What is Postpartum Blues?
Mental health issues that aren’t classified as psychotic are among the most common health problems during pregnancy and the period after childbirth. These issues can include depression (often known as postpartum blues or postpartum depression), anxiety, post-traumatic stress disorder (PTSD), and personality disorders. The term “postpartum blues” refers to a low mood and mild depression symptoms that come and go quickly.
The symptoms of postpartum blues can include feeling sad, crying a lot, exhaustion, irritation, anxiety, not getting enough sleep, difficulty focusing, and mood swings. These symptoms usually start to appear two to three days after childbirth, get worse over the next few days, but then generally go away on their own within two weeks of starting.
What Causes Postpartum Blues?
There are a number of things that can increase the chances of experiencing postpartum blues after giving birth, such as having mood changes during your monthly periods or pregnancy, a history of major depression or ongoing mild depression (dysthymia), having been pregnant multiple times, or having family members who have experienced postpartum depression.
Interestingly, things like economic status, ethnicity or race, whether the pregnancy was planned or unplanned or achieved naturally or through IVF, the type of delivery (vaginal or cesarean), family history of mood disorders, or a history of postpartum depression don’t seem to increase your chances of experiencing postpartum blues.
We’re not exactly sure what causes postpartum blues, but hormone changes have long been thought to play a role, as typically, there is a significant drop in hormones such as estradiol, progesterone, and prolactin after giving birth. Similar mood changes have been noticed during different parts of the menstrual cycle, like in premenstrual dysphoric disorder which is a severe form of premenstrual syndrome.
In one study, the three factors that most often appeared in women who developed postpartum blues were high levels of depression during pregnancy, at least one previous instance of diagnosed depression, and a history of depression or other mood changes related to their menstrual cycle.
Other studies have suggested that increased levels of an enzyme called monoamine oxidase or decreased serotonin activity in the period immediately after giving birth could also increase a woman’s chances of experiencing postpartum blues.
Risk Factors and Frequency for Postpartum Blues
Postpartum blues, a condition that often occurs in women within the first few weeks after giving birth, is extremely common. It’s estimated that around 50% of women or more may experience this. If a woman has postpartum blues, she is around 4 to 11 times more likely to also experience major depression during the postpartum period.
Signs and Symptoms of Postpartum Blues
Similar to all mental health diagnoses, the main method to diagnose a condition is through an interview. If a woman shows up right after giving birth or within two weeks of childbirth, and she’s feeling down or showing signs of depression but these don’t meet the standards for major depression, she may be diagnosed with postpartum blues. However, if her symptoms match the requirements for major depression or if her mood issues last for more than two weeks after childbirth, then it is unlikely that she has postpartum blues.
Testing for Postpartum Blues
If a new mom is experiencing symptoms like crying, feeling low (dysphoric affect), irritability, anxiety, trouble sleeping, and changes in eating habits, she might be experiencing what’s known as “postpartum blues”. These signs usually start two to three days after giving birth and should go away within two weeks. However, these symptoms should not be as extreme as those seen in major depression or postpartum depression.
If these symptoms carry on for more than two weeks, however, it could indicate postpartum depression. To check for this, doctors might use a screening tool called the Edinburgh Postpartum Depression Scale. It’s a test that’s been shown to work well across different groups of people and can track changes in depression over time.
In the latest version of the Diagnostic and Statistical Manual of Mental Disorders, a guide used by doctors to diagnose mental health conditions, postpartum depression has been renamed “depressive disorder with peripartum onset.” In some rare cases, the depressive symptoms might come along with psychotic features. This used to have its own classification called “postpartum psychosis” but has now been integrated into the same diagnosis, but differentiated with the term “with psychotic features” if these are present.
On the other hand, postpartum blues doesn’t get its own separate diagnosis in this manual. Instead, it is referred to as either “adjustment disorder with depressed mood” or “depressive disorder not otherwise specified.” However, for purposes of coding the diagnosis, it’s recognized in the ICD-10 diagnostic manual as “postpartum depression, not otherwise specified.”
Treatment Options for Postpartum Blues
Mood disorders after giving birth can vary in severity. At the lighter end of the spectrum is the “postpartum blues,” which is usually mild and temporary, whereby women might feel a bit down or sad but recover on their own. All that’s typically needed during this time is understanding, reassurance, education about the condition, and emotional support.
However, it’s important for healthcare providers to monitor women diagnosed with postpartum blues closely. They need to check whether the symptoms meet the criteria for a more serious condition called postpartum depression. This check includes making sure that the symptoms don’t fit the description of a depressive episode when they first show up and that they don’t last for more than two weeks. If a woman is diagnosed with postpartum depression, the healthcare provider will likely recommend treatments like psychotherapy (a type of therapy involving talking about feelings and thoughts with a professional) and antidepressants (medications that can help reduce symptoms of depression).
Furthermore, if the postpartum depression comes with psychotic features (which can include things like losing touch with reality or having strange beliefs), antipsychotic medications might also be necessary.
Even though symptoms of postpartum blues are typically mild and temporary, it’s still important to monitor women for severe symptoms like thoughts of suicide, excessive suspicion, or thoughts of hurting the baby. It’s also beneficial to arrange for help at home so that women can get enough sleep. If sleeping problems continue, cognitive therapy (which helps individuals identify and change thought patterns that lead to harmful behaviors or emotions) and/or medications may be recommended.
What else can Postpartum Blues be?
Changes in sleeping patterns, energy levels, and mood can often happen during and after pregnancy. These changes, also known as the postpartum period, can be differentiated from the so-called ‘baby blues’ by assessing whether the changes in mood and activity are normal or whether they are causing significant distress or impairment in the woman’s life.
‘Baby blues’ needs to be distinguished from postpartum depression or, according to the new edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), a depressive disorder with a peripartum onset. In this case, symptoms must meet certain criteria for a depressive episode and these mood disturbances must continue for over two weeks. The DSM-5 lays out the criteria for depressive disorders, which includes:
- Feeling Depressed
- Lack of Interest in Activities (Anhedonia)
- Changes in Weight or Appetite
- Trouble Sleeping (Insomnia) or Sleeping Too Much
- Physical Agitation or Slowness
- Feeling Tired or a Loss of Energy
- Feelings of Worthlessness or Undue Guilt
- Difficulty Concentrating
- Thoughts about Death or Suicide
The same rules apply in diagnosing depressive disorder with a peripartum onset, but with the added criteria that these symptoms occur during pregnancy or within a month after giving birth.
What to expect with Postpartum Blues
Postpartum blues refer to mood shifts that are usually light, brief, and go away on their own. Even so, a diagnosis of postpartum blues can increase the likelihood of developing postpartum depression or anxiety disorders after childbirth. According to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5), a reference book for mental health professionals, the chances of developing postpartum depression gets higher in those who displayed mood or anxiety symptoms during pregnancy.
Possible Complications When Diagnosed with Postpartum Blues
: People diagnosed with postpartum blues, feelings of sadness and mood swings following childbirth, are at a higher risk for developing serious conditions like postpartum depression or postpartum psychosis. In fact, a study in Africa highlighted that women identified as having postpartum blues five days after delivery were twelve times more likely to develop postpartum depression a month later and ten times more likely to be diagnosed with postpartum depression two months after delivery.
Postpartum depression shares its features with another condition known as major depressive disorder. However, women suffering from postpartum depression often experience higher levels of anxiety and have a greater chance of developing bipolar disorder in the future, compared to women with major depressive disorder triggered by events other than childbirth.
According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), psychotic symptoms occur in about 0.1% to 0.2% of women after childbirth. The risk is higher in women having their first child, individuals with a previous history of depressive or bipolar disorders, and those with family history of bipolar disorder. Moreover, after an individual has one depression episode with psychotic features after childbirth, the risk of it recurring in subsequent pregnancies is 30% to 50%.
Common Risk Factors:
- Being diagnosed with postpartum blues
- Having the first child
- Personal history of depressive or bipolar disorders
- Family history of bipolar disorder
- Being a woman
Preventing Postpartum Blues
In terms of preventing mental health issues after the birth of a child, also known as ‘postpartum blues’, it can be a bit tricky. The things that usually put you more at risk of getting postpartum blues include the number of children you’ve had, how your child was delivered, whether you’ve had a history of depression or bipolar disorder, or changes in your mood related to menstrual cycles. Unfortunately, these factors can’t be changed or modified.
However, don’t worry! The most important step towards managing postpartum blues is recognizing the symptoms early on. Quick action, open conversations with the individuals affected and their families, and access to mental health resources and professionals are vital. Screening processes are also necessary to spot any ideas of self-harm or harm to the infant, unrealistic or suspicious beliefs, or symptoms of psychosis, which is a severe mental disorder where thought and emotions are impaired.
If any symptoms start to appear and are identified, it’s critical to make sure the new mom has the support she needs, and resources are readily available for her to access. This robust network of support can be instrumental in managing and mitigating the effects of postpartum blues.
