Postpartum depression

Pregnant women usually look forward to the happy days and weeks they will spend with their new child after the birth. However, they may instead feel down and experience mood fluctuations once the baby arrives. In the event of brief “baby blues” that last for just a few days, respite and support can help.

If this low mood persists for more than two weeks, this may indicate the early stages of depression. The depression that a woman may experience after the birth of her baby is known as postpartum depression (PPD) or postnatal depression (PND). It can greatly affect the mother’s own well-being and her behavior toward the child. Prolonged periods of deep sadness and mood swings following childbirth should therefore be taken seriously and support should be obtained.

Postpartum depression displays the typical symptoms of depression, which is an illness that can occur at any stage of life. The main difference is that mothers with postpartum depression often develop strong feelings of guilt towards their baby. They blame themselves for failing to live up to their image of the ideal mother and worry because they find it difficult to care for the new baby.

Many mothers find it difficult to talk about their feelings with others in this situation. Feelings of shame and fear may cause them to feel increasingly isolated. Some women report that they feel like strangers to themselves.

Postpartum depression differs from the “normal” baby blues that almost half of all women who give birth experience after the baby arrives. The baby blues are a dip in mood that occurs after giving birth and normally lasts for a few days but occasionally persists for up to two weeks.

Mood swings, crying, and irritability are very common during this period. In most cases, a mother experiencing baby blues simply needs support and understanding to alleviate these feelings.

The negative feelings experienced with postpartum depression are far stronger than those during temporary baby blues. Typical symptoms of postpartum depression include:

• persistently low mood (deep sadness, crying, feelings of emptiness, hopelessness)
• loss of interest in things that are normally a source of pleasure
• anxiety
• sleep disorders
• loss of appetite
• difficulties concentrating
• self-doubt
• negative thoughts
• thoughts of self-harm or of harming the baby

These signs and feelings only indicate depression if they last for at least two weeks.

Becoming a mother can be difficult and challenging at times, both physically and mentally. It is therefore unsurprising that after a while, some women respond to problems and excessive strain by developing depression.

A number of risk factors are specific to postpartum depression. It is more likely to affect a woman if she:

• has previously had anxiety disorders or depression.
• experienced/experiences stress and stressful life events during her pregnancy and after the birth.
• is in an unhappy relationship or lives alone, suffers domestic violence or generally lacks social support.

The impact of postpartum hormonal changes is still unclear.

Up to 15 in every 100 women suffer from depression in the first three months after giving birth. This depression can be mild for some women and more severe for others.

Without treatment, there is a risk that the depression will become chronic. If left untreated, postpartum depression usually lasts between 4 and 6 months. Some symptoms may persist even after a year has passed.

Treatment should be sought for postpartum depression to prevent the depression from persisting for a long time.

Studies show that professional support can help prevent postpartum depression from occurring in the first place. Regular home visits from midwives or specially trained carers are useful. Psychotherapeutic support can also help to prevent the mood from deteriorating.

In Germany, the “Early Support” (“Frühen Hilfen”) network supports pregnant women and parents who feel under particular strain. These include mothers who receive little support from others or couples who are extremely unsure how to care for their child. The “Early Support” services are free of charge and include things like support from a family midwife or meetings for parents.

As with other forms of depression, postpartum depression is diagnosed through a consultation with a doctor or psychotherapist. 

These perform two steps to determine whether a woman is suffering from postpartum depression: they ask about symptoms that could indicate depression and they try to rule out other medical conditions or problems that cause similar symptoms. Doctors may need to perform physical examinations to do this.

With mild postpartum depression, more emotional support and practical help with daily life may be all that are needed. In such cases, it is very important for the people providing support to show understanding and give the mother courage. It can also help mothers who are affected by postpartum depression to talk to other women who have been through the same thing – for example, by speaking to friends or acquaintances or attending self-help groups.

Especially when treating moderate to severe depression, medical or psychological support is important. The aims of this include increasing the mother’s self-esteem and improving her relationship with the child. In these cases, treatment by a professional psychotherapist or a specially trained adviser is recommended. Studies show that this type of support makes things at least a little easier for many women.

Postpartum depression can also be alleviated by antidepressants. However, these are usually only considered if the symptoms are so severe that the support from friends, relatives or a psychotherapist alone is not able to help sufficiently. Anyone who takes antidepressants during pregnancy or when breastfeeding should specifically consult a doctor about the necessary considerations. Although most antidepressants are not hazardous to the child, they are still prescribed in as low a dose as possible to be on the safe side. This is because small amounts of the active ingredient can be transferred to the baby via the breast milk. 

There are many other treatment forms and measures that women can try if they suffer from postpartum depression. For example, sport and exercise can alleviate the symptoms of depression. This especially includes endurance sports such as cycling, walking or swimming. Regular running can also have a positive effect. Studies indicate that even yoga can help with postpartum depression.

For more information about the treatment of postpartum depression, please visit gesundheitsinformation.de. 

People with depression often find it difficult to ask others for help. In many cases, their closest family members also feel helpless and don’t know who they can turn to. However, there are often professionals or people in the women’s immediate environment who have a great deal of understanding and will help them deal with the difficult situation.

The family practice is often the first point of call, although women can also consult a gynecological or psychotherapeutic practice. An initial consultation in a psychotherapeutic practice can be obtained without a medical referral or applying to a health insurance provider. The psychotherapeutic consultation can be used to obtain advice about problems and determine whether psychotherapy would be helpful.

Pregnancy and family advice centers also offer postpartum support. The Federal Center for Health Education (Bundeszentrale für gesundheitliche Aufklärung – BZgA) can help you find advice centers near you.

The website elternsein.info provides information (in German) about everyday life with a child – including about negative feelings following the birth.

The website of the association “Schatten & Licht e. V.” provides detailed information about birth-related mental disorders and help services.