How to Identify and Treat Delayed Postpartum Depression?

What is postpartum depression?

Having a baby is a life-changing event, so it’s no surprise that new mothers experience many emotional changes after giving birth. 

Postpartum depression is defined as an episode of major depression which is associated with childbirth. It has been estimated that PPD affects nearly 15 to 20% of new mothers. However, it’s very likely that the condition is under-diagnosed and under-treated, which means that postpartum depression statistics might not be accurate. But although postpartum depression has become more widely acknowledged in recent years, there are other variants of this condition that you might not know about. 

Delayed postpartum depression, also known as late-onset postpartum depression, can affect women up to 18 months after delivery. It can even appear later than that in some women, depending on the hormonal changes that occur after having a baby.

How long can postpartum depression take to appear?

Although many people might think that postpartum depression only appears right after birth, that’s not always the case. Many cases of PPD do appear shortly after birth, due to the abrupt hormonal changes that take place once you deliver your baby — usually 4 to 6 weeks after birth. But for other women, symptoms of PPD can appear anytime within the first 18 months of their baby’s life.

In these cases, it can be even more difficult to diagnose PPD. New mothers usually have follow-up appointments a few weeks after birth, but after that, many don’t go to the doctor regularly. This lack of medical attention can delay the diagnosis of late-onset PPD.

Physicians believe that delayed postpartum depression is also associated with the decreased support that new mothers experience after the first few weeks of their baby’s life. After their partners have gone back to work, and the support that they received during those first few weeks has diminished, it can be easy to feel overwhelmed and alone.

What are the first symptoms of delayed PPD?

The symptoms of delayed PPD and regular PPD are the same. It’s important to differentiate between PPD and the “baby blues”. The “baby blues” refers to feelings of sadness, worry, fatigue, and self-doubt which plague up to 80% of new mothers soon after birth. However, the “baby blues” only last a few days or weeks at most, and they resolve spontaneously. 

These feelings are nothing more than a manifestation of the new responsibility that mothers take on for their babies, combined with physical fatigue and sleep deprivation. PPD, on the other hand, signals a more severe condition which is caused by an imbalance in brain chemistry.

In postpartum depression, hormones decrease significantly after delivery. Your levels of estrogen and progesterone, which were high during pregnancy, naturally go down once the baby arrives. In addition to the physical and emotional demands of new motherhood, these hormonal changes can affect the chemistry in your brain. 

However, these hormonal changes aren’t the sole cause of PPD. Other factors, such as physical exhaustion, sleep deprivation, feelings of unattractiveness, and having trouble adjusting to a new role in life also play a part in the development of delayed postpartum depression. In most cases, it’s a combination of these environmental and lifestyle factors along with an increased sensitivity to hormonal changes which cause of PPD.

When it comes to delayed postpartum depression, other situations can increase your stress levels. While at first, your newborn baby slept most of the day, now they might be teething or have colics. They also require more care, since they’re learning how to walk and talk, and exhaustion can set in more easily. And while you probably had extra help from friends or relatives during the first few weeks of your baby’s life, it’s very likely that you’re dealing with these new challenges by yourself.

Postpartum depression after pregnancy is similar to any other episode of depression that may occur at another point in your life. Postpartum depression is characterized by a loss of interest and joy in life, or being in a depressed mood nearly every day. While the “baby blues” go away on their own, In 10-14 days  the symptoms of delayed postpartum depression are more severe and last longer. The symptoms of delayed postpartum depression include:

• Loss of interest in usual activities.
• Weight gain or weight loss that isn’t associated with dieting.
• Decreased or increased appetite.
• Unexplained, constant crying.
• Fatigue or loss of energy.
• Feelings of guilt, worthlessness, hopelessness.
• Changes in your sleep pattern (late sleep early awakening)
• Excessive worrying over your baby.
• Suicidal thoughts or attempts.

What are the risk factors?

• Previous history of mental health issues
• Stressful life events before or during your pregnancy
• Having a baby that requires a NICU stay
• Difficult breastfeeding
• Unplanned or unwanted pregnancy
• Traumatic childbirth or C-section
• Previous history of addiction
• Financial instability
• Having a baby with birth defects or other health complications.

Keep in mind that these risk factors don’t automatically mean that you’ll suffer from PPD. Women can develop PPD even if no risk factors are present. Women who do have these risk factors, on the other hand, might never develop PPD, especially if they have a strong support network after birth.

Delayed PPD can also affect men

Delayed postpartum depression can also affect new dads. Even though moms are the ones who go through pregnancy and childbirth, both parents can have difficulty dealing with their new responsibility and changing roles. In fact, it has been estimated that anywhere between 4 to 25% of new fathers can experience symptoms of paternal postpartum depression (PPPD), or male postpartum depression.

The symptoms of paternal postpartum depression can be very similar to those of maternal PPD, but some men externalize their depression in different ways. Doctors agree that men are more likely to engage in behaviors like aggression, hypersexuality, and substance abuse. Parents who have difficulty bonding with their babies have a higher risk of developing PPPD, and they tend to “shut down” rather than express their emotions.

How can delayed PPD be treated?

The best course of action to treat delayed PPD will depend on the severity of your symptoms. But in each case, the first and most important step is to talk to someone about your feelings. If you suspect that what you’re dealing with is more than just the “baby blues”, discuss your feelings with your partner, a trusted friend or family member, or your doctor.

If you’ve ever thought about harming yourself or the baby, please go to the doctor as soon as possible, since this constitutes a medical emergency. Many women delay seeking help due to feelings of shame and guilt, but delayed PPD can be treated and it’s not the patient’s fault. The duration of postpartum depression will largely depend on how soon it is diagnosed and treated.

The most common treatment for delayed PPD includes some sort of psychotherapy. Cognitive behavioral therapy (CBT) and interpersonal psychotherapy (IPT) are two of the most widely used forms of therapy to aid in the recovery of postpartum depression. These forms of therapy aim to help patients understand their emotions, understand themselves and their relationships, and regain control over their emotional state. Support groups can also be helpful, since they will allow you to come into contact with other women with their own postpartum depression stories, which will help with feelings of guilt and loneliness.

If you’re suffering from a more severe case of delayed postpartum depression, your doctor could prescribe antidepressant medications. Antidepressants such as selective serotonin reuptake inhibitors (SSRIs), serotonin norepinephrine reuptake inhibitors (SNRIs), and most tricyclic antidepressants (TCAs) are widely considered to be safe while breastfeeding. In some cases, your baby might be slightly more irritable while you take these medications; please discuss any changes in your child’s behavior with a doctor.

Your doctor will also advise you to develop healthy habits, such as a balanced diet, exercise, getting enough sleep, and seeking support from your partner and loved ones.

There is a certain level of stigma associated with all forms of PPD, but it’s important to understand that untreated postpartum depression could have many negative effects on your mental health and your family’s dynamic. Untreated postpartum depression can cause language delays, increased crying, and behavioral problems for your child. There is also an increased risk of harming yourself or the baby.

Seeking help for postpartum depression quickly can allow you to bond more easily with your baby and form a healthy attachment. Although treatment for postpartum depression won’t be effective immediately, it will have you feeling better in a few weeks, finally able to enjoy your time with your new baby!