Depression after childbirth – what can help?

Photo of young woman with postpartum depression

Pregnant women usually look forward to the days and weeks after the birth of their child. Many have heard of the "baby blues": sadness and severe mood swings that often occur a few days after birth. If the gloomy mood persists, it could indicate the onset of depression.

Caring for a newborn is a demanding task. Sometimes it is difficult to cope with the changes that the constant care of the baby means for your own life. Adjusting to everyday life and adapting to the new life is exhausting – and can be depressing at times. Along with many positive feelings, mood swings and irritability are completely normal.

This phase usually lasts only a short time and passes by itself as things settle down. However, if the depressed mood becomes a persistent depression , it can put a great strain on the relationship with the child. It is therefore important to take deep sadness and mood swings after birth seriously and get more support. Depression after the birth of a child is also called "postpartum depression" or postpartum depression.

What characterizes postpartum depression? Information about $CMS_IF( ! tt_headline.isEmpty)$$CMS_VALUE(tt_headline.toText(false).convert2)$$CMS_END_IF$

It is hardly different from depression , which can also occur in other phases of life. However, there is one big difference: mothers often feel strong feelings of guilt toward their baby. They worry because they are having a hard time taking care of their baby. They often cannot respond empathetically to the child. Many are afraid to talk to others about their feelings and fear that they do not fit the image of a "good mother". This can cause them to become increasingly isolated. Some women report that they become strangers to themselves.

Some women feel so bad that they are unable to seek the help they need. Then it is good if the doctor, midwife, partner, relatives or friends recognize what is going on and provide more support.

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In postpartum depression, the negative feelings are much stronger than in "normal" baby blues. Typical signs of postpartum depression include:

  • Persistent low mood (deep sadness, frequent crying)
  • Indifference to things that normally bring pleasure
  • Anxiety
  • Sleep disturbances
  • Loss of appetite
  • Concentration disorders
  • Self-doubt
  • Brooding
  • Thoughts of self-harm or of harming the baby

Depression is not said to exist until these symptoms last at least two weeks.

As many as 15 out of 100 women get depression in the first three months after giving birth , about half of them (8 out of 100) get a mild to moderate form. About 7 out of 100 women develop major depression .

Without treatment, postpartum depression usually lasts 4 to 6 months. Some symptoms may persist even after a year has passed. Women who don’t seek treatment are more likely to have chronic depression.

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Normally, postpartum depression is not dangerous. However, it is very stressful for a mother and can also affect the relationship with the child – especially if the mother finds it difficult to respond to her child’s needs.

It is also not uncommon to develop obsessive thoughts. For example, some mothers think about harming their child – but the vast majority would never do it. Nevertheless, the very thought is frightening and may, for example, make them reluctant to bathe the child alone. Then the knowledge that such thoughts are not usually translated into action can provide relief.

However, if depression is severe, there is a risk of remaining depressed for a long time. Rarely, there is an attempt to kill oneself (suicide). While this is the exception, especially during the breastfeeding period, any person who is seriously considering suicide needs urgent medical help.

After childbirth, another serious condition can occur, postpartum psychosis or "postpartum psychosis". This mental illness is rare, occurring in about 1 in 1000 women. However, the risk is higher for women who have already had a manic-depressive illness (bipolar disorder).

People who develop psychosis become delusional. They lose touch with reality and have hallucinations. Some develop delusions of persecution, others stand out due to inappropriate behavior, confused statements or extreme mood changes. If psychosis is suspected, quick psychiatric help is very important.

What can trigger postpartum depression? Information on $CMS_IF( ! tt_headline.isEmpty)$$CMS_VALUE(tt_headline.toText(false).convert2)$$CMS_END_IF$

Becoming a mother can be difficult and demanding at times, both physically and emotionally. Therefore, it is not surprising if some women react to problems and excessive demands with depression after a while.

Women are more likely to develop postpartum depression if they are

  • have ever had anxiety disorders or depression.
  • Stress and stressful experiences during pregnancy and postpartum have.
  • live in unhappy relationships or without a partner, experience domestic violence and generally have little social support.

The influence of hormonal changes as a result of pregnancy is still unclear.

Can postpartum depression be prevented?? Information on $CMS_IF( ! tt_headline.isEmpty)$$CMS_VALUE(tt_headline.toText(false).convert2)$$CMS_END_IF$

Studies show that psychosocial and psychological support can help prevent postpartum depression from developing in the first place. Regular home visits by midwives or specially trained nurses are helpful. Psychotherapeutic treatment can also help prevent mood deterioration. Studies of women who were at increased risk for depression show the following results:

  • At the end of the support programs, an average of 3 to 4 out of 100 participants were diagnosed with depression.
  • In contrast, depression was found in an average of 7 out of 100 women who had not participated in a support program.

In other words, programs have been able to prevent depression in an average of 3 to 4 out of every 100 women. But that also means you can’t always prevent depression. Studies to date also argue for offering support programs not to all women, but specifically to women at higher risk. These are, for example, women who have a history of depression or who have experienced a difficult pregnancy, such as a premature birth.

In Germany, for example, there is a program called "Fruhe Hilfen" ("Early Help") , which supports parents who are particularly stressed after the birth of a child. These include mothers who have little support from others or couples who are very insecure about caring for the baby. "Early help" includes, for example, accompaniment by a family midwife, parenting meetings, or counseling on parenting issues. In addition, it is possible that health insurance companies will pay for home help.

What are the benefits of counseling and psychotherapy?? Information about $CMS_IF( ! tt_headline.isEmpty)$$CMS_VALUE(tt_headline.toText(false).convert2)$$CMS_END_IF$

In the case of mild depression, it may be sufficient to receive more emotional support and practical help in everyday life. It is very important that the support person is non-judgmental and does not criticize. It may help to talk to other women who have had the same experience – for example, among acquaintances or in self-help groups .

However, especially in the case of moderate or severe depression, medical or psychological help is important. Research has found that many women feel at least somewhat better when they have been supported by trained psychotherapists and trained counselors.

Cognitive behavioral therapy (CBT) has also been shown to be helpful . This involves working with a psychotherapist trained in CBT to address the thoughts, beliefs and behaviors that are making your life difficult.

Another treatment method that has been shown to help is interpersonal psychotherapy. It consists of weekly sessions with a psychotherapist who tries to find out what is making it difficult to cope with the changes in life. The goal is to develop an individual strategy that can help in everyday life. Interpersonal psychotherapy, unlike cognitive behavioral therapy, is not covered by public health insurers.

Can medication help? Information on $CMS_IF( ! tt_headline.isEmpty)$$CMS_VALUE(tt_headline.toText(false).convert2)$$CMS_END_IF$

Antidepressants can alleviate depression after childbirth. However, they are usually only considered when symptoms are so severe that social support or psychotherapy alone do not help adequately. The choice of medication may depend on which symptoms are the most important – whether it is fatigue and reduced drive or restlessness and sleep disturbances.

For women taking antidepressants before pregnancy, it is not advisable to abruptly stop the medication if they become pregnant. It is often possible to continue taking the medication at a lower dose, for example. The doctors will advise you on this. It is important that doctors, midwives, and family members know about this if a woman decides to stop taking the medication for the duration of pregnancy and breastfeeding. This way, everyone can pay attention to how she is doing and how she is coping in everyday life.

Whether St. John’s wort can help with postpartum depression has not been well studied. This herbal remedy can relieve mild depression in some people . Whether it also helps during pregnancy and breastfeeding, and what side effects it can have then, has hardly been investigated so far. In addition, interactions with other medications are possible.

The benefit of hormonal agents consisting of estrogen and progestin for the treatment and prevention of postpartum depression is not proven.

Can medication harm the child? Information about $CMS_IF( ! tt_headline.isEmpty)$$CMS_VALUE(tt_headline.toText(false).convert2)$$CMS_END_IF$

Anyone taking antidepressants while breastfeeding should discuss exactly what to look out for with their doctor. Most antidepressants are safe for the baby while breastfeeding. However, treatment is started at the lowest possible dose. Because small amounts of the active ingredient can be passed on to the baby via breast milk, possibly leading to side effects. For example, there have been isolated reports of restlessness or drowsiness in children whose mothers were taking certain antidepressants. These symptoms disappeared after a switch to bottle feeding. It is also possible to decrease the dose or change the medication.

Are there any other treatment options? Information on $CMS_IF( ! tt_headline.isEmpty)$$CMS_VALUE(tt_headline.toText(false).convert2)$$CMS_END_IF$

There are a variety of other treatments and interventions women try for postpartum depression. Sport and exercise can alleviate depressive symptoms. In contrast, consumption of omega-3 fatty acids showed no effect in studies. Other interventions such as massage, acupuncture and light therapy have not been studied well enough to say whether they help or not. Light therapy involves spending a certain amount of time with your eyes open near a special lamp so that its light falls on your retina.

Where women and families can find help? Information on $CMS_IF( ! tt_headline.isEmpty)$$CMS_VALUE(tt_headline.toText(false).convert2)$$CMS_END_IF$

Asking other people for help can be very difficult when you are depressed and ashamed of your feelings. In most cases, however, there are people in the personal environment or professional helpers who do not condemn you but support you in coping with the difficult situation.

If you have symptoms, you should see a doctor. This could be a family practice, but it could also be a gynecology or psychotherapy practice . An initial consultation in a psychotherapy office is possible without a doctor’s referral or application to the health insurance company. Psychotherapeutic consultations are available to advise on problems and to assess whether psychotherapy would be helpful.

Many women who have had postpartum depression once are afraid that they will become depressed again after having another child. It is important for them to prepare well during pregnancy for the first time with the child. With medical guidance and good support from the environment, it is possible to prevent recurrence of postpartum depression.

Craig M, Howard L. Postnatal depression . BMJ Clin Evid 2009: pii: 1407.

Cuijpers P, Brannmark JG, van Straten A. Psychological treatment of postpartum depression: a meta-analysis . J Clin Psychol 2008; 64(1): 103-118.

German Society for Psychiatry and Psychotherapy, Psychosomatics and Neurology (DGPPN). S3 Guideline and National Health Care Guideline (NVL): Unipolar Depression . AWMF registry no.: nvl-005. 03.2017.

Dorsch VM, Rohde A. Postpartum mental health disorders – 2016 update . Gynecology up2date 2016; 10 (4): 355-374.

McDonagh M, Matthews A, Phillipi C, Romm J, Peterson K, Thakurta S et al. Antidepressant treatment of depression during pregnancy and the postpartum period . Evid Rep Technol Assess (Full Rep) 2014; (216): 1-308.

Molyneaux E, Howard LM, McGeown HR, Karia AM, Trevillion K. Antidepressant treatment for postnatal depression . Cochrane Database Syst Rev 2014; (9): CD002018.

Myers ER, Aubuchon-Endsley N, Bastian LA, Gierisch JM, Kemper AR, Swamy GK et al. Efficacy and safety of screening for postpartum depression . 04.2013. (AHRQ Comparative Effectiveness Reviews; Volume 106).

Scottish Intercollegiate Guidelines Network (SIGN). Management of perinatal mood disorders. A national clinical guideline . 03.2012. (SIGN publications; Vol 127).

Sockol LE, Epperson CN, Barber JP. A meta-analysis of treatments for perinatal depression . Clin Psychol Rev 2011; 31(5): 839-849.

IQWiG health information should help to understand the advantages and disadvantages of important treatment options and health care offers.

Whether any of the options we have described are actually useful in a particular case can be clarified in discussion with a health care professional. Health can support, but not replace, talking with doctors and other professionals. We do not offer individual counseling.

Our information is based on the results of high-quality studies. They are written by a team of authors from the fields of medicine, science and editing and reviewed by experts outside IQWiG. How we develop our texts and keep them up to date, we describe in detail in our methods .

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