Postpartum Depression

Mar 28, 2023 | Depression, Mental Health

Many women get baby blues after childbirth. Mothers experience crying, mood swings, anxiety, exhaustion, and an overwhelming sense of despair. However, although baby blues is part of the depressive mood post-delivery, it does not represent the entire spectrum of postpartum depression. While many new mothers develop baby blues after delivery, a significant percentage get an acute form of depression after the initial onset. The depressive mood comes with severe symptomology as well. 

Depression moods have been defined as baby blues, postpartum depression, or postpartum psychosis. Collectively these mental conditions are called postpartum disorders. However, the term ‘postpartum disorders’ is not recognized by the previous or current Diagnostic and Statistical Manual of Mental Disorders (DSM)

Nevertheless, the DSM acknowledges the symptoms exhibited by women post-birth in the depressive mood and psychotic states. Notably, DSM acknowledges rapid exaggerated mood swings – from extreme crying to uncontrollable laughing and heightened irritability and temper. Deciphering the ambiguity of defining postpartum depression, symptoms, and its prevalence is vital in raising awareness to prevention and quick access to treatment. 

Postpartum depression is characterized by psychosis when the depressive episode is comorbid with the bipolar spectrum of disorders or schizophrenia. If the mother has a history of postnatal psychosis, even when they are mentally healthy or developed the condition in previous birth(s) there is a high likelihood of getting the psychotic form of the disorder. 

Defining Postpartum Depression

According to the DSM-5 criteria for diagnosis, postpartum depression develops four to five weeks after delivery. The DSM-5 specifier applies to an ongoing or most recent depressive episode, major depressive disorder, bipolar I disorder, and bipolar II disorder. DSM-5 also recognizes that mood disorders can develop during pregnancy or after birth. However, their diagnostic criteria leave out several women who develop depression months after delivery. The condition is still harmful to the mother, especially if there is no treatment.  

Nevertheless, clinical practice and research recognize nonpsychotic postnatal depression that develops four weeks, three months, six months, or one year after delivery. The clinical aspect of diagnosis includes many women who would disregard their symptoms by following the DSM-5 guidelines. 

Causes of Postpartum Depression

Several risk factors increase the chances of developing postpartum depression. 

Psychological Factors

The likelihood of getting postpartum depression increases if the mother has a history of mood and anxiety disorder. The propensity toward the disorder increases if the mother has untreated anxiety or depression during pregnancy. The risk increases after delivery because a history of depression raises susceptibility to hormonal changes. 

Sudden hormonal fluctuations are already a given after pregnancy. The physiological condition affects the mother’s well-being. The changes become strong enough to alter maternal mental health when coupled with the biochemical imbalance of existing or untreated depression. 

Additionally, women with severe premenstrual syndrome (PMS) also have a higher likelihood of becoming depressed after delivery.  PMS occurs because of serotonin dysregulation. Lower serotonin levels contribute to premenstrual depression, sleep, mood, and appetite dysregulation, and fatigue.

Similarly, after delivery, high polymorphism of the serotonin transporter gene occurs, depleting the levels of tryptophan – the amino acid that synthesizes serotonin. Thus, low concentrations of serotonin in the brain trigger and sustain depressive moods. 

Obstetric Factors

Having multiple pregnancies or having many children raises maternal psychological burdens, increasing depression likelihood after delivery. However,  there is conflicting evidence on studies of multiparous women and postpartum depression. Risky pregnancies also heighten the probability of depression post-delivery. The risks include conditions that require emergency cesarean section (CS) deliveries or hospitalization post-delivery.

Pregnancy complications interfere with maternal expectations, in turn affecting their mood after delivery. For instance, women desiring to give birth naturally and forced by medical circumstances to through CS get severely affected after giving birth. 

It is also evident that preparedness during the pregnancy journey reduces the risk of depression after birth. Attending birth classes, lack of complications, using epidural anesthesia, and consistent breastfeeding stabilize maternal mood post-birth. Other birth-related factors that increase the risk of depression include sleeplessness during pregnancy in women with a history of depression and developing postpartum anemia. 

Biological Factors

Postpartum depression is higher in young women than older women. Statistics on depression after delivery are highest for teenage mothers than adult mothers. Adolescent mothers face psychological, physical, and economic challenges in the months leading to birth and post-birth. Pregnancy for adolescent girls is also marred with depression and problematic behavior like conduct disorder and substance abuse. 

Reports show depression rates as high as 56% for teen mothers compared to 10% to 15% for adult mothers. Changes in mood swings caused by their developmental status can also be a contributing factor. However, limited studies are showing a correlation between the adolescent’s childbearing status and depression. Their developmental process also requires assessment to ascertain the impact of pregnancy on their psychological and emotional development. 

Gestational Diabetes

Glucose metabolism during pregnancy also increases the risk of postpartum depression. The most implicated condition is gestational diabetes mellitus (GDM). GDM is characterized by high blood sugar. The physiology of GDM stresses the fetus both during and after birth. Knowing the impact of the condition on the child may bring distress to the mother triggering depression. The probability of getting postpartum depression with GDM is 15% compared to 9% for pregnant women without the condition

Pregnancy Hormones

Hormonal fluctuations post-pregnancy also contributes to postpartum depression. Studies show pregnancy hormones have a vital role in influencing mood. Estrogen (estradiol) in particular has a role in mood regulation. It affects the activity and expression of dopamine, serotonin, adrenaline, and noradrenaline. All these neurotransmitters mediate circuits that regulate mood. Estrogen also activates the expression of serotonin receptors in the brain. 

Additionally, estrogen affects how the amygdala responds. It binds to the beta receptors in the central amygdala to reduce anxiety and regulates your response to fear. In the hypothalamus, estrogen regulates temperature, energy balance, stress, and motivated behavior. 

Fluctuations of this hormone in a woman’s reproductive cycle show deficits in function. For instance, during menopause or in the post-menstrual cycle, as estrogen levels wear off, women experience hot flashes due to temperature imbalance, mood disorder (mood swings), demotivation, and so forth. After birth, estrogen levels also go down, increasing the likelihood of getting mood disorders like depression

Aside from estrogen’s role in the reproduction cycle, it is also essential in thyroid function. It stimulates the growth of the thyroid glands and regulates the protein that binds to the thyroid hormone in the blood.  Excess or insufficient thyroid causes mood disorder. Thus, estrogen concentrations indirectly cause mood abnormalities through the thyroid pathway. 

Social Factors

Social factors are potential external stressors that trigger anxiety and depression during pregnancy. Support during- and post-pregnancy is crucial for a healthy mental state. Having a reliable partner or caregiver(s) keeps the mother at peace. Support means help, accountability, security, and company throughout the pregnancy period.  

Having help also means someone there to monitor your medication, assist in workouts and baby-related preparations. Assistance lessens the burden of carrying the pregnancy. Post-birth, having support means shared responsibility so that the mother can have periods of rest. Taking care of the newborn baby can make mothers neglect their health. Support means someone else is taking care of the mother. Without help, the mother can easily succumb to the pressure and experience repulsion from the increasing responsibilities.  

Other forms of support include shared financial responsibility. The mother is assured of a continued supply of resources in case they are unable to work. There is also emotional support which is vital for the mother and the child. Having someone to help you keep your emotions in check or affirm and validate your feelings is crucial for the mother’s mental health. Intelligence support is vital in getting information concerning the pregnancy, knowing when to act, and what needs to be done throughout the pregnancy journey. 


Nutrition, exercise, and sleep during and after pregnancy affects the mother’s mental state as well. For instance, lack of essential nutrients interferes with the chemical balance in the brain. Supplement your diet with food elements like the B vitamins, which function as co-factors in mental processes. 

Furthermore, B vitamins are required in all energy reactions – most of which occur in the brain. For example, nerve transmission is a process that consumes a lot of energy. Much of this energy comes from metabolic reactions that use B vitamins as co-factors. Other vital elements from the diet include zinc and selenium, which help in the synthesis of neurotransmitters.

Sleep also has a significant role in preventing depression. After birth, the mother can be deprived of sleep as the baby adjusts its sleeping pattern. Sleep affects the mother’s glucose metabolism, inflammatory processes, and quality of life. 

As for exercise, there is plenty of research showing the impact of physical workouts on mood. Exercise activates the reward pathway increasing feelings of pleasure, satisfaction, motivation, and relaxation. The physical activity should be appropriate to the mother’s condition. For instance, you cannot exercise immediately after birth when you have had a CS delivery. The stitches need to heal. 

Get Help

Postpartum depression can morph into a severe form of depression when left untreated. If you are having a difficult time managing the condition, consult a counseling psychologist. A therapist has the expertise and resources to improve your mental health and enable you to nurse your baby and take care of yourself. Do not suffer alone in silence while there is plenty of help available.  

New Dimensions Can Help!

If you are struggling with mental health or substance abuse issues, New Dimensions can help.  To learn more about our treatment programs, visit our website at or call us at 800-685-9796.  You can also visit to find a therapist.