Postpartum Depression - The Basics

Postpartum depression (PPD) is a depressive disorder associated with pregnancy, childbirth and the postpartum period. According to the leading authority for the definition and diagnosis of mental illness -- the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM for short) -- postpartum depression is not qualitatively different from depression that occurs at other times, except for the timing of when it occurs. In other words, the "official" answer to the question "what is postpartum depression?" is that it is any major or minor depressive episode that occurs within four weeks after childbirth.

PPD is considered a bio-psychosocial phenomenon. This means it is caused by a complex combination of biological, psychological and social/cultural factors all working together. Contrary to much popular belief, then, PPD is not purely biological in origin. PPD is also not the same thing as the postpartum blues or "baby blues".

Many experts view postpartum depression as primarily an issue of coping and adjustment, where PPD exists at one extreme of an entire continuum of adjustment experiences. Within this perspective, the distinction between PPD and "normal" postpartum adjustment experiences often has more to do with the intensity of feelings and the amount of coping going on rather than something one does or does not have.

The main symptoms of PPD include: high levels of anxiety, crying for no apparent reason, immense sadness, insomnia, cognitive impairment, feeling overwhelmed, an inability to care for oneself and/or the baby, a lack of feeling for the baby or others, exaggerated mood swings, feelings of inadequacy, numbness, helplessness, and in some cases, suicidal thoughts.

Like other forms of depression, PPD can be more or less severe in nature. Sometimes, women suffering from postpartum depression -- especially in its milder form -- will get better on their own. More often, women suffering from postpartum depression find themselves getting better with extra help and emotional support, more self-care, and some cognitive "shifting" of their expectations and beliefs. Other times, medication is also needed to properly treat PPD. This is particularly the case when mothers are suffering from more major depression.

The Edinburgh Postpartum Depression Scale is one of the most commonly used screening tools used to help diagnose PPD. However, diagnosing, classifying, and otherwise defining PPD is NOT necessarily a straightforward or clear cut process. There is, in fact, considerable academic debate around many aspects of postpartum depression, including:

* whether PPD is qualitatively unique from other kinds of depression or whether it is similar to depression that occurs at other times

* whether PPD is more biological or social-psychological in origin

* whether PPD only occurs within the first 4-6 weeks postpartum, or whether mothers can get PPD while still pregnant and/or after the initial 4-6 postpartum period

* where the proper "cut-off" point is between PPD and "normal" postpartum adjustment emotions like guilt, anger, fatigue, loss, overwhelm, and anxiety.

More information about postpartum depression as well as the differences between PPD and the postpartum "blues" can be found at the Motherhood Cafe.

Stephanie Knaak, PhD, is the creator of the Motherhood Cafe. Her PhD is in the field of Sociology, specializing in parenting culture. She has published numerous academic articles, has appeared on TV, and has spoken on both national and international platforms as an expert on various motherhood issues, including postpartum adjustment, postpartum depression, and infant feeding.