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Sexual & Reproductive Health

Postpartum Mood Disorders: What New Moms Need to Know

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Bringing a baby home is supposed to be one of the most joyful times in a woman’s life, but for many, the experience isn’t always so rosy.

In fact, most new moms will get the baby blues, where hormonal changes cause anxiety, crying and restlessness that goes away within the first two weeks after giving birth. Also called postpartum blues, the baby blues are actually a mild — and temporary — form of depression that goes away once your hormones level out.

For other women, it’s not just about a mild case of the blues. As many as one in five new moms have their time with a new baby marked by postpartum depression, a more serious but highly treatable condition. 

Lauren Osborne, M.D., assistant director of the Johns Hopkins Women’s Mood Disorders Center, explains what women need to know about baby blues, postpartum depression and postpartum psychosis.

Baby Blues or Postpartum Depression?

Almost every new mother — up to 85 percent of them — will experience the postpartum blues. You may feel happy one minute and overwhelmed and crying the next. 

“No mother is happy all the time,” says Osborne. “It’s normal to be frustrated and even need to put the baby down sometimes.”

If symptoms are severe or last for more than two weeks, a new mom should be concerned about a postpartum mood disorder, such as postpartum depression. Women who had anxiety or depression before giving birth are at higher risk. The signs and symptoms of postpartum depression include:

  • Anxiety
  • Sadness
  • Anger and irritability
  • Difficulty sleeping
  • Intrusive thoughts (which may include thoughts of harming the baby)

“People tend to think of depression as sadness, but that’s not always the case,” Osborne says. “Particularly in the postpartum period, there’s a lot of anxiety and irritability, plus lack of sleep, which is a huge risk factor for postpartum depression.” 

And while it’s not necessarily a symptom of depression to be sleeping poorly with a newborn, it can make postpartum depression symptoms worse. 

There’s good news on the research front, however. Researchers at the Johns Hopkins Women’s Mood Disorders Center identified epigenetic biomarkers — differences in the activity of certain genes — that predict who’s most likely at risk for postpartum depression.

Recognizing Postpartum Psychosis

While postpartum depression is relatively common, postpartum psychosis is an extremely rare disorder, affecting just 0.1 percent of new mothers. That number rises to 30 percent in mothers who have bipolar disorder. Symptoms of postpartum psychosis include:

  • Confusion and cognitive impairment that may come and go 
  • Coming in and out of consciousness
  • Extremely disorganized behavior
  • Hallucinations or delusions

It’s important not to ignore these symptoms, even if you have no history of mood disorder. “Postpartum psychosis can occur in women with no previous history of psychiatric illness,” says Osborne.

She stresses that postpartum psychosis is a psychiatric emergency requiring immediate medical attention because it carries a high rate of suicide and harm to the baby.

Treating Postpartum Mood Disorders

Being diagnosed with a postpartum mood disorder can put a cloud over what is supposed to be a happy time. But it doesn’t have to — the most important things to know about postpartum mood disorders are that they are highly treatable and not something a new mother needs to feel ashamed about. Even in the most severe cases of postpartum psychosis, one recent study showed that 98 percent of patients got better with treatment. 

Treatment for postpartum depression includes antidepressant medications, which have good evidence of safety in breast-feeding. The gold-standard treatment for postpartum psychosis includes both lithium (a mood stabilizer) and an antipsychotic medication. With these medications, it is important for a doctor to monitor the baby to ensure that breast-feeding is safe. 

Preventing Postpartum Mood Disorders

Osborne says not enough studies exist that look at preventing postpartum mood disorders, although they are becoming more common. For example, one study showed that mothers who learned soothing and sleep-promoting methods for their babies had lower rates of postpartum depression. Another study showed that taking an antidepressant right away in the postpartum period could help prevent mood episodes in women with a history of postpartum depression. 

Sleep is another key area of postpartum care to help prevent mood disorders. 

“If I see a woman who’s at risk for postpartum depression, I have her come in with her partner so we can make a proactive plan for sleep,” she says. Proper sleep can make the difference in preventing a mood disorder. Getting at least four hours of sleep may mean taking shifts for feeding or having the partner do everything but nursing.

She says the main message she’d like mothers to hear is that women shouldn’t be afraid to seek help. 

“We need to break down the stigma of mental illness, especially for new mothers, because it does respond to treatment,” she says.

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