings of depression.

Risk factors

Women who have experienced depression or anxiety in the past or during pregnancy are more likely to develop postpartum depression. Other recognized risk factors:

  • Recent stressful events (e.g., moving, financial stress).
  • Lack of social support.
  • Low self-esteem.
  • Decrease in marital satisfaction.
  • Difficulty breastfeeding.
  • Family member with a history of depression or mood disorder.

Image of parenthood and depression

In our society, becoming a parent is often perceived as having to be a positive experience due to photos posted on social media, among other reasons. However, it is not always so. Such an image of parenting can contribute to feelings of guilt or incompetence, or to a loss of self-esteem in women and men for whom being a parent is not always easy and positive.
Suffering from postpartum depression does not make you a bad parent. Do not hesitate to inform your social circle. Everyone needs help at some point in life.

Postpartum depression in fathers

Père souffrant de dépression post-partum

As with mothers, fathers can also suffer from postpartum depression. However, their symptoms are less apparent than those exhibited by mothers. Additionally, men generally find it more difficult to ask for help.

They may tend to express their distress through anger, impatience, irritation, anxiety symptoms, domestic violence, and substance abuse (e.g. alcohol, drugs) rather than through sadness and crying.

In the first three months following the delivery, about 8% of fathers experience postpartum depression, and this rate increases three to six months after the birth of the child. Thereafter, the proportion of fathers affected decreases.

Causes among fathers

Fathers are more likely to develop depression symptoms if their spouse suffers from depression. They are also more likely to experience postnatal depression if they have one or more of the following risk factors:

  • History of depression.
  • Unplanned pregnancy.
  • Lack of interest in their job.
  • Poor social relationships.
  • Low socio-economic status.
  • Unsatisfactory conjugal relationship.

For many fathers, postnatal depression begins during the pregnancy. In fact, half of fathers who experience depression during pregnancy are still depressed in the two months following the birth. Moreover, recent studies suggest that anxiety disorders are also very common among fathers and often coexist with depression. The proportion of anxiety disorders diagnosed among fathers ranged from 4% to 16% during pregnancy and from 2% to 18% in the postpartum period.

New fathers may also need help during this period and should promptly seek medical help.

Adoptive parents are also at risk!

Parents who adopt a child are also at risk of post-adoption depression, even though there are no birth-related hormonal changes. There are several reasons for post-adoption depression, including the impression that the bond with the child does not happen as the parent imagined, and changes caused by the child’s arrival being greater than the parent anticipated.

What are the possible consequences?

Postpartum depression hinders the parent’s ability to properly care for their child, which reduces the interactions between them. If left untreated, postpartum depression can not only harm the mother or father, but also the development of the attachment bond between the baby and the parent suffering from depression.

This may disrupt the child’s cognitive, social, and emotional development. For example, the child may experience sleep disorders, more episodes of colic, and developmental delays. Emotional difficulties, behavioural disorders, and cognitive impairment may also develop up to adolescence.

The spouse of someone with depression and the other members of their immediate social circle must therefore ensure that they receive the help they need.

Treatment

Mère souffrant de dépression post-partum chez le médecin

Postpartum depression requires immediate medical attention. While support from a spouse, friends, parents, or self-help groups is essential, professional assistance is also required. Without treatment, depression can last for a long time.

Since treatment is most effective when postpartum depression is detected early, the mother or father who believes they might be depressed must talk to a health care professional (e.g., physician, psychologist, nurse clinician). The professional consulted will determine the appropriate treatment based on the extent of any depression symptoms and mental health problems exhibited before the pregnancy.

Some parents may be offered psychotherapy, while others may also need antidepressants for a certain period. This will help the parent with postpartum depression find happiness and experience the full enjoyment of their baby.

Postpartum psychosis

Postpartum psychosis is a rare and very serious disease that develops within days of delivery. It is manifested through confusion, hallucinations, delusions, and aggression. The mother must immediately be taken to hospital, because her safety and that of her child are at stake.

Prevention of postpartum depression

To prevent postpartum depression, it is important to assess the woman’s level of distress during pregnancy. A large proportion of mothers who were diagnosed with postnatal depression already had symptoms of anxiety or depression during the pregnancy. For more information, see our fact sheet on Depression during pregnancy.

It is also important to be aware of the symptoms of postpartum depression, as it helps to quickly recognize the signs, reduce the discomfort associated with perinatal mental disorders, and seek help when necessary. Support from your social circle also helps to prevent postpartum depression.

This preventative work must also be carried out with fathers, as they are often less aware of the symptoms of distress associated with becoming a father. The importance of including fathers in early pregnancy monitoring is also being increasingly recognized.

Fathers are less likely to suffer from postpartum depression when they have good communication with their spouse. Likewise, preparing for the baby’s arrival reduces the risk, as it helps them build confidence and feel less excluded from the mother-baby relationship.

Postpartum depression and COVID-19

According to a Quebec study, women who were pregnant during the COVID-19 pandemic were twice as likely to experience anxiety or depression symptoms severe enough to be diagnosed with major depression or anxiety disorders. As a result, they were more likely to suffer from postpartum depression. For more information, see COVID-19 and pregnancy: more distress for future mothers (in French).

What is the baby blues?

A mother begins to experience the baby blues in the early days following childbirth. Symptoms include irritability, anxiety, vulnerability, and mood swings. This is a natural response explained by physiological changes (significant drop in hormones), increased stress, and a lack of sleep.

How long does the baby blues last?

The baby blues can affect up to 80% of women. It is usually brief, lasting from a few hours to 15 days. In most cases, the symptoms fade on their own without outside intervention.

How can I get over the baby blues?

Here are some ways to help you feel better:

  • Tell your spouse or family members that you are not feeling well and that you need more help to take care of the baby and daily tasks.
  • Take care of yourself: Sleep, take baths (unless you have had a cesarean section), go out to clear your mind, treat yourself.
  • Do activities with your baby: Go for walks outside, practise skin-to-skin contact, etc.

If, after several weeks, you are still feeling unhappy or overwhelmed by events, or if you feel little interest in your baby, you probably do not have baby blues, but rather postpartum depression.

Things to keep in mind

  • More severe than baby blues, postpartum depression requires care, and treatment is more effective when it is detected early.
  • Fathers can also suffer from postpartum depression, but their symptoms are less apparent than those of mothers.
  • If left untreated, postpartum depression can have negative impacts for the child.

 

Naître et grandir

Scientific review: Nicole Reeves, psychologist
Research and copywriting:
The Naître et grandir team
Updated: January 2022

 

Photos: Getty Images/FatCamera, ~UserGI15613517, and pondsaksit

 

Useful links and resources

Note: Hyperlinks to other sites are not updated on a continuous basis. Thus, some links may not work. In such case, use the search tools to find specific information.

  • CANADIAN MENTAL HEALTH ASSOCIATION. Postpartum Depression. 2016. cmha.ca
  • BAUER, Maeva. La dépression périnatale : un trouble sous-estimé. 2021. www.ordrepsy.qc.ca
  • BERTHELOT, Nicolas et al. “Uptrend in distress and psychiatric symptomatology in pregnant women during the coronavirus disease 2019 pandemic,” Acta Obstetricia and Gynecologica Scandinavica, 99 (7), July 2020, pp. 848-855.
  • DORÉ, Nicole and Danielle LE HÉNAFF. From Tiny Tot to Toddler, Practical guide for mothers and fathers. Institut national de santé publique du Québec, Québec. www.inspq.qc.ca
  • EDWARD, Karen-leigh and others. “An Integrative Review of Paternal Depression,” American Journal of Men’s Health, 9 (1), January 2015, pp. 26-34.
  • GAVIN, Norma I. et al. Perinatal Depression: A Systematic Review of Prevalence and Incidence, Obstetrics & Gynecology, 106 (5), part 1, November 2005, pp. 1071-1083.
  • GLANGEAUD-FREUDENTHAL, Nine and Florence GRESSIER. Accueillir les pères en périnatalité. Toulouse, Éditions Érès, coll. La vie de l’enfant, 2017, 312 pp.
  • KENDIG, Susan et al. “Consensus Bundle on Maternal Mental Health: Perinatal Depression and Anxiety,” Obstetrics & Gynecology, 129 (3), March 2017, pp. 422-430.
  • LACHARITÉ, Carl et al. Les besoins du père lors de la période périnatale : état des lieux. 2021. www.ordrepsy.qc.ca
  • THE SOCIETY OF OBSTETRICIANS AND GYNAECOLOGISTS OF CANADA. Mental health and postpartum depression.www.pregnancyinfo.ca
  • LEACH, Liana S. et al. “Prevalence and course of anxiety disorders (and symptom levels) in men across the perinatal period: A systematic review,” Journal of Affective Disorders, 190, January 2016, pp. 675-686.
  • MAYO CLINIC Postpartum depression. 2018. www.mayoclinic.org
  • O’HARA, Michael W. et al. “Perinatal mental illness: Definition, description and aetiology,” Best Practice & Research Clinical Obstetrics and Gynaecology, 28 (1), January 2014, pp. 3-12.
  • PAULSON, James F. and Sharnail D. BAZEMORE. “Prenatal and postpartum depression in fathers and its association with maternal depression: A meta analysis,” The Journal of the American Medical Association, 303 (19), May 2010, pp. 1961-1969.
  • POSTPARTUM DEPRESSION. Postpartum Depression in Adoptive Parents. 2019. www.postpartumdepression.org
  • RAMCHANDANI, Paul G. et al. “The effects of pre- and postnatal depression in fathers: A natural experiment comparing the effects of exposure to depression on offspring,” Journal of Child Psychology and Psychiatry, 49 (10), October 2008, pp. 1069-1078.
  • Canadian Paediatric Society. Caring for Kids. Depression in pregnant women and mothers: How it affects you and your child 2020. https://caringforkids.cps.ca/
  • STEIN, Alan et al. “Effects of perinatal mental disorders on the fetus and child,” The Lancet, 384 (9956), November 2014, pp. 1800-1819.
  • UNDERWOOD, Lisa et al. “Paternal Depression Symptoms During Pregnancy and After Childbirth Among Participants in the Growing Up in New Zealand Study,” JAMA Psychiatry, 74 (4), April 2017, pp. 360-369.
  • VERREAULT, Nancy et al. “Rates and risk factors associated with depressive symptoms during pregnancy and with postpartum onset,” Journal of Psychosomatic Obstetrics & Gynecology, 35 (3), August 2014, pp. 84-91.
  • WILLIAMS, Janet et al. Best practice guidelines for mental health disorders in the perinatal period. Vancouver, BC Mental Health & Substance Use Services et Perinatal Services BC, 2014, 120 pp.

 

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