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The exact reasons why some new mothers develop postpartum depression and others don’t are unknown. But a number of interrelated causes and risk factors are believed to contribute to the problem.
Causes

The rapid hormonal changes that accompany pregnancy and delivery may trigger depression. After childbirth, women experience a big drop in estrogen and progesterone hormone levels. Thyroid levels can also drop, which leads to fatigue and depression. These hormone dips—along with the changes in blood pressure, immune system functioning, and metabolism that new mothers experience—can all play a part in postpartum depression. It has been theorized that women who are more sensitive to these hormone imbalances develop postpartum depression.

Women who have just given birth are also dealing with numerous changes, both physical and emotional. They may still be coping with physical pain from the pregnancy and delivery. They may also have difficulties losing the baby weight, leading to insecurities about their physical and sexual attractiveness. In addition to changes to their body, they are also dealing with lifestyle changes. The lifestyle adjustment can be particularly difficult for first time moms, who must get used to an entirely new identity. The stress of caring for a newborn can also take a toll. New mothers are often sleep deprived. In addition, they may feel overwhelmed and anxious about their ability to properly care for their baby. All of these factors can contribute to and trigger postpartum depression.
Risk factors

Women with a previous history of depression are at an increased risk of experiencing postpartum depression. Your risk is also elevated if you have a history of severe PMS or premenstrual dysphoric disorder, if the pregnancy was unplanned, or if you had postpartum depression following a previous pregnancy. According to the National Institute of Mental Health, women with a prior history of postpartum depression have a 50% chance of recurrence.

Stressful events during pregnancy or birth also increase the odds of developing postpartum depression. Stressful events might include a difficult delivery, prenatal problems, premature birth, or illness during pregnancy. Finally, research has shown that women with marital difficulties or a general lack of social support have a greater chance of developing postpartum depression.

If you’ve recently given birth and have one or more of these risk factors, it is especially important to be on the lookout for any signs or symptoms of postpartum depression.

What causes postpartum depression?

Postpartum depression seems to be brought on by the changes in hormone levels that occur after pregnancy. Any woman can get postpartum depression in the months after childbirth, miscarriage, or stillbirth.

You have a greater chance of getting postpartum depression if:

    * You’ve had depression or postpartum depression before.
    * You have poor support from your partner, friends, or family.
    * You have a sick or colicky baby.
    * You have a lot of other stress in your life.

You are more likely to get postpartum psychosis if you or someone in your family has bipolar disorder (also known as manic-depression).
What are the symptoms?

A woman who has postpartum depression may:

    * Feel very sad, hopeless, and empty. Some women also may feel anxious.
    * Lose pleasure in everyday things.
    * Not feel hungry and may lose weight. (But some women feel more hungry and gain weight).
    * Have trouble sleeping.
    * Not be able to concentrate.

These symptoms can occur in the first day or two after the birth. Or they can follow the symptoms of the baby blues after a couple of weeks.

If you think you might have postpartum depression, fill out this postpartum depression checklist (What is a PDF document?) . Take it with you when you see your doctor.

A woman who has postpartum psychosis may feel cut off from her baby. She may see and hear things that aren’t there. Any woman who has postpartum depression can have fleeting thoughts of suicide or of harming her baby. But a woman with postpartum psychosis may feel like she has to act on these thoughts.
Who is at risk of postpartum depression?
Although experts estimate that about 1 in 10 women suffer from some level of postpartum depression — and 1 in 1,000 from postpartum psychosis — it’s still relatively misunderstood, and the exact cause of it isn’t known. Some say that a combination of factors might be to blame — or that certain factors are correlated with a greater predisposition to PPD:

           

 

history of hormonal or thyroid imbalances
 

exhaustion
 

overwhelming home or work conditions (including death in family, job change or layoff or a move)
 

personal or family history of depression, PPD or other mental problems
 

unrealistic expectations (including tendencies toward perfectionism)
 

physical problems following delivery
 

baby who is sick, colicky or has other problems
 

little or no support from spouse, family members or friends
 

isolation
 

personal or family history of abuse, physical or emotional abandonment, and/or neglect