June 1, 2024, is the deadline to apply for CFR’s Fall 2024 Postgraduate Certificate Program cohort in Marriage & Family Therapy, Sex Therapy, and Clergy track. Apply here.

Understanding Post-Partum Depression

July 30, 2019

Dr. Jane Summers is the Medical Director at Council for Relationships, and founding Director of Women’s Psychological Health Services. Having specialized in women’s behavioral health throughout her career, Dr. Summers’ approach prioritizes understanding the unique issues that effect the emotional health of women such as reproductive health and hormonal changes over the lifespan and challenges created by family and societal roles.

“I can’t be depressed–I wanted to have this baby, I should be happy.”

“I’m probably just tired.”

“Maybe it’s my hormones making me feel bad–that’s normal.”

Having a baby is understandably a time of anticipated excitement and joy. So it is no wonder that for many women who experience feelings of despair, overwhelming fatigue, irritability and emotional withdrawal from others, the contrast between their expectations and the reality of how they feel is so confusing and so great.

In fact, many of these same women may not recognize and understand that rather than reflecting inadequacy or ambivalence as new mothers, they are experiencing the symptoms of post-partum depression, or PPD. These painful and debilitating symptoms of depression affect anywhere from 12-20% women of post-partum. PPD can occur regardless of how much the pregnancy and baby are planned and longed for.

Perhaps it is not surprising that many women who are experiencing post-partum depression may not seek help from their health care providers. In addition to the sense of immobilization and helplessness that is so often a central feature of depression, the accompanying symptom of harsh self-criticism may be especially pronounced when the post-partum mother is feeling anything but the pleasure and devotion in caring for her newborn that she expected to have. Women are not immune to their own, their family’s, and society’s expectations of what new motherhood is “supposed to feel like”. The myth is that all women are unconditionally happy with the birth of a baby and the months that follow. Women may question themselves and feel ashamed or undeserving if they do not meet this expectation. Instead of reaching out for help, acknowledging the difficulties they are experiencing, they try may try to mask their symptoms or pretend to themselves and others that they are ok. They wrongly assume that their lack of pure joy is a reflection of themselves as the mothers they will be and assume that their own unwarranted negative self-assessment will be mirrored in those in whom they confide.

In order to increase opportunities for identification and appropriate care in the face of post-partum depression symptoms, it is important that soon-to-be and new mothers as well as all of those involved in their care should be aware of what it is that they may be experiencing or may be observed by others. All women experiencing PPD deserve support and warrant treatment.


What is Post-Partum Depression, or PPD?

PPD can be similar to other episodes of Major Depression that occur unrelated to childbirth.  Symptoms may include: depressed mood, changes in the ability to sleep, changes in appetite and eating, low energy, decreased motivation, difficulty enjoying activities that would usually bring pleasure, feelings of guilt, social withdrawal, irritability, helplessness, hopelessness, suicidal thoughts. In the postpartum period, it is important to recognize that sleep changes, weight changes, energy changes need to be assessed in the context of disruptions that are often part of normal recovery from delivery and caring for a newborn infant.

Symptoms that can be more predominant in PPD than other Major Depressive episodes include feeling extremely anxious, sometimes without perceived depressed mood; having intrusive thoughts, frequently about harming the baby; excessive worrying about the health and safety of the baby; fantasies of fleeing home and parental responsibility.  While women who have intrusive thoughts rarely have a desire or an impulse to act on them, the unwanted nature of the thoughts as well as the content can be very upsetting. Unaware that the thoughts are symptoms of anxiety and PPD, women who have them are often ashamed, mistakenly thinking that the thoughts actually reflect who they are as mothers. This understandable but unwarranted shame can prevent new mothers from confiding in partners the symptoms they are experiencing and can prevent them from seeking help.


What causes PPD?

PPD is thought to be caused by the huge hormonal shifts that normally occur at the end of pregnancy and after delivery. Just as some women are more biologically vulnerable to the hormonal shifts that occur premenstrually, some women are more vulnerable to these late pregnancy/postpartum shifts.

Sleep deprivation is another biological upheaval that can cause vulnerability to depression. New babies are awake and needing to be fed and changed throughout the day and night making it difficult to get adequate sleep without a lot of support and help. This sleep deprivation can be cumulative and effects mood

Especially for first time parents, the assumption of a new identity and so many new tasks associated with having a baby is stressful. While self-doubt may be a universal component of being a new parent, in combination with other factors may contribute to and dramatically exacerbate PPD.


How is PPD treated?

PPD is very treatable. The first step is being evaluated by a clinician with expertise in this area. Involving partners and other sources of support in the assessment process can help in achieving a diagnosis and identifying practical approaches to appropriate care and help at home.  Sometimes this involves steps to ensure the opportunity for the new mother to sleep, help with household chores and care of older children. Psychotherapy supports the mother in differentiating thoughts and feelings she is having as symptoms of an illness rather than realistic assessment of herself as well as helping her with the task of gradually developing her identity as a mother ( especially if this is her first child).

Medication is recommended for many women with PPD. This form of treatment is extremely well studied for efficacy in treating this depression as well as for safety in breast feeding.

PPD is very treatable. As women recovery from this depressive episode, they are able to see themselves realistically, continue developing their maternal knowledge, skills and identity, and increasingly enjoy their children and family relationships.


A postpartum woman or family member can be in touch with her obstetrician or midwife or directly with CFR or other specialized therapists/psychiatrists. Learn more about Women’s Psychological Health Services