Postpartum Depression Signs Every New Parent Should Know | My Growth Counselling

The first weeks with a new baby are full of tiredness, tears and big feelings, which makes postpartum depression signs easy to explain away. A broken night of sleep, a healing body and a house turned upside down would leave anyone feeling low. So how do you know when it has become something more?

I'm Sherriden Brown, a Registered Psychotherapist in Mississauga. I trained as a midwife, and today I work with new parents and couples in the months around a birth. I'm not a physician, so this guide can't diagnose you or anyone you love. What it can do is describe the warning signs clearly, so you know when to bring them to a family doctor, a midwife or another care provider.

In this guide, we'll look at how postpartum depression shows up, how it differs from the baby blues, the symptoms that are easy to miss, who is more likely to experience it, what partners tend to notice first, and when to reach out. If you're reading this because you think you may have postpartum depression, noticing is already a step in the right direction.

What Are the Signs of Postpartum Depression?

Postpartum depression (PPD) can begin during pregnancy or at any point in the first year after a baby arrives. The Office on Women's Health (OWH) describes it as a serious mental health condition in which feelings of sadness or hopelessness don't go away and get in the way of daily life. The signs and symptoms it lists include:

• Sadness, hopelessness or unusual crying
• Anger or moodiness
• Guilt, shame or feeling worthless
• Loss of interest or pleasure in things you used to enjoy
• Withdrawing from friends and family
• Eating or sleeping more or less than usual
• Thoughts of harming the baby or yourself
  
  

The Centers for Disease Control and Prevention adds two that many new parents recognize right away: feeling distant from your baby and doubting your ability to care for them. Symptoms range from mild to severe, and they don't have to match this list exactly to matter.

Time is a useful marker. The OWH suggests contacting a doctor, nurse or midwife when symptoms last more than two weeks. Mayo Clinic's page on postpartum depression symptoms and causes notes that symptoms usually develop within the first few weeks after giving birth, though they can start during pregnancy or up to a year later.

Baby Blues or Postpartum Depression?

Most new mothers feel shaky at some point after birth. The baby blues, with mood swings, crying spells and trouble sleeping or eating, are common in the first days. The CDC notes that they typically resolve within a few days, and Mayo Clinic says they can last up to two weeks.

Postpartum depression brings the same symptoms of depression seen at other times of life, and it differs from the blues in how long it lasts and how much of your life it takes over. The symptoms are more intense, they stay, and they start to interfere with caring for yourself, your baby or your day. If the postpartum baby blues haven't lifted by the two-week mark, or if they are getting heavier instead of lighter, that is the time to talk to your doctor or midwife.

It's also possible to have postpartum depression and still get through the day. Plenty of parents keep up the feeding schedule, answer messages and smile at visitors while feeling hollow underneath. Being able to function doesn't rule it out.

Symptoms of Postpartum Depression That Are Easy to Miss

Sadness is the symptom people expect. Several other symptoms of PPD are less obvious, and they are often the ones parents feel most embarrassed to mention.

• Irritability and anger. Snapping at your partner or feeling a rage you can't explain can be a sign of depression. The CDC includes feeling angry on its list of symptoms.
  
  
• Anxiety that won't switch off. Postpartum anxiety often travels with depression. In Statistics Canada's 2018/2019 Survey on Maternal Health, 10% of mothers reported feelings consistent with postpartum depression alone, 5% with an anxiety disorder alone, and 8% with both.
  
  
• Feeling numb or distant from your baby. Some parents expect a rush of love and feel flat instead. That distance can be a symptom, and it's one reason many parents stay quiet.
  
  
• Frightening thoughts. Unwanted thoughts about something happening to your baby are common among new parents and can come with depression and anxiety. Tell your health care provider about them, even if you're afraid to say them out loud. Thoughts of harming your baby or yourself call for help right away, which I cover below.
  
  
• Sleep that won't come. Some parents find they can't fall asleep even when the baby is sleeping.
  
  
• A harsh inner critic. Constant self-doubt, guilt and the sense that everyone else is managing better than you are can be part of postpartum depressive symptoms.
  
  

Depression during and after pregnancy is a health condition like any other, and it says nothing about your worth as a parent.

How Common Is Postpartum Depression in Canada?

More common than most new parents realize. In the 2018/2019 Survey on Maternal Health, Statistics Canada found that 23% of mothers reported feelings consistent with postpartum depression or an anxiety disorder, and the figure for Ontario was also 23%. The CDC reports that about 1 in 8 women in the United States with a recent live birth had symptoms of postpartum depression.

These numbers come from what mothers reported rather than from clinical diagnoses, but they point the same way. Many women with postpartum depression are carrying it quietly.

Who Is More Likely to Experience Postpartum Depression?

Any new mother can develop postpartum depression, and it can follow any birth, not only the first. Hormones play a part, including the sharp drop in estrogen and progesterone after childbirth, but they are only one piece.

The risk of postpartum depression goes up with a history of depression, a family history of depression, depression during pregnancy, a previous episode of postpartum depression, a traumatic birth, a baby with health needs, breastfeeding difficulties, financial strain and little support. Relationship stress appears on both the OWH and Mayo Clinic lists, which is a large part of why I work with partners as well as individuals.

What Partners Often Notice First

If your partner has just had a baby, you may see changes before they say a word. They may seem unusually irritable or teary, pull away from you and the baby, stop eating properly, or talk about being a bad parent. You might not be sure whether you're looking at exhaustion or something more.

A calm, specific observation gives your partner room to answer. For example: "I've noticed you haven't been sleeping even when the baby is, and I'm worried about you." A label like "you have postpartum depression" is harder to hear and isn't yours to give.

Partners can struggle too. A 2010 meta-analysis in JAMA found that about 10.4% of fathers experienced depression during the prenatal and postpartum periods, with rates highest three to six months after the birth. It also found a moderate link between a mother's depression and a father's. Mayo Clinic adds that fathers who have had depression before, or who face relationship or financial strain, carry a higher risk of depression. If maternal depressive symptoms are present in your home, check in on your own mood as well.

PPD also changes how two people relate to each other. A parent who feels like a failure may withdraw. Their partner, worried or lonely, may push for answers or go quiet. Each response is understandable, and together they can become a cycle that leaves both people feeling shut out. This is the pattern Emotionally Focused Therapy is designed to work with. Seeing that cycle early helps protect the emotional bond between you, at a time when you both need each other most.

Postpartum Psychosis: When It's an Emergency

Postpartum psychosis is rare, and it is an extreme form of postpartum mood illness. Mayo Clinic says it usually develops within the first week after delivery. The signs include confusion, hallucinations, delusions, paranoia, obsessive thoughts about the baby, and attempts to harm yourself or your baby. It requires immediate treatment.

If you or someone you love shows these signs, call 911 or go to the nearest emergency department. If you're the partner, stay with them and call 911 instead of waiting to see whether it passes.

Treatment for Postpartum Depression

Postpartum depression is treatable. The CDC says most people get better with treatment, and the first step is to talk to a health care provider and ask for a referral to a mental health professional. Several options can treat postpartum depression, and the right mix differs from person to person. The treatment options often include one or more of the following:

• Therapy or counselling, on your own or with your partner.
• Support groups and practical help at home.
• Self-care basics, such as rest, regular meals and gentle movement.
• Medication. A physician or psychiatrist may recommend an antidepressant, and some antidepressants can be used while you breastfeed. If you're nursing, tell your provider so the two of you can decide together.
  
  

At a postpartum checkup, your care provider may use a ten-question screening questionnaire called the Edinburgh Postnatal Depression Scale as part of depression screening. It's a screening tool rather than a diagnosis, and a higher score is a reason for a closer conversation.

Untreated postpartum depression can last for many months or longer, according to Mayo Clinic, so there is good reason not to wait. Counselling can also help before symptoms become severe. The U.S. Preventive Services Task Force recommended in 2019 that clinicians offer or refer pregnant and postpartum people at increased risk of perinatal depression to counselling, mostly cognitive behavioural therapy and interpersonal therapy, which were found effective at preventing it.

How Therapy Can Help With Postpartum Mental Health

Therapy gives you a place to say what you haven't been able to say anywhere else, including to the people who love you. With new parents, I focus on the emotional side of what's happening: the exhaustion, the shame, the fear of doing it wrong, and how all of it touches your closeness with your partner and your baby. Therapy can help you manage symptoms and understand what is driving them.

I'm certified in Emotionally Focused Therapy, which I offer for individuals and for couples. Partners can come alone or together. Sessions are available online anywhere in Ontario, or in person at my office in Port Credit, where babies are welcome. Therapy is meant to work alongside the care you receive from your doctor or midwife, and it doesn't replace it.

You can read more about postpartum symptoms and treatment on my pregnancy and postpartum counselling in Mississauga page, or in my shorter post, Do I Have Postpartum Depression?.

When to Get Help

Reach out to your doctor or midwife if any of these are true:

• Low mood, anger, anxiety or loss of interest has lasted more than two weeks
• The baby blues haven't faded, or they're getting heavier
• Everyday tasks, caring for yourself or caring for the baby feel impossible
• You're pulling away from the people you love
  
  

If you have thoughts of harming yourself or your baby, act right away. Call 911, or call or text 9-8-8, Canada's Suicide Crisis Helpline, which is open 24 hours a day. (In the United States, the equivalent is the 988 Suicide and Crisis Lifeline.) For help finding mental health services in Ontario, ConnexOntario is free and open 24/7 at 1-866-531-2600.

Postpartum Support International also offers online support groups for parents, and its provider directory covers the United States and Canada.

Postpartum Depression FAQs

When does postpartum depression start?

Symptoms usually develop within the first few weeks after birth, but they can begin during pregnancy or up to a year later, according to Mayo Clinic. The OWH says postpartum depression most often begins within the first month.

How long does postpartum depression last?

It varies from person to person. Without treatment it can last many months or longer, and with treatment most people get better, according to the CDC. If you've felt low for more than two weeks, talk to your doctor or midwife rather than waiting to see what happens.

Can I have postpartum depression if I love my baby?

Yes. Loving your baby and living with depression can exist side by side. Depression affects mood, energy, sleep and concentration, and it doesn't measure how much you care. Feeling distant from your baby can be a symptom too, and it's worth mentioning to your doctor or midwife.

Can postpartum depression start during pregnancy?

Yes. Mayo Clinic notes that symptoms can begin during pregnancy. Clinicians often use the terms perinatal depression and peripartum depression to cover pregnancy and the year after birth.

Does my partner have to come to therapy?

No. Individual sessions are available if you want a space of your own, and partners can attend alone or together.

Where to Go From Here

If you think you or your partner may be experiencing postpartum depression, please take what you've read here to someone who can assess it properly. Start with your family doctor or midwife, who are part of your postpartum care team, and know that therapy is available alongside that care. Whether you're in the Mississauga area or anywhere in Ontario, I offer a free 15-minute consultation to talk about what's going on and whether we'd be a good fit.

You may also find these pages helpful: pregnancy and postpartum counselling, emotionally focused individual therapy, couples counselling and more about me.

Book your free 15-minute consultation

This article is general information. It isn't medical advice, and it doesn't replace an assessment by a health care professional. If you are in crisis, call 911 or 9-8-8.

Sources

• Office on Women's Health, Postpartum depression
• Centers for Disease Control and Prevention, Symptoms of Depression Among Women
• Mayo Clinic, Postpartum depression: Symptoms and causes
• Statistics Canada, Maternal Mental Health in Canada (2019)
• Paulson and Bazemore, Prenatal and postpartum depression in fathers and its association with maternal depression, JAMA 2010;303(19):1961-1969 (abstract via RTI International)
• U.S. Preventive Services Task Force, Perinatal Depression: Preventive Interventions (2019)
• 9-8-8: Suicide Crisis Helpline
• ConnexOntario
• Postpartum Support International