New mother, new baby, new sadness — Who knew?

What is the most common complication of pregnancy? If you guessed gestational diabetes or hypertension, you would be wrong. The correct answer is perinatal (postpartum) depression.

New moms can go through a range of emotions, from joyful to feeling completely overwhelmed. Washington University physician, Shannon Lenze, PhD, is a psychologist whose areas of specialty include perinatal mental health, depression and anxiety. She answers questions about postpartum depression and its effects on new moms and dads.

What causes a new mom to become depressed during what should be the happiest time of her life?

The idea that pregnant and postpartum women should be happy is a myth. This can be a very stressful time for many women. Many pregnancies are unplanned, some women do not have adequate support to help with newborn care, others have experienced medical complications (including pre-term delivery or NICU admission), and others may have biologic vulnerabilities that make them sensitive to hormone changes.

Perinatal depression is common; one in five women will experience significant symptoms (this number can increase to one in three for women of color), while one in seven will develop a major depressive disorder.

What is the difference between “baby blues” and postpartum depression?

“Baby blues” occur in an estimated 50-85% of women after delivery. This occurs in the first week or two after delivery and is characterized by tearfulness or crying, mood swings, anxiety, loss of appetite, and irritability, or feeling “overemotional”. Usually these symptoms peak around three to five days postpartum and diminish by 10-12 days postpartum. Postpartum depression is more severe and lasts at least two weeks.

What are the most common symptoms of postpartum depression?

Symptoms of depression include: persistent sadness, lack of interest or enjoyment from things, excessive guilt, difficulty concentrating, hopelessness or helplessness, worthlessness, changes in appetite (increased or decreased), changes in sleep (difficulty sleeping or sleeping too much), extreme fatigue, psychomotor agitation (restlessness) or psychomotor retardation (slowing of movements or speech), and thoughts of death or suicidal ideation.

Anxiety or worry frequently occurs along with depressive symptoms and may include ruminative or intrusive thoughts about accidently harming the baby or other worries about the baby or baby care. Other women may experience feeling “out of control” or angry. They may have difficulty bonding with the baby or feel regret for having a baby. Some women become fearful of leaving the house or being alone.

Is there such a condition as postpartum psychosis? If so, how is this different from postpartum depression?

Postpartum psychosis is a severe psychiatric emergency. Postpartum psychosis is rare, occurring in one to two out of 1000 deliveries. The onset is usually sudden within the first one to two weeks postpartum.

Symptoms of postpartum psychosis include delusions (strange beliefs), hallucinations (hearing, seeing, or feeling things that aren’t there), paranoia/suspiciousness, bizarre behavior, rapid mood swings, hyperactivity, irritability, racing thoughts, muddled thinking, or decreased need for sleep. Women with histories of bipolar disorder or with family histories of bipolar disorder may be more at risk. 

What are the warning signs that a mom could be a danger to her baby, herself or others?

Any change in behavior may be an indication that something is wrong. For example, a woman suddenly convinced her partner is unfaithful or who suddenly begins speaking or writing fervently about religion (who wasn’t particularly religious prior).  All women should be screened for depression during pregnancy and postpartum. Any woman endorsing anxious, depressive, or psychotic symptoms should be directly asked about thoughts of harm to self or others.

What treatments are available for a mom with postpartum depression?

Support groups or telephone “warm-lines” can be helpful for many women. These are often led by women who have experienced postpartum depression themselves.

Psychotherapy (talk therapy or counseling):  This might be with a social worker, nurse practitioner, licensed professional counselor, psychologist, or psychiatrist. Interpersonal psychotherapy (focusing on life events, social support and relationships), cognitive behavioral therapy (focusing on the link between thoughts, behaviors and emotions), problem-solving therapy (focusing on practical solutions to pressing problems) are a few specific types of therapy that are evidence-based.

Antidepressant medication: Selective serotonin reuptake inhibitors (SSRIs) are the most commonly prescribed. Some women prefer not to take medications due to the potential risks of transmission to fetus in utero or infant postpartum through breast milk. These risks need to be carefully weighed against the risks of continued depression. We know that depression during pregnancy and postpartum are associated with adverse cognitive and socio-emotional development for infants that extend into adulthood.

Many women benefit from combination of psychotherapy and antidepressant medication.

Alternative treatments: exercise, bright light therapy, meditation, massage, and yoga. These interventions may also be beneficial, especially in conjunction with other treatments.

If you see a friend or spouse who is struggling with postpartum depression, what should you do to help?

If you see someone struggling – ask what you can do to help. Encourage her to talk about her feelings and listen without judging. Suggest that she seems like she is overwhelmed and should reach out for support.  Be prepared to help find resources.

What can the Washington University Perinatal Behavioral Health Service (PBHS) offer to new moms?

PBHS is a full-service for families. We have clinical services in a variety of settings including: the antepartum unit, postpartum unit, St. Louis Children’s Hospital NICU and CICU, BJC outpatient OB clinic, and a soon-to-be established clinic focused on treatment of opioid dependence. We also take referrals from outside OBGYN providers or patients. We offer screening, education, case management, referrals to community services, psychotherapy, and psychiatric management for mental health needs during pregnancy and postpartum.

Important to note – postpartum depression also occurs in dads! The incidence is lower than in women (1 in 10), but still happens. Symptoms are the same that occur in women but may also include more “externalizing” symptoms like irritability, anger, and use of substances to cope. Depression in fathers has been shown to have adverse effects for their partners and also for child development.

If you or someone you know is suffering from perinatal depression, and would like to make an appointment with Dr. Lenze, please call 314-286-1700.

For more information on Perinatal Behavioral Health Services, call 314-454-5052 or visit 

Barnes-Jewish Center for Outpatient Health
4901 Forest Park Health
St. Louis, MO 63108