Postpartum feelings

• Many women go through emotional changes after giving birth.
• You can take steps to help manage stress.
• Postpartum depression is serious; ask for help.

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About 1 out of every 8 women has postpartum depression after delivery. It is the most common
complication among women who have just had a baby.

Postpartum depression is a serious medical condition. It is not something a woman can
control. It is not a sign of being a bad mother. It poses risks for the woman and her baby.
The most important things to do are:

• Recognize the signs of postpartum depression (see below)
• Reach out and get help because a range of treatments are available

Changes in the woman's hormones after delivery probably cause postpartum depression. Women
who have been depressed before are at increased risk for postpartum depression.

Postpartum depression is not the same as the "postpartum blues," a condition that is more
common and less serious. Postpartum blues usually ends by the tenth day after the baby is
born. For more information, see the article on the postpartum blues.

It's usually best for a team of health care professionals to work with a woman who has
postpartum depression. Team members include the provider who is caring for her, a mental
health professional, and the provider who is taking care of the baby, especially if the
mother is breastfeeding. Together, the team and the woman decide what is best for her and
her baby.

What is postpartum depression?
A woman who has postpartum depression feels sad, "down" or depressed. She also has five or
more of the following symptoms lasting 2 weeks or longer:

• Having little interest in her usual activities or hobbies
• Feeling tired all the time
• Changes in how much or how little she wants to eat
• Gaining or losing weight
• Having trouble sleeping or sleeping too much
• Having trouble concentrating or making decisions
• Thinking about suicide or death

Postpartum depression can begin at any time within the first 3 months after delivery. It can
seriously threaten both the woman and her baby. Since the mother is seriously ill, she may
not be able to care for her baby as she would if she were well. The disease may make it hard
for the mother to breastfeed or bond with her baby. For these reasons, postpartum depression
is a threat to newborns.

If you have any of the symptoms listed above, talk to your health care provider. If
necessary, your provider can refer you to a mental health professional.

IMPORTANT: If you ever think about hurting yourself or your baby, contact your health care
provider immediately.

Treatments
Postpartum depression can be treated in several ways. Support groups may help. Some women go
to therapy or counseling with a mental health professional. This professional may talk with
the woman about the risks and benefits of antidepressant medications.

The most commonly used antidepressants for postpartum depression come from a group of drugs
called selective serotonin reuptake inhibitors (SSRIs). Here are the names of some of those
drugs:

• Zoloft (sertraline)
• Paxil (paroxetine)
• Celexa (citalopram)
• Prozac (fluoxetine)

Like many drugs, antidepressants can have side effects. Women differ in the type and
seriousness of the side effects that they have. Because no drug is proven to be entirely
safe, a woman and her health care team must look at her case and weigh the risks and
benefits of various drugs.

Breastfeeding and antidepressants
Breast milk is the best food for a baby during the first year of life. If a woman is taking
an antidepressant, some of it will get into her breast milk. For this reason, health care
providers give the woman who is breastfeeding the lowest possible dose to relieve her
symptoms. When the mother is breastfeeding, Zoloft (sertraline) is often used. Research has
found that less Zoloft gets into the breast milk than other antidepressants.

St. John's wort and other herbal remedies
St. John's wort is an herb that some people use to treat depression. According to the
National Center for Complementary and Alternative Medicine, some research has shown that St.
John's wort is useful for treating mild to moderate depression. Other studies have shown
that it is does not help one type of major depression. Herbal products, such as St. John's
wort, vary in strength and quality from product to product. We need more research to help
us know whether St. John's wort is useful and safe for treating postpartum depression.

IMPORTANT: Do not take this herb or other herbal remedies without first speaking to your
health provider.

For more information 
Postpartum Support Network: Provides information, online chat rooms and links to local
support groups.

Depression After Delivery: Assists women during and after pregnancy. Provides materials,
phone contacts and information about local support groups.

Maternal and Child Health Library, National Center for Education in Maternal and Child
Health: Provides information and resources about postpartum depression.

PPD Hope Information Center, Family Mental Health Foundation. Provides information and a
help line.

Depression During and After Pregnancy, a resource for women, their families and friends,
provided by the U.S. Department of Health and Human Services.

March 2006 (R 5-07, 5-09)