What Is Postpartum Depression?

While it’s common for women to experience a short 1­–2 week period of “baby blues” after delivery, for some mothers, this feeling lingers and is known as postpartum depression.1,2 Postpartum depression is moderate to severe depression that can present in women anytime between delivery and 1 year later, but is generally seen within the first 3 months after birth.1,2

Postpartum depression develops in 10% to 15% of all births in the U.S., and about 11% worldwide.2,3,4 Symptoms can make it difficult for mothers to care for themselves and their children. In a study across several U.S. states, between 2004 and 2012, the prevalence of postpartum depressive symptoms declined from 14.8% to 9.8%.8

Despite the decline, there is still a need to continue educating expectant mothers on the symptoms of the disorder should they suspect themselves or their loved ones are struggling with depression following birth. It is also necessary to understand how using alcohol to self-medicate when struggling with postpartum depression to avoid more serious issues in the future.

Have you been drinking?

What Causes It?

While a specific cause has yet to be identified, there are a few elements believed to contribute to postpartum depression including:

  • Fluctuations in hormone levels.1,2,9
  • History of mood disorders (e.g., major depression, bipolar disorder).1,2
  • Lack of sleep.1,2,9

Some factors may also increase the risk of developing postpartum depression, such as:

  • Being under 25 years old.1
  • Current alcohol or drug use.1
  • Having an unplanned pregnancy, or experiencing mixed feelings about pregnancy.1,2,3
  • Experiencing a stressful life event during pregnancy or delivery.1,2,5
  • Having a close relative with depression, anxiety or other mental illness.1,2
  • Poor relationship with a partner, or no partner.1,6
  • Lower socioeconomic status, which can contribute to financial or housing issues.1,3,5,11
  • Lacking social and/or emotional support.7,8,10
  • History of substance use.12, 13

What Are Its Symptoms?

Symptoms can occur within the first year after delivery and includes:1,2,4

  • Feeling depressed, sad, isolated, hopeless, tearful, or empty.
  • Loss of interest or pleasure in many or all activities.
  • Increased or decreased appetite.
  • Sleeping too much or too little.
  • Restlessness, fatigue or lethargy.
  • Irritability and anxiety.
  • Physical complaints, such as unexplained aches and pains.
  • Feeling worthless or overly guilty.
  • Difficulty focusing, concentrating, or making decisions.
  • Inability to care for oneself or the baby.
  • Intense worry about the baby, or little interest in the baby.
  • Feeling negatively toward the baby or having thoughts about harming the baby. (rare)
  • Thoughts of death or suicide. (rare)

How Is It Treated?

Postpartum depression is typically treated with talk therapy and/or medication.2 This could include 1 or more of the following methods:

  • Talk Therapy – Meeting with a therapist on a regular basis can help women work through postpartum depression and develop healthy coping skills to recover.1,2,5,9 The two most common types of therapy used are interpersonal therapy (IPT) and cognitive behavioral therapy (CBT).1,2,7 IPT focuses on how personal relationships can influence mood, and aims to improve those relationships as well as improving the quality of social supports in a woman’s life.2,7 CBT views the relationships between thoughts, emotions, and behaviors, and helps to identify and modify unhelpful thoughts and actions, which can improve depressive symptoms.2,7
  • Medications – Antidepressants can be a very helpful tool for postpartum depression.1,2,4,7,9 Most of these medications can take up to 4 weeks to fully work, and health care providers can advise on which are safe to use when breastfeeding.2,4,9
  • Group Therapy – IPT and CBT can also be performed effectively in group settings, which have the added benefit of addressing the feelings of isolation that new mothers often face.5,9
  • Support Groups – This is a group of peers who can empathize and provide support to women going through postpartum depression or managing co-occurring disorders such as an alcohol use disorder (AUD). Support groups are not a substitute for formal treatment but can be a helpful tool for many, especially women who do not receive it from family, friends, or a partner.1,5 The presence of social support may also help to reduce the severity of postpartum depression or alcohol use disorder symptoms.1

Risks of Using Alcohol to Self-Medicate

Women suffering from postpartum depression may be more likely to drink alcohol, possibly in an attempt to self-medicate.12 This is risky because alcohol can worsen symptoms of depression, reduce the ability to take care of or connect to her child emotionally, and could potentially lead to situations where a child is neglected or abused.3,4,12

If a woman is breastfeeding, drinking alcohol to self-medicate could potentially be harmful to the baby as well. Alcohol reduces the production of milk when lactating and can be passed to the baby through breast milk.15,16,17,18 Exposure to alcohol while breastfeeding can cause altered sleep patterns, growth issues, and developmental delays in newborns.15,16,17,18

Alcohol use can worsen depression and there may be some contraindications to drinking while taking antidepressants.19 For example, drinking alcohol while taking antidepressants may adversely interact with monoamine-oxidase inhibitors and may worsen the side effect profile of other medications.19 Consult with a doctor or pharmacist before consuming alcohol while taking any prescription drugs.

Co-occurring Postpartum Depression and Alcohol Abuse

Between 2015 and 2017, 11.5% of pregnant women reported having a drink within the past 30 days, and 3.9% of pregnant women reported binge drinking (having at least 4 drinks on a single occasion) within the last 30 days.20 Of the pregnant women who reported binge drinking, the average frequency was 4.5 episodes in the past 30 days.20

Drinking during pregnancy is associated with fetal alcohol spectrum disorders, and pregnant women with an AUD may be at greater risk for postpartum depression or other mental health disorders, low use of prenatal healthcare, poor nutrition, child neglect or abuse, domestic violence, and housing or economic instability.3,12,13,21

When seeking treatment for postpartum depression and an AUD, it is important to address both issues at the same time, since they can influence the progression of and treatment outcomes for each other. Ideally, treatment should also include parenting training to allow the mother to acclimate to her new role, since both issues can impair a woman’s ability to bond with her baby.12,13,16 Treatment methods such as CBT, which are effective for both postpartum depression and alcohol use disorder, can be especially helpful. Ensuring that the mother and baby have safe living arrangements and sufficient food can also assist in recovery efforts.12,13

Postpartum depression is more than just the “baby blues,” and might not go away without treatment. It can linger for years and have negative effects on the mother, the child, and other family members. However, treatment and support groups are available for anyone struggling with postpartum depression and/or an alcohol use disorder.

Sources:

[1]. National Institute of Health. (2018). Postpartum depression.

[2]. National Institute of Mental Health. Postpartum depression facts.

[3]. Wilton, G., Moberg, D.P., & Fleming, M.F. (2009). The effect of brief alcohol intervention on postpartum depression. The American Journal of Maternal Child Nursing, 34(5), 297-302.

[4]. National Health Service. (2018). Feeling depressed after childbirth.

[5]. Stewart, D.E., Robertson, E., Dennis, C-L., Grace, S.L., & Wallington, T. (2003). Postpartum depression: literature review of risk factors and interventions.

[6]. MedlinePlus. (2018). Postpartum depression.

[7]. Fitelson, E., Kim, S., Baker, A.S., & Leight, K. (2010). Treatment of postpartum depression: clinical, psychological and pharmacological options. International Journal of Women’s Health, 3, 1-14.

[8]. Ko, J.Y., Rockhill, K.M., Tong, V.T., Morrow, B., & Farr, S.L. (2017). Trends in postpartum depressive symptoms-27 states, 2004, 2008, and 2012. Morbidity and Mortality Weekly Report, 66(6), 153-158.

[9]. American College of Obstetricians and Gynecologists. (2013). Postpartum depression.

[10] O’Hara, M.W., & Swain, A.M. (1996). Rates and risk of postpartum depression-a meta-analysis. International Review of Psychiatry, 8(1), 37-54).

[11]. Katon, W., Russon, J., & Gavin, A. (2014). Predictors of postpartum depression. Journal of Women’s Health, 23(9).

[12]. Chapman, S.L, & Wu, L.T. (2013). Postpartum substance use and depressive symptoms: a review. Women & Health, 53(5), 479-503.

[13]. Gopman, S. (2014). Prenatal and postpartum care of women with substance use disorders. Obstetrics and Gynecology Clinics of North America, 41(2), 213-228.

[14]. American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders, fifth edition. Arlington, VA: American Psychiatric Association.

[15]. Holland, K. (2018). Is it safe to drink alcohol while breastfeeding?

[16]. Reece-Stremtan, S., Marinelli, K.A., and the Academy of Breastfeeding Medicine. (2015). ABM clinical protocol #21: guidelines for breastfeeding and substance use or substance use disorder, revised 2015. Breastfeeding Medicine, 10(3), 135-141.

[17]. Haastrup, M.B., Pottegård, A., & Damkier, P. (2014). Alcohol and breastfeeding. Basic & Clinical Pharmacology & Toxicology, 114(2), 168-173.

[18]. Gibson, L., & Porter, M. (2018). Drinking or smoking while breastfeeding and later cognition in children. Pediatrics, 142(2).

[19]. National Health Service. (2019). Can I drink alcohol if I’m taking antidepressants?

[20]. Denny, C.H., Acero, C.S., Naimi, T.S., & Kim, S.Y. (2019). Consumption of alcohol beverages and binge drinking among pregnant women aged 18-44 years-United States, 2015-2017. Morbidity and Mortality Weekly Report, 68(16), 365-368.

[21]. American Society of Addiction Medicine. (2017). Public policy statement of substance use, misuse, and use disorders during and following pregnancy, with an emphasis on opioids.