Postnatal Depression (Postpartum Depression) – Causes & Duration

If you've recently given birth, you've almost certainly heard of the "baby blues" – that state of anxiousness and emotional overwhelm in the first week or two after delivery. If the unease persists, however, and you find yourself increasingly weighed down by negative feelings as the days go by, don't dismiss your emotions in the hope that they'll simply "pass on their own".

Postnatal depression is a genuine condition affecting roughly one in five mothers and one in ten fathers – and one which, if left unaddressed, can persist for months and worsen over time. Here's what you should know about the causes of postpartum depression, how long it lasts and what you can do in such situations.

What is postnatal depression?

Postnatal (or postpartum) depression is a form of depression experienced by people who have recently become parents. It usually begins in the first weeks or months after the baby's birth, but it can emerge at any point up to the child's first birthday. The symptoms vary from person to person and range from mild sadness to a depression that makes any activity impossible.

Unlike the "baby blues" – that anxiousness and fearfulness affecting around three in ten women in the first 7 to 10 days after giving birth – postpartum depression lasts longer than two weeks after delivery and, without treatment, can continue for months. According to the statistics, roughly one in seven to ten mothers who experience the baby blues subsequently develops postnatal depression.

Postnatal (postpartum) depression – causes

No single precise cause of postpartum depression has been established, but there are a number of factors that may contribute to the development of the disorder:

• A history of mental illness or depression
• A lack of support from family or friends
• Difficulties within the relationship
• Psychological or physical trauma, including trauma from childhood
• Recent stressful life events
• Conflicting feelings about the pregnancy
• The birth of a child with special needs or health problems
• Hormonal imbalances, in particular hormonal disturbances in the period after birth, such as the sudden drop in oestrogen and progesterone levels
• Lack of sleep
• Feelings of loneliness and anxiety
• An altered perception of one's own body image

Postnatal depression – risk factors

Although the exact causes are unknown, certain genetic, psychosocial and biological factors have been identified as being linked to a higher risk of postnatal depression.

Biological factors

There are a number of biological factors that occur immediately after birth and can affect a mother's emotional state. One of these is hormonal fluctuation, particularly the fall in oestradiol levels and the rise in serum prolactin concentrations. Such changes increase the risk of developing postnatal depression.

The sudden drop in serum cortisol concentrations, combined with the release of cytokines after birth, also triggers an inflammatory immune response in the body, which can have a negative impact on a new mother's mental health.

Genetic factors

There are several hypotheses suggesting that certain genetic factors also contribute to the development of depression after birth. One holds that depression in the first two months after delivery may be triggered by polymorphism of the serotonin transporter gene. According to studies, the serotonin and oxytocin genes show the closest association with postpartum depression.

Another hypothesis is that susceptibility to postnatal depression arises from the formation of antibodies against the thyroid gland as a result of the body's immune response, as well as from falling endorphin and insulin levels in the blood.

Psychosocial factors

This concerns the environment in which a mother lives after giving birth, and all the social and psychological factors involved. These include a troubled relationship, a lack of help and support from family and/or friends, conflict or domestic violence within the relationship, and the financial challenges that come with being responsible for a child.

Other psychosocial factors that may contribute to the development of postpartum depression include a difficult birth, giving birth following an unwanted pregnancy, or emotional or physical trauma in childhood.

Breastfeeding

Some mothers find breastfeeding uncomfortable or experience it as a psychological burden – particularly if they are following strict and restrictive advice about nutrition while breastfeeding. In such cases, exclusive breastfeeding up to six months, or continuing to breastfeed after introducing solids, may contribute to the development of postnatal depression.

Physical recovery after birth

The period after giving birth is full of challenges. The body is recovering, but the process doesn't happen overnight. Alongside postnatal bleeding, new mothers may have to contend with discomfort in the intimate area or pain following a caesarean section, urinary incontinence, constipation, haemorrhoids or even more serious complications. 

All of this can have a considerable effect on emotional wellbeing. That's why postnatal care is so important, both for a mother's mental health and for helping the body recover as effectively as possible.

From an emotional health perspective, what's needed is rest, patience with your own body and the support of those closest to you. Just as important is a self-care ritual, for which natural, gentle products that support recovery are recommended – such as 100% organic period products and hygiene items made from purely natural ingredients.

Symptoms of postpartum depression

Like any mental health condition, postpartum depression presents differently in every person. The symptoms and their intensity are experienced differently depending on each patient's circumstances. In severe forms, it can lead to a loss of motivation and of the ability to care for oneself and the baby, or even to suicidal thoughts.

Once the depression begins, the most common symptoms include:

• Loss of appetite
• Irritability or anger
• Severe exhaustion
• Negative thoughts
• Difficulty forming an emotional bond with the child
• Frequent bouts of crying
• Difficulty concentrating and making decisions
• Constant worry about the baby's safety and wellbeing
• Feelings of guilt and helplessness

When does postnatal depression occur?

Postpartum depression can begin as early as the first weeks or months after birth. But even if everything seems fine at first, it can appear at any point up to the child's first birthday.

When should you seek professional help for postpartum depression?

Because the disorder often develops gradually, many women don't realise they are suffering from postpartum depression. Sometimes it may resolve on its own. However, it isn't advisable to ignore signs and symptoms on the assumption that "it's nothing, it'll pass", because often it doesn't – even when the relationship is a happy one and the mother has family support.

Every patient experiences her feelings differently in the period after birth, and many women need professional help to get through this phase. Some signs that professional support is needed include:

• The emergence of a tendency to reject the baby
• Sudden mood swings and spontaneous aggression with no identifiable or understandable cause
• The onset of confusion, hallucinations and irrational thoughts
• The emergence of obsessive thoughts relating to the child
• Losing touch with reality

Treating postnatal (postpartum) depression

Depression may seem a frightening diagnosis, but there are professionals with the expertise and knowledge to provide specialist help, so that this phase can be overcome. Treatment for postpartum depression may consist of:

Medication

In severe cases, or where other approaches haven't produced results, a doctor may recommend treatment with antidepressants. These must, however, be taken with care and strictly as directed by a specialist.

Psychotherapy

As a rule, the first recommended treatment for postnatal depression is taking part in a self-help course or in cognitive behavioural therapy sessions. Their advantage is that a breastfed baby isn't affected by any side effects that antidepressants might cause.

Therapy initially runs over 12 to 16 weeks, in order to learn how to manage emotional states; it can then be adjusted according to each patient's progress.

Complications of postnatal depression

Contrary to popular myths, depression isn't a problem that simply disappears of its own accord before long. Unlike the baby blues, postnatal depression can last for years and, without treatment, lead to serious complications:

• Anxiety disorders: this may be generalised anxiety disorder, or social anxiety disorder, panic disorder or PTSD (post-traumatic stress disorder).
• Obsessive-compulsive disorder: in the form of images, thoughts or intrusive impulses that occur repeatedly and compulsively, triggering anxiety and recurring behaviour.
• Postpartum psychosis: this can present as a combination of hallucinations, delusions and bipolar states.

Common questions about postnatal depression

There are many myths about postpartum depression – starting with the idea that the condition doesn't exist at all. They can lead to feelings of guilt and to symptoms being ignored, which can have serious consequences. That's why it's important to be accurately and as fully informed as possible on this subject – particularly if you've recently become a mother or are about to.

Where there are myths, there are also plenty of questions, and we want to make sure no uncertainties remain once you've read this article. So we'll close with clear answers to the most frequently asked questions about postnatal depression.

How can postnatal depression be prevented?

There's no method that guarantees preventing postnatal depression, but there are things you can do for your mental and emotional wellbeing that may reduce your susceptibility to the condition.

One of them is not to ignore the signals your body sends, and to speak to your doctor at the very first symptoms, even if they seem insignificant. Bear in mind that depression worsens gradually and can begin with less intense sensations.

Don't hesitate, either, to ask the people around you for help when you need support and rest. You don't have to face every challenge alone simply because you're a mother – and asking for help doesn't mean you care any less about your baby's wellbeing. You need to look after yourself first in order to be able to look after your child afterwards.

There are also things you can do during pregnancy to help you feel well after the birth – such as maintaining a healthy, active lifestyle and attending antenatal classes.

How long does postnatal depression last?

Postnatal depression can last months or even years, particularly if left untreated. It can appear at any point up to your baby's first birthday, but that doesn't mean you'll be cured as soon as your child turns one. Everyone experiences it differently, and the duration of the depression depends on your own experience, on environmental factors and on the treatment used.

Does postnatal depression only affect mothers?

It isn't only mothers who suffer from postpartum depression. The condition can affect anyone who has recently become a parent – including fathers. According to the statistics, postnatal depression affects one in five mothers and one in ten fathers. Even surrogate or adoptive parents can experience this form of depression.

What's the difference between postpartum depression and the "baby blues"?

The "baby blues" presents as fearfulness or anxiousness in the first 7 to 10 days after birth and disappears within two weeks at most. Postpartum depression can appear at any point during the baby's first year and can last longer than two weeks – even months or years – with the potential for serious complications if no professional help is sought.

Can postpartum depression affect the relationship with the baby?

Yes, the relationship with the baby can suffer if the mother has postpartum depression, for several reasons. Difficulty connecting with the child and forming an emotional bond, a loss of interest in spending time with them, or constant worry about the child are among the symptoms of postpartum depression that have a negative effect on the relationship with the child.

At the same time, depression can impair a mother's ability to care for herself and her baby, which may even pose a risk to the child's health.