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Postpartum depression: What to look for and how to cope

Baby blues are common after giving birth, but when they interfere with your daily life, it's time to get help.

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Giving birth should immediately fill you with love and give life a whole new meaning. At least, that's what society will have you believe. But for many new parents (or even the majority of them), the days, weeks or sometimes months that follow childbirth can be clouded by physical exhaustion, hormonal imbalances and extreme adjustments to a new role as caregiver. 

Julianne Zweifel is a clinical psychologist and adjunct professor at UW Health in Madison, Wisconsin who works with people who have postpartum mood dysregulation, which can vary from postpartum "baby blues" to postpartum depression. She says the pressure to feel a certain way after giving birth can lead new parents to feel inadequate when they don't feel what they perceive to be the "right" feelings.

"I like to describe it as [being] analogous to having only seen black-and-white photos all your life, and suddenly [you] see color photos," says Zweifel about new parents' expectations. "Like, 'wow, I didn't even recognize this dimension existed.'" 

With the heapings of hormonal changes and personal adjustments pregnancy and childbirth bring, it's no wonder many people experience sadness or other emotions, referred to as "postpartum blues," following the birth of a baby. But sometimes these emotions can be extremely distressing to the person, last much longer than what's considered normal or interfere with daily life. Below, we speak with Zweifel about how to identify postpartum depression, and when to seek help.

Postpartum blues vs. postpartum depression

Zweifel says as many as 65% to 70% of people will experience postpartum "baby blues," or mood swings that begin roughly within a week of delivery. "Once you start using numbers like that, that means that's the normal response," she says. But baby blues will resolve on its own, usually getting better in about 7 to 10 days. If feelings of classic depression persist without showing signs of getting better after about two weeks, Zweifel says, it's likely postpartum depression. About 1 in 8 people will experience postpartum depression after giving birth, according to the Centers for Disease Control and Prevention.

Symptoms of postpartum depression can be more intense and last longer than baby blues, and can potentially interfere with your ability to care for your baby or handle daily tasks, according to the Mayo Clinic. PPD can manifest differently and may include typical symptoms of depression, such as severe mood swings, feelings of worthlessness and a withdrawal from family and friends, but may also include feelings specific to your role as a parent, including feelings that you're not a good parent or thoughts and fears that you'll harm your child, per the Clinic. 

Zweifel wants to clear up the misconceptions about PPD and the idea that it makes people harm their child. 

"Somehow, our society has assumed that's a part of the scenario, and I feel like that's part of the problem," she says. There is a big difference, she says, between fearing that you'll "lose control" and hurt your child, or having intrusive thoughts of you dropping them, than of actually harming your child. "The intent is different there," Zweifel says. 

Postpartum psychosis is a very rare condition which can result in the afflicted person attempting to harm themselves or their baby. According to the Mayo Clinic, some of the signs of postpartum psychosis include confusion, paranoia, excessive energy and agitation, hallucinations and delusions. 

Read more: 13 suicide and crisis intervention hotlines to call or text when you need help

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Having a baby with colic, frequent and intense crying in a healthy infant, can increase the risk of postpartum depression in new parents, per the Mayo Clinic. 

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Postpartum depression causes

Many factors can contribute to depression after childbirth, including social factors like not having a support system, societal pressure to feel a certain way and the way a person's body reacts to hormonal changes.

Hormones

Estrogen and progesterone levels skyrocket during pregnancy and then very quickly after birth, they start to drop. This huge dip in hormones is what causes many people to experience strong emotions following birth. 

Research suggests that there's not different hormone levels or amounts in people who experience PPD compared to people who don't, Zweifel says. But there might be a difference in how their brain responds to changes in estrogen. Zweifel called the varying chemical effect of estrogen as a "prominent working theory," but it helps explain why oftentimes the people who experience severe mood changes in connection with their menstrual cycle may also be more likely to experience PPD or have more mood-related symptoms during menopause. 

"That subset is experiencing the same changes and same patterns," Zweifel says. "But the receptor sites in their brain, essentially, sort of respond differently. They're extra sensitive."

Outside factors

Zweifel says a lot of people experiencing symptoms of depression who come into her office feel better almost immediately after she dispels myths about what makes someone an inferior parent -- missing the "golden hour" of contact with a newborn for medical reasons, for example, or choosing to formula feed instead of breastfeed. Another record she has to set straight is the idea that all parents have an immediate bond with their infant, and if they don't, it means there's something wrong with them. 

"Bonding with an infant takes time, and our society does a terrible job of being honest with women about this," Zweifel says. She likes to instill the idea of a "fourth trimester," because there's still so much developing happening on the baby's end in the first few weeks of life that makes the parent-child relationship very straining on the parent, often leaving them "starved for validation" because the baby isn't able to acknowledge the parent, or even able to focus their eyes yet. 

In addition to unrealistic expectations of what it means to be a parent, Zweifel says other factors like being the only parent who gets up when the baby cries can exacerbate PPD, or having a child with acid reflux or other medical conditions that require extra care. 

Other risk factors, per the CDC, include being a parent to multiples (twins, triplets or more), being a teen parent, having a family or personal history of depression, having a preterm or complicated birth, experiencing difficulty getting pregnant and other stressful events surrounding pregnancy. 

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Non-carrying parents can also develop postpartum depression.

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PPD is also not a limited experience to the person giving birth. Although the other parent won't be experiencing the hormonal changes that can cause symptoms of depression, similar lifestyle changes, added stress, lack of sleep and societal pressure remain. A 2014 study published in the journal Pediatrics found that depression among new dads increased an average of 68% the first year of their child's life.

In short, parenting is hard, and so many things can tip the scale in the fragile time following a birth. If your mental health is a concern to you, reach out for help. If you're interested in seeking treatment with medicine, Zweifel recommends finding a psychiatrist or another professional who works specifically with people on postpartum mood dysregulation. 

The information contained in this article is for educational and informational purposes only and is not intended as health or medical advice. Always consult a physician or other qualified health provider regarding any questions you may have about a medical condition or health objectives.