What Are the Causes of Postpartum Depression?

An estimated 10 percent to 15 percent of women who give birth in the United States will experience postpartum depression. Postpartum depression is a mental disorder that goes beyond the even more common "baby blues," (80 percent of women experience baby blues). Understanding the causes may help mothers cope and seek treatment.

Identification

• Baby blues: a common term for the common experience of symptoms including mood swings, sadness, fatigue, irritability and difficulty concentrating following childbirth, but lasting only up to two weeks.

  Postpartum depression: a form of depression that follows childbirth. Symptoms can be the same as the symptoms of baby blues; but when they last longer than two weeks, are severe or accompanied by suicidal thoughts, they may indicate postpartum depression.

Diagnosis

• The Diagnostic and Statistical Manual, Fourth Edition defines it as a condition that begins within four weeks of birth, persists a majority of the time for two weeks or more, with at least five of the following symptoms: low or depressed mood, lack of interest or pleasure in previously enjoyable activities, anxiety, sleep disturbances, appetite disturbances, fatigue, physical agitation, low energy, feelings of worthlessness, excessive guilt, trouble concentrating or decision making, suicidal thoughts or thoughts of death.

Theories

• The causes of postpartum depression are not fully understood and subject to debate; but two theories dominate scientific research: the medical or biological model, and the stress and coping model.

Medical Model

• Following birth, estrogen and progesterone levels drop dramatically. It is possible these hormones play a direct role in areas of the brain related to depression; they also may affect neurotransmittors related to depression. Levels of thyroid hormones also drop after birth, and this can cause depressive symptoms. An imbalance of neurotransmittors independent of hormone levels may also be a cause.

Stress and Coping Model

• Physical stressors (e.g., lack of sleep, fatigue and pain from delivery, changes in metabolism and blood pressure), emotional stressors (e.g., feeling unattractive, overwhelmed by unrealistic expectations, a loss of identity), and lifestyle changes (disruption of routine, financial concerns, lack of free time) can create physiological changes that lead to depression.

Considerations

• One theory of causality that attracts less attention maintains that the symptoms of postpartum depression are not a mental illness, but rather a natural reaction of grief over a loss of identity and life before the new birth. Still, whatever the cause, postpartum depression should be considered a potentially serious condition that warrants medical treatment from mental health professionals; effective treatments exist.

  Articles in popular media may be misleading, inaccurate or incomplete when compared to the current state of scientific understanding of postpartum depression. This article, for example, which is necessarily brief, does not provide complete detail.

Misconceptions

• In addition to distinguishing from baby blues, a distinction should be made between postpartum depression, which does not result in suicide or infanticide, and postpartum psychosis, which may result in suicide or infanticide. Postpartum psychosis, a very rare disorder affecting an estimated 0.1 percent of women, may resemble a manic episode and involves a break from reality, hallucinations or delusions.