Differentiating Between Postpartum Depression and Baby Blues
While feelings of sadness and fatigue are common after childbirth, differentiating between baby blues and more serious postpartum depression is critical for delivering adequate care.
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- Postpartum depression is a highly stigmatized form of depression occurring within one year of a live birth. Easily confused with baby blues, postpartum depression can result in postpartum suicide, which accounts for 20% of postpartum deaths, according to an article published in Current Psychiatry Reports. The effects of untreated postpartum depression are severe. Typical outcomes of untreated postpartum are poor mother–child bonding, an increased risk of suicide for either parent, emotional or behavioral problems for the child, and developmental delays. Differentiating between postpartum mood disorders and complications is critical for providing adequate and timely care to patients.
Despite a limited understanding of postpartum depression, research has pointed to genetic and social risk factors. In addition to assessing the patient’s risk, providers may also use screening tools to identify postpartum depression. Once identified, providers can consider which treatment is ideal for the patient depending on the severity of the condition, the patient’s lifestyle, and their medical history.
Postpartum Depression vs Baby Blues
There are multiple different mood changes and mood disorders that occur after childbirth. While many of these conditions may have similar symptoms, key differences allow providers to deliver a differential diagnosis and determine the appropriate care.
According to the Mayo Clinic, postpartum ‘baby blues’ can include mood swings, crying, anxiety, and sleep complications. The Cleveland Clinic estimates that up to 75% of people experience baby blues after delivery.
This condition happens to many individuals within the first few days after labor. For many, these symptoms resolve within a couple of days; however, they can last up to two weeks. Baby blues are a less severe, easily resolvable mood disorder.
However, childbirth can bring about more severe mood disorders, such as postpartum depression and psychosis. In some cases, referred to as peripartum depression, depressive symptoms begin during pregnancy and continue after birth.
It is easy to mistake postpartum depression and baby blues. At first glance, the symptoms are similar; however, there are some key differences. As previously mentioned, symptoms of baby blues are short-lived and last no more than a couple of weeks. The most common symptoms of baby blues are mood swings, anxiety, sadness, feeling overwhelmed, concentration issues, changes in appetite, and sleep complications.
Conversely, postpartum depression can last for an extended time after childbirth. The symptoms of postpartum depression are more severe than baby blues and tend to last exponentially longer. These symptoms include difficulty bonding with the baby, intense irritability, feelings of shame or inadequacy, severe anxiety — often accompanied by panic attacks, thoughts of self-harm or harming the baby, and suicidal thoughts.
Symptoms often begin in the first few weeks after birth; however, some cases start during pregnancy or within the first year of birth. While postpartum depression is typically defined as depression in the first year after delivery, a 2020 study published in Pediatrics notes that 25% of individuals who had postpartum depression were still experiencing depressive symptoms after three years.
Postpartum depression is not exclusive to the parent who delivers the child. It can also occur in the other parent and is characterized by feeling sad, tired, overwhelmed, or anxious. Additional symptoms may include eating and sleeping pattern changes.
Postpartum psychosis, another mood disorder after childbirth, is more severe, developing within the first week after delivery. This condition is rare but can include symptoms such as feeling lost or confused, obsessive thoughts about the baby, hallucinations, delusions, sleep problems, excessive energy, paranoia, and thoughts of self-harm or harming the baby. Roughly 0.1% of individuals will experience postpartum psychosis after childbirth.
Postpartum Depression Causes and Risk Factors
The causes of postpartum depression are not fully understood and may vary from patient to patient. With that in mind, the Mayo Clinic identifies three potential causes of postpartum depression: genetics, physical changes, and emotional changes.
A family history of postpartum depression leads to an increased risk of postpartum depression, suggesting a genetic or hereditary cause for the condition. In addition to genetics, physical changes after birth, including hormonal changes, may affect mood and mental health, contributing to postpartum depression. Finally, emotional changes caused by sleep deprivation, significant lifestyle change, body image issues, and more may contribute to the development of postpartum depression.
A study by the University of Virginia (UVA) School of Medicine, Johns Hopkins University, and Flo Health determined that postpartum depression rates are highest among first-time mothers, young mothers (under 25), and twin mothers.
According to a UVA news release, the study was based on the results of a postnatal survey conducted on the Flo app. Data was collected from 1.1 million individuals globally. Study results indicated that the rate of postpartum depression in women between 18 and 24 was 10%, the highest of all age categories. Roughly 6.9% of women over 39 experienced postpartum depression. Finally, the lowest rate was 6.5% for women between 35 and 39.
Another study in Nature Scientific Reports determined that postpartum depression risks increase without social support. A study examining South Korean women determined that those with low or moderate social support had a 78% higher risk of postpartum depression than those with high social support.
Other factors linked to an increased risk of postpartum depression include the following:
- personal history of depression, bipolar disorder, or postpartum depression
- family history of depression or mood disorders
- stressful events
- having a child with health problems
- breastfeeding complications
- financial problems
- problems with a partner
- an unplanned pregnancy
New Research
Researchers are constantly looking to understand the pathophysiology of postpartum depression. A 2022 study published in Nature Molecular Psychiatry determined that changes in extracellular RNA communication in immune cells may be linked to a higher risk of postpartum depression.
These changes may also alter cell-cleanup abilities. “Deficits in autophagy are thought to cause toxicity that may lead to the changes in the brain and body associated with depression,” said Jennifer L. Payne, MD, director of the Reproductive Psychiatry Research Program at the University of Virginia School of Medicine, in a UVA press release. “We have never fully understood the biological basis for postpartum depression, and this finding gets us closer to an understanding.”
Screening and Treatment
Usually, postpartum depression is diagnosed at a postpartum visit 2–3 weeks after delivery. Providers will conduct a depression screening to diagnose postpartum depression. One of the most common screening tools is the Edinburgh Postnatal Depression Scale.
This screening tool uses ten questions to assess happiness, anxiety, and guilt. Questions are scored on a scale of 0–3. A score of ten or more indicates depression risk, signaling providers to monitor the patient and offer resources.
Baby blues, which resolve within a few weeks, are usually not treated through medicines or therapies by the provider. Despite no standard treatments, the Mayo Clinic recommends lifestyle changes, including getting as much sleep as possible, developing and accepting help from the support system, setting aside time for self-care, avoiding substance use, and following up with a healthcare provider.
For postpartum depression, providers may consider psychotherapy, antidepressants, or other medications.
Psychotherapy
Psychotherapy requires talking to a mental health professional to better cope with feelings and address mental health concerns. The most common type of psychotherapy is cognitive behavioral therapy (CBT), referred to as talk therapy.
Psychotherapy may be done individually or in group settings. The Mayo Clinic is recruiting patients for an observational study on postpartum mental health. Focusing on women over 18 in their first year postpartum, the researchers in this study hope to determine the effects of a facilitated peer support group on mental health.
Antidepressants
Antidepressants may also be a valid option for some patients. Many providers may recommend combining antidepressants with psychotherapy. There may be risks associated with some antidepressants for the child if they are breastfed. However, many good options are available. Common antidepressants for postpartum depression include sertraline, fluoxetine, duloxetine, bupropion, and imipramine.
According to the Cleveland Clinic, “medications can transfer to your baby through your milk. However, the transfer level is generally low, and many antidepressant medications are considered safe.” Because of this, providers are urged to weigh the risks and benefits depending on the patient and the type of antidepressant.
Brexanolone
In 2019, the FDA approved brexanolone for postpartum depression in adult women. The drug works to slow hormonal changes after childbirth that may contribute to postpartum depression.
An article by Johns Hopkins Medicine explains that the medication is a synthetic version of allopregnanolone, a byproduct of progesterone. “When a baby is about to be born, levels of the hormone progesterone are at their height in the mother’s body. As soon as the baby is born, the amount of this hormone falls steeply. Research links this sudden drop in progesterone to postpartum depression since the hormone acts on the brain and helps balance mood,” stated the organization.
The medication is not widely used despite its availability, as it may have serious side effects. When brexanolone is used, it requires an in-patient stay and patient monitoring as the medication is administered intravenously for 60 hours.
Other Treatment Options
Finally, other medicines may be used to treat symptoms associated with postpartum depression, such as anxiety or insomnia. Different ways to manage postpartum depression include regular exercise, eating a balanced diet, setting realistic expectations, arranging self-care time, avoiding isolation, and leaning on a support system.
“Most women with postpartum depression are not diagnosed or treated. Clinicians caring for new mothers can be aware of factors like age, first pregnancy, and twin pregnancies that put women at a higher risk of developing postpartum depression and screen and intervene early,” said Payne in a UVA news release. “Early intervention can prevent the negative outcomes associated with postpartum depression for both mothers and their children.”
