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Postpartum Depression

By: Dr. Lisa Couperthwaite, Clinical Psychologist, BounceBack Ontario Program and Ontario Structured Psychotherapy Program

The following information may be helpful to those struggling with depression and low motivation, and is not a substitute for obtaining professional evaluation or advice. The information below should be used to supplement and not replace the advice of your doctor or another qualified mental health professional. 

The journey of welcoming a new baby often brings significant personal and other life changes for new parents. These changes have the potential to be accompanied by a range and kaleidoscope of different feelings, thoughts, physical sensations, and demands on our time, energy, and other resources. While this can be a predominantly beautiful and happy time for some, others can find it more challenging, and still others, somewhere in between these two extremes. It is common for parents to experience some mood disturbance during the postpartum period (the period following birth), which is usually short-lived. However, some people develop significant and/or lasting symptoms of depression, anxiety, or other potential psychiatric symptoms that may warrant professional help.

Young woman suffering from a severe depression/anxiety (color to

Baby Blues versus Postpartum Depression (PPD)

Many new parents experience what’s commonly referred to as “baby blues” or “postpartum blues”. These “postpartum” or complicated early parenthood feelings are widely transient feelings of sadness, anxiety, frustration, or general overwhelm that occur in all kinds of parents, including biological, non-biological, and adoptive parents. These experiences can quite understandably affect both birthing and non-birthing parents due to sleep deprivation, lifestyle changes, and changes in the environment and new demands. Birthing parents have an added element of rapid hormonal changes following childbirth, typically manifesting emotional impacts such as mood swings, crying spells, anxiety, and difficulty sleeping within the first few days of becoming a new parent. “Baby blues” generally requires no specific medical treatment and tend to subside within a couple of weeks.  Psychotherapeutic support may be in these situations to support adaptive coping and the development of healthy routines if desired. 

It’s crucial to differentiate between “Baby Blues” and a postpartum mental health disorder, such as Postpartum Depression. The former tends to be relatively mild, short-lived, and does not require treatment. The latter is more severe, persistent, distressing and may start to interfere with their ability to function and prompt identification and treatment are important. Other diagnosable mental health conditions are also possible during pregnancy and following birth (generally referred to as the “peripartum period”) related to symptoms of anxiety, obsessions, compulsions, elevated or expansive mood, substance use disorders, and/or psychosis. 

If mental health symptoms persist, are particularly distressing, and/or interfere with daily tasks, it is strongly advised to reach out to a healthcare provider for assessment. Understanding the distinction between “Baby Blues” and a PDD (or another potential peripartum/postpartum diagnosable mental health disorder) is an important step to differentiate between those experiencing understandable difficulties adjusting to their new role as parents and those requiring prompt professional medical evaluation and intervention. Untreated postpartum psychiatric disorders can become chronic, so prompt help is essential. 

It is important to note that signs of PPD are often missed because significant changes in sleeping patterns, interests, thoughts, energy levels, moods, and body weight are often a normal part of new parenthood for birthing parents. Society’s messaging about parenthood is that it should be a happy time, and this can lead to internalized stigma and shame for the parent experiencing PPD or another postpartum/peripartum psychiatric disorder and create barriers to getting much-needed help. 

What Is Postpartum Depression?

Postpartum Depression (PPD) and other postpartum psychiatric diagnoses are the most common complications of childbearing. The term “peripartum” is often used rather than “postpartum” because these difficulties can start during pregnancy and continue after childbirth. Studies indicate that depression and anxiety affect about 1 in 7 birthing parents during the perinatal period. 

Unlike temporary and more mild “baby blues”, PPD can cause significant distress and may interfere with a person’s ability to function in several different important life areas. PDD usually starts within the first month after childbirth. However, it can emerge anytime within the first year after giving birth, sometimes starting with milder symptoms that escalate over time. It can last for weeks to months or longer. In more serious cases, the person may have severe and persistent enough symptoms that reach the threshold for a diagnosable clinical depression (i.e., a diagnosis according to the Diagnostic and Statistical Manual of Mental Disorders, DSM-5-TR, of major depressive disorder, with peripartum onset). 

Each birthing parent is different; however, common symptoms of PPD include persistent feelings of depression and anxiety, feelings of hopelessness, low interest in things one would usually enjoy (including the baby), or difficulties bonding with the baby; increased or decreased appetite or weight; sleep disturbance and persistent low energy (though these can be difficult to gauge for new parents); feeling worthless and/or guilty; concentration changes, which can be worsened by sleep deprivation; and/or difficulty making everyday decisions. Some may even experience recurrent thoughts of death, thoughts of dying by suicide, thoughts that they or their baby may be better off dead, or thoughts that the world is an awful place for their baby and they would be better off not in it. 

There is no single cause of depression and, therefore no single cause of PPD. The biopsychosocial model of depression accepted by most researchers and healthcare providers is that a combination of physical, hormonal, social, psychological, and emotional factors may all play a role in triggering PDD. The factor or factors that cause PPD in one person versus another are likely quite different. Risk factors for PPD include having a personal or family history of depression and a history of PDD with a prior pregnancy. 

It’s essential to seek professional help from a healthcare provider if you suspect you or a loved one is experiencing Postpartum Depression. Early intervention can be instrumental in managing symptoms and improving the quality of life for both the parent and the child.

How Do I Know if I Have Postpartum/Peripartum Mental Health Difficulty, such as PPD?

It is important not to attempt to self-diagnose or diagnose loved ones. Instead, seek help from a healthcare provider if there are any potential concerns that you or a loved one are experiencing emotional or other difficulties that feel distressing, difficult to bear, or are impacting day-to-day functioning. Early identification and intervention are key. If you or someone you know is exhibiting concerning signs and symptoms – anything outside the norm for the affected person, or a worsening in mental health symptoms the person may have had prior to pregnancy – reaching out to a healthcare provider for assessment, support and possible treatment, is crucial. If symptoms are prolonged and left untreated, this can be detrimental to the health of the parent and can also disrupt relationships, undermine the attachment of the child to the parent experiencing psychological difficulties, and potentially affect the child’s long-term development in negative ways. 

Treatment Options

Treatment of PPD is highly individual. It is strongly recommended that individuals seek a professional evaluation from one’s primary care provider. If you or someone you love is affected, it is important to talk about feelings and practice self-compassion.

It is essential to follow the advice of healthcare provider(s), though it is the affected parent’s choice to engage in one treatment or another. The person affected must consent to treatment, and it is important that the parent ask as many questions as needed to understand what treatments are recommended and why, and the risks/benefits of each option, to ensure fully informed consent. One can also seek a second opinion if they are unsatisfied with the treatment options provided; however, it is important to note that prompt treatment is often essential. 

Potential treatment options for PPD that a healthcare provider or other specialists may propose could include one or sometimes a combination of the following:

  • Psychotherapy such as interpersonal and cognitive-behavioural therapy (CBT) 
  • Supportive counseling
  • Increased social support from friends and family and more emotional support from partners
  • Psychotropic medication
  • Massage
  • Hormone therapy
  • Bright light therapy
  • Electro-convulsive therapy (ECT; generally, this is a very last resort recommendation)

Helping a Friend or Loved One

Supporting a friend or loved one experiencing, or who you suspect may be experiencing, PPD or another postpartum mental health difficulty can be a significant help on their path to recovery. Here are some ways you can provide support:

  1. Be Present and Listen: Sometimes, simply being there to listen without judgment can be immensely comforting. Let them share feelings and experiences at their own pace.
  2. Educate Yourself: Learn about the range of mental health difficulties people can experience peripartum/postpartum, potential symptoms, and treatment options to better understand what your loved one is going through.
  3. Encourage Professional Help: Encourage the person to consult with a healthcare or mental health provider. Offer to help with making appointments or accompany them if they wish.
  4. Offer Practical Help: Offering help with household chores, childcare, or running errands can provide significant relief.
  5. Check-In Regularly: Regular check-ins to see how they’re doing can show that you care and are there to support them.
  6. Be Patient: Recovery from peripartum/postpartum mental health difficulties can take time. Show patience and understanding, recognizing that what they are dealing with is challenging.
  7. Maintain a Supportive Environment: Foster a positive, supportive environment by being compassionate, understanding, and optimistic.
  8. Take Care of Yourself: Supporting someone experiencing these sorts of peripartum/postpartum mental health difficulties can be emotionally taxing. Ensure you also have a support system and are taking time for self-care.
  9. Seek Support Groups: Engage in support groups for friends and family of individuals experiencing PPD or another peripartum/postpartum mental health difficulty to share experiences and learn coping strategies.

Your support can play a crucial role in your loved one’s recovery. By showing empathy and understanding and providing practical support, you can make a significant positive impact on  well-being during this sometimes challenging, yet meaningful time.  


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