Postpartum Depression

What is Postpartum Depression?

Any life transition or major life event (even joyous ones), can make an individual vulnerable to psychiatric symptoms, including depression. This vulnerability is due to several factors including hormonal fluctuations during pregnancy and the postpartum period, increased stress and demands on the individual (there’s a lot to learn when caring for a newborn), changes in sleep (poor sleep can increase one’s risk of depression 10 fold), and others. An individual may be at higher risk of postpartum depression if they have a personal or family history of depression, or mood disorders (such as bipolar disorder) or an anxiety disorder.

Individuals with postpartum depression will typically have a subjective low mood and/or decreased ability to feel positive emotions, in addition to changes in energy, sleep, appetite, self-confidence, focus, and/or motivation. Individuals may suffer from crying spells, feelings of hopelessness, and even suicidal thoughts; postpartum depression is a serious medical illness (albeit a treatable medical illness), that warrants evaluation and treatment by specialist.

The diagnosis of postpartum depression can be made, when a constellation of symptoms consistent with depression are present, for greater than 2 weeks after the birth of a newborn.

What is the Difference Between Postpartum Depression and “Baby Blues?”

It is very common for women to have mild symptoms of depression, following the birth of a baby. Symptoms may include low mood, increased anxiety, difficulty with sleep, poor concentration and others. These symptoms generally start within 2-3 days of childbirth, and last up to 2 weeks. This constellation of symptoms during the 2 week period after childbirth, is frequently referred to as “Baby Blues,” which is considered a largely normal phenomenon.

Unlike “Baby Blues,” if symptoms last more than 2 weeks, are moderate or severe, or if the individual’s ability to care for themself or their child are compromised, a psychiatric evaluation and treatment for postpartum depression is warranted.

How Common is Postpartum Depression?

Approximately 10-15% of women experience depression during the postpartum period.

About half of these women develop symptoms of depression, or a depressive episode, during pregnancy, and half develop symptoms of a depression following childbirth.

What are Risk Factors for Developing Postpartum Depression?

Risk factors for the development of Postpartum Depression include:

• A personal history of depressions prior to pregnancy
• A personal history of depression during the pregnancy
• A family history of depression, postpartum depression or other mood disorders

While research is not as robust, these additional risk factors may increase a mother’s likelihood of developing postpartum depression:

• Perinatal Anxiety or an underlying anxiety disorder
• Stressful life events during or following pregnancy
• Limited social and/or financial support
• Single Marital Status
• Age <25
• History of physical and/or sexual abuse or trauma
• Unintended or unwanted pregnancy
• History of pre-menstrual dysphoric disorder (PMDD)
•  Adverse pregnancy and neonatal outcomes (stillbirth, preterm birth, low birth weight, neonatal death)
• Others

What Symptoms May be Associated with Postpartum Depression?

The following symptoms are common among individuals suffering from postpartum depression, and may be an indication for an individual to reach out for help.

• Depressed mood
• Anhedonia: Difficulty enjoying things that one typically enjoys, or difficulty feeling positive emotions.
• Feelings of hopelessness
• Increased anxiety or feeling overwhelmed
• Irritability, anger or mood swings.
• Decreased confidence and lower self-esteem
• Crying spells
• Difficulty with focus and concentration
• Low energy and motivation
• Changes in appetite, or unexpected fluctuations with weight
• Disturbances with sleep (such as insomnia or broken sleep)
• Suicidal thoughts
  • Call 911 or 988 if you experience suicidal thoughts
• Others

What is Postpartum Psychosis?

Postpartum Psychosis is a medical emergency where individuals experience hallucinations (such as hearing voices) or delusions (fixed, false beliefs, that an individual holds despite evidence to the contrary). Examples could be paranoia that the mother or child are unsafe, that god is speaking directly to the mother or child, that the mother or child must perform a specific mission or task, or others.

Postpartum psychosis is a symptom of severe depression, and can lead to harm (or death) of the mother and/or child.

If you, or someone you know may have postpartum psychosis, seek immediate medical attention, by calling 911 or 988, or going to the nearest emergency room.

What Treatments are Available for Postpartum Depression?

There are various treatments for postpartum depression including:

• Medication Management.
• Psychotherapy
• Behavioral Modification and activation

* Postpartum depression can affect mom’s ability to care for herself and her baby. We believe strongly that if someone is struggling during the postpartum period, having an evaluation with a provider with specialization and/or training in women’s mental health and all of the above treatment modalities is vital. This way a thorough evaluation can be completed, and a discussion of risks and benefits of each treatment modality (or combination of modalities) can occur.

What is Pregnancy Treatment Planning?

Pregnancy treatment planning refers to an evaluation and formulation of a plan, by a mental health professional, for women who are considering pregnancy or are pregnant, to determine their best course of action regarding their current psychiatric medications, or the future prescription of psychiatric medications, to prevent or limit the risk of postpartum depression. Pregnancy treatment planning includes a discussion of possible risks and benefits of psychiatric medications, to both mom and the developing baby.

Dr. Emily Bernstein, the Director of Women’s Mental Health at Rittenhouse Psychiatric Associates, is experienced in offering this service to women considering pregnancy, and women who are currently pregnant.

Click here, for our page on Women’s Mental Health, and additional information about Dr. Emily Bernstein, MD.

Do You Offer Both In-office and Virtual Online Psychiatric Appointments for Postpartum Depression?

Yes, we offer both in-office and virtual online psychiatric appointments for the treatment of postpartum depression, and for pregnancy treatment planning.

Why Choose Rittenhouse Psychiatric Associates for my Pregnancy Treatment Planning and/or Postpartum Depression Treatment?

The providers at Rittenhouse Psychiatric Associates are academically oriented providers, most of whom teach, or have taught, at academic institutions. Our providers are Board Certified Psychiatrists and Psychiatric Nurse Practitioners and we have several licensed and doctoral level therapists and psychologists. We are experienced in working with individuals who struggle with various psychiatric conditions, including Women’s Mental Health and Postpartum Depression.

• A Dedicated Director of Women’s Mental Health, Dr. Emily Bernstein, with a focus on Pregnancy Treatment Planning and Postpartum Depression.
• Board Certified Psychiatrists and Psychiatric Nurse Practitioners
• Licensed Therapists and Doctoral Level Psychologists
• Academically Oriented providers, most of whom teach, or have taught, at local Academic Institutions, such as Johns Hopkins Hospital & The University of Pennsylvania.
• Appointments generally available within 2 weeks.
• In-office and online Virtual Appointments for Pregnancy Treatment Planning and the treatment of Postpartum Depression
• Providers experienced in treating co-occurring psychiatric conditions.
• Providers who are welcoming to all individuals.