Understanding postpartum mental health

How to know when you need help after childbirth

Welcoming a baby can be a joyful time — bringing home your child and beginning life with your newly expanded family. However, many people experience mixed emotions during the postpartum period, which are the weeks after giving birth.

Hormone levels fluctuate the first few weeks after delivery, so it’s common to have the “baby blues” – mood swings, crying spells, and feeling anxious or overwhelmed. But there is a more severe, long-lasting form of depression known as postpartum depression.

What is postpartum depression?

Postpartum depression (PPD) can seem like baby blues at first, but it is much more serious. Symptoms include:

• Feeling depressed, hopeless, worthless, or ashamed
• Extreme mood swings; feeling very irritable or angry
• Crying a lot
• Feeling like you aren’t bonding with your baby, or that you don’t love your baby
• Fear that you’re not a good parent
• Loss of energy, or feeling overwhelmingly tired
• Sleep problems like sleeping too much, or being unable to sleep
• Eating much more than usual, or losing your appetite
• Pulling away from family and friends
• Struggling to think clearly, make decisions, or concentrate
• Severe anxiety and panic attacks
• Thoughts about death in general, or specific thoughts of harming yourself or your baby

It’s important to know that having PPD does not mean you’re a bad parent, or that you don’t love your child. Up to 20% of new parents develop PPD.¹

What is postpartum anxiety?

Postpartum anxiety (PPA) can happen alongside PPD, or separately. In addition to the same symptoms as PPD, PPA symptoms include:

• Feeling like you can’t relax
• Worrying all the time, maybe so much that you have trouble eating, sleeping, or sitting still
• A strong urge to clean, check things, or repeat actions so you feel less afraid
• Intrusive thoughts, such as upsetting thoughts or disturbing mental images. Almost half of new parents experience this.²
• Fear of being alone with the baby
• Fixation on protecting the baby

Treating postpartum depression and postpartum anxiety

There are a number of small changes you can make right away that can help with symptoms of depression and anxiety:

• Ask for help. Start by telling your partner, trusted friend, or another loved one about what you’re experiencing. If you’ve had symptoms for more than two weeks, call your doctor, nurse, or midwife.
• Get more sleep. Rest helps your brain function better. Enlist your partner, friends, and family to support you by taking care of your baby while you rest.
• Do fun things. Go out with your partner or friends, or make time for something you used to enjoy.
• Talk to people. Be open with your support system about what you’re feeling, and what you need. Join a support group for new parents, either in your area or online.
• Delay other changes. The stress of growing your family is enough. Put off other big changes as much as you can.
• Look after your health. Once you’re cleared for activity, try light exercise like a walk outside or a yoga class. Eat nutritious and nourishing foods, and make sure you’re drinking plenty of water.

Cognitive behavioral therapy

Talk therapy from a psychologist or therapist can be extremely helpful. Cognitive behavioral therapy (CBT) teaches you to identify your emotions and change your thought patterns from negative behaviors and patterns to healthier ones. This type of therapy teaches you healthy ways to respond to stress and anxiety.

Medical treatment options

Once you’ve consulted with a healthcare provider, they may recommend prescription medications to help ease your symptoms.

• Selective serotonin reuptake inhibitors (SSRIs) help regulate mood by increasing the amount of serotonin in the brain. These include medications such as fluoxetine (Prozac) and sertraline (Zoloft^®).
• Serotonin-norepinephrine reuptake inhibitors (SNRIs) are another option for treating PPD. These medications, like venlafaxine (Effexor) or duloxetine (Cymbalta), work by increasing levels of serotonin and norepinephrine in the brain to improve mood and well-being.

Keep in mind that antidepressants often take time to take full effect, and they can have side effects. It’s important to have support and check in with your provider for any dose or therapy adjustments, as needed.

Talk to your doctor and pharmacist

If you think you may have PPD or PPA, talk to your doctor right away. If they prescribe medication, your pharmacist can advise you about common side effects or possible interactions with other medications.

Remember, if your health benefits include Express Scripts^® Pharmacy, our registered pharmacists are here 24/7 to answer your questions, and we have pharmacists specially trained to support postpartum health issues.

If you’re having any suicidal thoughts or thoughts about harming your baby, text or call 988 to connect to the National Suicide Prevention Lifeline. Trained counselors are available 24 hours a day, 7 days a week.

1 National Library of Medicine: Postpartum Depression (October 7, 2022): ncbi.nlm.nih.gov/books/NBK519070/.
2 National Library of Medicine: Intrusive thoughts and images of intentional harm to infants in the context of maternal postnatal depression, anxiety, and OCD (August 2017): ncbi.nlm.nih.gov/pmc/articles/PMC5519121/.