January 3, 2017

My Baby Is Here—Why am I not happy?

Postpartum depression is not a figment of our imagination.

Melissa Kidder

My baby was born a week ago, and I thought this was going to be the happiest time of my life—getting to bond with my newborn. Yet I find myself crying for no real reason and doubting whether I can even handle caring for my baby. What’s wrong with me?

This scenario plays out in the lives of new mothers far too often.

Many physical changes occur during pregnancy and after the birth of a baby. Additionally, childbirth can trigger a mix of powerful emotions, including joy and excitement, along with anxiety and fear. Up to 20 percent of women report feelings of sadness, panic, anxiousness, frustration, depression, and hopelessness. Every mother is different and may experience some or all of a wide range of feelings. Everyone feels sad sometimes, but these feelings often pass within a few days.

Approximately 60 to 80 percent of new moms experience “postpartum baby blues.” Symptoms include frequent crying—sometimes for no apparent reason—along with anxiety, mood swings, difficulty sleeping, food cravings, loss of appetite, and even questioning their own ability to care for their baby. These symptoms are somewhat mild and present as early as two to three days following the birth, may last a week or two, and go away on their own. Getting rest, proper nutrition, and having the support of family, friends, and other mothers can help.

On the other hand, some new moms have a more severe, long-lasting group of symptoms referred to as postpartum depression. They experience feelings of sadness, anxiety, guilt, and fatigue that can be extreme and may even interfere with their ability to care for themselves, their newborn, or their family. This occurs in about 10 percent of new mothers, and can present any time during the first few months and up to a year following the birth of a baby.

Some other common symptoms include oversleeping or being unable to sleep even when the baby is asleep; trouble concentrating and making decisions; physical aches and pains such as frequent headaches, muscle pain, and stomach problems; feeling sad, hopeless, or overwhelmed; eating too little or too much; loss of interest in hobbies and activities; trouble bonding or forming an emotional attachment to their newborn; persistently doubting their ability to care for their baby; and even thinking about harming themselves or their baby.

What Causes Postpartum Depression?

Postpartum depression does not occur because of something a mother does or does not do. It can affect any new mom regardless of age, race, ethnicity, or economic status.

Postpartum depression appears to result from a combination of emotional and physical factors. Hormonal changes, such as a sharp decrease in estrogen and progesterone, occur during the hours following childbirth. These changes may trigger depression in a manner similar to smaller hormonal changes that trigger mood swings before menstrual periods.

It is also difficult for new mothers to get the rest they need to recover fully from the birth, which leads to exhaustion, further contributing to these symptoms.

Emotional factors can also play a role. Feelings of doubt about the pregnancy are common. Even when the pregnancy is planned, it may take longer than anticipated to adjust to the idea of having a baby. This can affect a woman’s self-esteem and the ways she deals with stress. Parents of babies who need to stay in the hospital longer than usual may also feel guilty, sad, or angry.

Risk Factors

Some of the risk factors for developing postpartum depression include having a history of depression or bipolar disorder at a previous time in the mother’s life; symptoms of depression during or after a previous pregnancy; or a family history of depression or other mental illness. Other risks include a lack of strong emotional support from a partner, family, or friends; a stressful life event during the pregnancy or shortly after birth, such as the death of a loved one; domestic violence; moving to a new city; or job loss.

The good news is that postpartum depression is temporary and treatable with professional help. If you experience some of these symptoms, call your doctor. Don’t wait for your postpartum checkup or hope it will get better on its own. There is no need to suffer alone.


If your doctor diagnoses you with postpartum depression, treatment can include talk therapy (also known as psychotherapy) with or without medications called antidepressants. Talk therapy may be one-on-one therapy with just you and a therapist, or group therapy, in which you meet with a therapist and other people with similar problems to yours. You may need such therapy for only a few weeks, or in some cases for a few months or longer.

It may be that your doctor feels you would benefit from medication and/or talk therapy. Usually it takes three to four weeks of medication to start feeling better. Antidepressants can cause side effects, but most are temporary and go away after a short time.

If you develop unusual or severe side effects, tell your doctor right away. You would benefit from a different type of medication.

If you take an antidepressant while breastfeeding, it can be transferred to your baby. The levels of the antidepressant in breast milk, however, are usually very low. Both you and your baby benefit from breastfeeding. Your doctor or health-care provider can help you weigh the benefits of breastfeeding against the possible risks of your baby being exposed to the medication.

Family and friends may be the first to recognize symptoms of postpartum depression in a new mother. They can encourage her to talk with her doctor or other health-care provider, offer emotional support, and assist with caring for the baby and other daily tasks at home.

With support, professional help, and appropriate treatment, you too can experience joy with your precious newborn.

Melissa Kidder, M.D., F.A.C.O.G., is an obstetrician and gynecologist at Loma Linda University Medical Center in California, and chair of the Gynecology and Obstetrics Department at LLU’s School of Medicine.