How to identify and treat delayed postpartum depression

If you’re a new parent, the chances are, your friends and family will have prepared you for the flip side of parenting a newborn: shifting hormones, disrupted sleep, and mountains of diaper changes. But it can be hard to relate to what they really mean until you’re settling in with your new baby at home. After all, having a baby is a huge life change.

These first weeks after you’ve given birth are called the postpartum period. There’s currently some discussion about how long the postpartum period should be defined. It’s often considered to be the first six to eight weeks after you’ve given birth. However, pregnancy and birth can impact everyone’s bodies differently. This is why the American College of Obstetricians and Gynecologists considers the postpartum period to extend up to 12 weeks after birth. You might have heard this time referred to as the fourth trimester.

You’ll have a number of postnatal appointments during this time. One thing your health care provider may speak to you and your loved ones about is looking out for symptoms of postpartum depression (PPD) to keep your mental health in check.

However, many new moms and dads (yep, it can affect men too) may not realize that a significant mood dip can hit later down the line, too. Fast-forward a few months, and it can be easy to mistake late-onset PPD for everyday life stress. Sadly, this can mean we’re less likely to ask for support. 

If your symptoms include crying spells, mood swings, anxiety, guilt, or sadness up to one year after giving birth, then these symptoms match those of delayed postpartum depression, and you should get help.

Adjusting to your new role as a parent can take time. But if you’re struggling, you don’t have to suffer in silence. Support is available, and there are lots of small steps you can take to feel better, so don’t be afraid to ask for help. 

Here, psychologist Kelly Vincent, PsyD, Nourished Wellness Group, California, US, shares everything you need to know about delayed postpartum depression, including symptoms, causes, and how to get better.

Key takeaways

• Postpartum depression is a serious mood disorder that affects 1 in 7 new parents (women and men).
• It can develop during pregnancy, in the newborn stage, or up to one year after you give birth (this is known as delayed postpartum depression).
• Treatment often involves a combination of medication and talking therapy, but simple lifestyle changes can help, too.
• Although postpartum depression symptoms can last several months, this is a very treatable condition, and most people go on to make a full recovery.
• If you have thoughts about harming yourself or your baby, call 911 or your local emergency assistance number right away. You are not alone, and help is available.

What is postpartum depression?

If you feel sad or hopeless, and you’re struggling to eat, sleep, or generally cope with your new responsibilities as a parent, then you may be experiencing postpartum depression. 

Not to be confused with the “baby blues” — a short-lived mood dip that many new moms experience in the two-week postpartum recovery window — postpartum depression is a more serious mental health condition. It can affect your ability to care for yourself and your baby, so it’s important that you get help.

“Postpartum depression is a type of mood disorder that affects women after childbirth,” explains Vincent. “It is often characterized by feelings of extreme sadness, anxiety, and exhaustion that can make it difficult for new mothers to complete daily care activities for themselves and their babies.” 

And it’s not just moms who are at risk. “Fathers and co-parents can definitely experience postpartum depression, although it’s less commonly discussed and recognized compared to maternal postpartum depression,” says Vincent. 

“Symptoms of paternal postpartum depression may be similar to those experienced by mothers and can include feelings of sadness, anxiety, irritability, fatigue, changes in appetite, sleep disturbances, and difficulty bonding with the baby,” she continues.

What causes postpartum depression?

Experts don’t know the exact cause of postpartum depression. But “research has shown that [it] can be caused by a combination of physical, emotional, and lifestyle factors,” according to Vincent.

Vincent explains that these can include:

• Hormonal changes after childbirth
• Lack of sleep
• Changes in routine
• The stress of caring for a newborn

“Mothers who have a predisposition or a history of depression are at a higher risk of developing postpartum depression,” says Vincent. If you had depression during pregnancy, you may be at a higher risk of developing PPD after you give birth. 

It can be hard to admit that you’re struggling, but remember that depression isn’t your fault. It can happen to anyone, regardless of age, gender, race, culture, or faith. First-time moms also have an increased risk of developing PPD for a number of reasons, none of which are caused by anything you did (or didn’t) do. 

As Vincent explains, caring for a baby can take a while to get used to. “Transitioning into parenthood can be very challenging and overwhelming. It can be very normal to experience these shifts in mood,” she says.

Can postpartum depression be delayed?

Postpartum depression typically develops within the first few weeks after giving birth, but it can start anytime during your child’s first year. “The onset of PPD can be delayed,” says Vincent. “It often depends on the individual and the circumstances. But symptoms can start anytime during pregnancy or up to the first year postpartum, [which] would make sense as the challenges in parenthood change as you move through different stages of the baby’s development.”

When you’re busy with a baby, it’s easy to dismiss your feelings and put yourself last, especially if symptoms start outside of the postpartum period. Postnatal follow-up appointments also tend to taper off at this time, which means health care providers are less likely to spot the signs. That’s why it’s particularly important for you and your loved ones to be aware of delayed PPD. If you do have any symptoms, don’t simply write it off as the stresses and strains of being a parent. Reach out to your health care provider, who can give you the advice and support you deserve.

What if you think you have postpartum depression two years later?

If you have depression symptoms outside of the typical postpartum window, don’t disregard your feelings. “Clinically, we would most likely diagnose major depression disorder or persistent depressive disorder, as the individual would be outside of the first year postpartum,” says Vincent. 

That said, the label doesn’t necessarily matter, notes Vincent. “You often are treating the same thing: a depressed mood. I would factor in the potential impact of motherhood and caring for their child as part of the depression roots.” 

If you experience symptoms of depression at any point in time — whether that’s during the first year after you give birth, two years later, or whenever — reach out to a medical professional. It can take some time to feel like yourself again, so the sooner you get treatment, the quicker you can recover.

What are the symptoms of postpartum depression?

According to Vincent, common symptoms of postpartum depression include:

• Low mood: Persistent sadness or mood swings
• Being tearful: Crying spells for no apparent reason
• Anxiety: Feeling unhappy or guilty
• Feeling flat: Loss of interest in activities you once enjoyed
• Struggling with attachment: Difficulty bonding with your baby
• Loss of appetite: Changes in your appetite or eating habits
• Difficulty sleeping or wanting to sleep all the time
• Feeling bad tempered: Irritability or anger
• Brain fog: Difficulty concentrating or making decisions
• Suicidal ideation: Thoughts of harming yourself or the baby. If this happens, then it’s considered a mental health emergency. Go to the emergency room right away. Doctors there will be able to provide help, support, and a treatment plan.

Rarely, a form of mental illness called postpartum psychosis can also develop after childbirth. If your moods become erratic or extreme, or you see or hear things that don’t exist outside of your mind, then get medical help immediately.

Any of these symptoms can feel scary and isolating, but please know that you’re not alone. Your health care provider will talk you through what you’re feeling and may recommend you to a mental health specialist. With the right support and treatment, you can start to feel like yourself again and enjoy this time with your baby.

What to do if you think you have late-onset postpartum depression 

It can be hard to admit that you’re struggling, especially if you’re a new parent. Many women feel an enormous pressure to be the “perfect mom.” But the truth is, there is no such thing as perfect. Juggling family life with work and running a home is a huge undertaking, and lots of parents find it hard. Add delayed postpartum depression into the mix, and taking care of a new baby can be really challenging.

If this sounds familiar, be kind to yourself. Adjusting to your new role as a mom can take time. That said, postpartum depression is a serious mood disorder that is unlikely to get better by itself, so it’s important that you reach out to your doctor. Support is available, and there are lots of steps you can take to feel better, so don’t be afraid to ask for help. 

Speak to someone 

If something is amiss, and you don’t feel like yourself, talk to someone. “​​One hundred percent, reach out for support,” says Vincent. “You deserve [it]. This can be a very common experience in parenthood and especially in the early days of motherhood. Support will allow you to feel seen, heard, validated, and supported.” 

For PPD support around the world, you can find services relevant to you on Flo’s page for helplines. In a crisis situation, make sure to contact your doctor or local emergency helpline.

Join a support group

If you’re the first new mom in your friend group, or you don’t have a close-knit family, finding a local support group is a great way to meet other moms going through the same thing as you. “Support groups can be an amazing option, as you can see firsthand you are not alone,” says Vincent. “Feeling a sense of connection to others who are experiencing the same thing can be extremely healing.” 

To find a PPD support group in your area or for dedicated PPD information, resources, and support, visit Postpartum Support International. There’s also a dedicated section for Dads with PPD. 

Consider your treatment options

The most effective treatment for postpartum depression involves a combination of medication, talking therapy, and self-help techniques. Everyone responds differently to treatment combinations, so you will need to discuss your options with your doctor, but with the right support, most people make a full recovery.

Therapy 

Your doctor will likely refer you to a mental health professional who has experience treating new moms. Postpartum depression is often treated with cognitive behavioral therapy, a talking therapy that can help you manage your problems by helping to shift the way you think and behave. Your doctor may also suggest solo or group counseling sessions along with mindfulness practices.

Antidepressants 

Your doctor may talk you through the different kinds of antidepressants you may be able to take. Selective serotonin reuptake inhibitors are just one kind. If you’ve decided to breastfeed, this could be a good option for you, as many types of antidepressants are compatible with breastfeeding. Talk to your doctor about the risks and benefits of different options. 

Self-care

Finding ways to take care of yourself, such as sharing your feelings with family and friends, getting enough sleep, exercising regularly, eating nutritious food, and taking time to enjoy your hobbies, can all make a huge difference to your mental health. Even small acts of self-care can have a big impact, so figure out what makes you feel good and try to make time for yourself.

In case you’ve been affected by anything in this piece or are struggling with your mental health and would like to speak to someone, Flo has gathered links to support services that might be helpful. Please visit this page for helplines in different countries.

For PPD support around the world, you can find services relevant to you on Flo’s page for helplines. In a crisis situation, make sure to contact your doctor or local emergency helpline.