How do you know if it’s postpartum depression or regular depression?

This is a common question I get from my patients, and it’s a great opportunity to talk about postpartum depression.

Our culture has been trending more towards being compassionate and accepting of those struggling with postpartum depression. I think this shift can be attributed to all of the people, including celebrities, who have been forthcoming and open to others about their illness. Afterall, roughly 1 in 5 women suffer from some form of perinatal mental illness, and it is an issue that spans across countries, cultures, religions, socioeconomic statuses and even genders.

How does someone know when it is postpartum depression versus depression that occurs at other times though?

The clinical term for actively experiencing depression is called a major depressive episode, or MDE. Once someone has met clinical criteria for one MDE, they are classified as having either Major Depressive Disorder or Bipolar Affective Disorder. In other words, MDE’s occur in different types of mental illnesses. Postpartum depression is a form of a MDE that is specific to the postpartum period. A MDE can be classified as postpartum depression if it starts anywhere between the time of delivery to 12 months postpartum, generally, depending on the reference (some sources say only up to 4 weeks postpartum, whereas others say up to 2 years postpartum). Most commonly, postpartum depression starts around 3-4 months after delivery though. In other words, postpartum depression only earns its name because of the timing of the episode’s onset. The symptoms are not necessarily different or unique to what depression is like in other times of a person’s life, and the best, most effective treatments are also the same. A 2020 research study by Putnick et al. in the journal, Pediatrics, found that a postpartum depression can last up to 3 years after delivery if it goes untreated. This is about the same for a MDE that occurs in other times of life. The negative impact that postpartum depression has on a developing baby, on one’s own body and on society is why it is so important to treat.

Besides timing of onset, the cause of postpartum depression is another factor that can make it unique. Female reproductive hormones change dramatically following delivery of a baby and placenta, which causes a chain reaction to other hormones and systems in the body that is not seen in any other time of life. These hormones have direct effects on the brain and neurotransmitters, especially those neurotransmitters and parts of the brain involved in emotional regulation. Research has provided evidence that there is a subset of women whose brains and neurological systems are particularly vulnerable to female reproductive hormonal changes. These women may never experience another episode of depression outside of the postpartum period, but may be more vulnerable to times of other reproductive hormonal changes, such as around menopause.

The postpartum time is a “perfect storm” for mental illness, not only because of the impact of reproductive hormonal changes, but also because of other extreme stressors. Physically, a person’s body has higher inflammation postpartum because of childbirth. People are also sleep deprived, which increases risk of mental illness, and they are going through the major stress of adapting to life with a new baby. Major stresses, in general, also increase the risk of mental illness due to the way that cortisol levels change. Having a new baby makes arguably one of the highest levels of stress during a lifetime.

Hormonal changes, and other changes in our body after childbirth, or even during times of stress are normal. This is how we adapt to change and how the body helps us get through stress. Depending on genetics and the environment, some people are more vulnerable to mental illness than others, or are more vulnerable at particular times of their life than at other times.

This is why optimizing physical and mental wellness around pregnancy and postpartum is so important in preventing mental illness. Check out our article on The Top 5 Natural Ways to Prevent Postpartum Depression.

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