Depressive illnesses, even the most severe cases, are highly treatable disorders. As with many illnesses, the earlier that treatment can begin, the more effective it is and the greater the likelihood that a recurrence of the depression can be prevented.

The first step to getting appropriate treatment is to visit a doctor. Certain medications, and some medical conditions such as viruses or a thyroid disorder, can cause the same symptoms as depression. In addition, it is important to rule out depression that is associated with another mental illness called bipolar disorder.   A doctor can rule out these possibilities by conducting a physical examination, interview, and/or lab tests, depending on the medical condition. If a medical condition and bipolar disorder can be ruled out, the physician should conduct a psychological evaluation or refer the person to a mental health professional.

The doctor or mental health professional will conduct a complete diagnostic evaluation. He or she should get a complete history of symptoms, including when they started, how long they have lasted, their severity, whether they have occurred before, and if so, how they were treated. He or she should also ask if there is a family history of depression. In addition, he or she should ask if the person is using alcohol or drugs, and whether the person is thinking about death or suicide.

Once diagnosed, a person with depression can be treated with a number of methods. The most common treatment methods are medication and psychotherapy.

Medication

Antidepressants work to normalize naturally occurring brain chemicals called neurotransmitters, notably serotonin and norepinephrine. Other antidepressants work on the neurotransmitter dopamine. Scientists studying depression have found that these particular chemicals are involved in regulating mood, but they are unsure of the exact ways in which they work.

The newest and most popular types of antidepressant medications are called selective serotonin reuptake inhibitors (SSRIs) and include:

• fluoxetine (Prozac)
• citalopram(Celexa)
• sertraline (Zoloft)
• paroxetine (Paxil)
• escitalopram (Lexapro)
• fluvoxamine (Luvox)

Serotonin and norepinephrine reuptake inhibitors (SNRIs) are similar to SSRIs and include:

• venlafaxine (Effexor)
• duloxetine (Cymbalta)

SSRIs and SNRIs tend to have fewer side effects and are more popular than the older classes of antidepressants, such as tricyclics – named for their chemical structure – and monoamine oxidase inhibitors (MAOIs). However, medications affect everyone differently. There is no one-size-fits-all approach to medication. Therefore, for some people, tricyclics or MAOIs may be the best choice.

People taking MAOIs must adhere to significant food and medicinal restrictions to avoid potentially serious interactions. They must avoid certain foods that contain high levels of the chemical tyramine, which is found in many cheeses, wines and pickles, and some medications including decongestants. Most MAOIs interact with tyramine in such a way that may cause a sharp increase in blood pressure, which may lead to a stroke. A doctor should give a person taking an MAOI a complete list of prohibited foods, medicines and substances.

For all classes of antidepressants, people must take regular doses for at least three to four weeks, sometimes longer, before they are likely to experience a full effect. They should continue taking the medication for an amount of time specified by their doctor, even if they are feeling better, to prevent a relapse of the depression. The decision to stop taking medication should be made by the person and her doctor together, and should be done only under the doctor’s supervision. Some medications need to be gradually stopped to give the body time to adjust. Although they are not habit-forming or addictive, abruptly ending an antidepressant can cause withdrawal symptoms or lead to a relapse. Some individuals, such as those with chronic or recurrent depression, may need to stay on the medication indefinitely.

In addition, if one medication does not work, people should be open to trying another. Research funded by NIMH has shown that those who did not get well after taking a first medication often fared better after they switched to a different medication or added another medication to their existing one.

Sometimes other medications, such as stimulants or antianxiety medications, are used in conjunction with an antidepressant, especially if the person has a coexisting illness. However, neither antianxiety medications nor stimulants are effective against depression when taken alone, and both should be taken only under a doctor’s close supervision.

Is it safe to take antidepressant medication during pregnancy?

At one time, doctors assumed that pregnancy was accompanied by a natural feeling of well being, and that depression during pregnancy was rare, or never occurred at all. However, recent studies have shown that women can have depression while pregnant, especially if they have a prior history of the illness. In fact, a majority of women with a history of depression will likely relapse during pregnancy if they stop taking their antidepressant medication either prior to conception or early in the pregnancy, putting both mother and baby at risk.

However, antidepressant medications do pass across the placental barrier, potentially exposing the developing fetus to the medication. Some research suggests the use of SSRIs during pregnancy is associated with miscarriage and/or birth defects, but other studies do not support this. Some studies have indicated that fetuses exposed to SSRIs during the third trimester may be born with “withdrawal” symptoms such as breathing problems, jitteriness, irritability, difficulty feeding, or hypoglycemia. In 2004, the U.S. Food and Drug Administration (FDA) issued a warning against the use of SSRIs in the late third trimester, suggesting that clinicians gradually taper expectant mothers off SSRIs in the third trimester to avoid any ill effects on the baby.

Although some studies suggest that exposure to SSRIs in pregnancy may have adverse effects on the infant, generally they are mild and short-lived, and no deaths have been reported. On the flip side, women who stop taking their antidepressant medication during pregnancy increase their risk for developing depression again and may put both themselves and their infant at risk.

In light of these mixed results, women and their doctors need to consider the potential risks and benefits to both mother and fetus of taking an antidepressant during pregnancy, and make decisions based on individual needs and circumstances. In some cases, a woman and her doctor may decide to taper her antidepressant dose during the last month of pregnancy to minimize the newborn’s withdrawal symptoms, and after delivery, return to a full dose during the vulnerable postpartum period.

Is it safe to take antidepressant medication while breastfeeding?

Antidepressants are excreted in breast milk, usually in very small amounts. The amount an infant receives is usually so small that it does not register in blood tests. Few problems are seen among infants nursing from mothers who are taking antidepressants. However, as with antidepressant use during pregnancy, both the risks and benefits to the mother and infant should be taken into account when deciding whether to take an antidepressant while breastfeeding.

What are the side effects of antidepressants?

Antidepressants may cause mild and often temporary side effects in some people, but usually they are not long-term. However, any unusual reactions or side effects that interfere with normal functioning or are persistent or troublesome should be reported to a doctor immediately.

The most common side effects associated with SSRIs and SNRIs include:

• Headache-usually temporary and will subside.
• Nausea-temporary and usually short-lived.
• Insomnia and nervousness (trouble falling asleep or waking often during the night)-may occur during the first few weeks but often subside over time or if the dose is reduced.
• Agitation (e.g., feeling jittery).
• Sexual problems-women can experience sexual problems including reduced sex drive, or inability to have an orgasm.

Tricyclic antidepressants also can cause side effects including:

• Dry mouth-it is helpful to drink plenty of water, chew gum, and clean teeth daily.
• Constipation-it is helpful to eat more bran cereals, prunes, fruits, and vegetables.
• Bladder problems-emptying the bladder may be difficult, and the urine stream may not be as strong as usual.
• Sexual problems-sexual functioning may change, and side effects are similar to those from SSRIs and SNRIs.
• Blurred vision-often passes soon and usually will not require a new corrective lenses prescription.
• Drowsiness during the day-usually passes soon, but driving or operating heavy machinery should be avoided while drowsiness occurs. These more sedating antidepressants are generally taken at bedtime to help sleep and minimize daytime drowsiness.

FDA warning on antidepressants

Despite the relative safety and popularity of SSRIs and other antidepressants, some studies have suggested that they may have unintentional effects on some people, especially adolescents and young adults. In 2004, the Food and Drug Administration (FDA) conducted a thorough review of published and unpublished controlled clinical trials of antidepressants that involved nearly 4,400 children and adolescents. The review revealed that 4% of those taking antidepressants thought about or attempted suicide (although no suicides occurred), compared to 2% of those receiving placebos.

This information prompted the FDA, in 2005, to adopt a “black box” warning label on all antidepressant medications to alert the public about the potential increased risk of suicidal thinking or attempts in children and adolescents taking antidepressants. In 2007, the FDA proposed that makers of all antidepressant medications extend the warning to include young adults up through age 24. A “black box” warning is the most serious type of warning on prescription drug labeling.

The warning emphasizes that patients of all ages taking antidepressants should be closely monitored, especially during the initial weeks of treatment. Possible side effects to look for are worsening depression, suicidal thinking or behavior, or any unusual changes in behavior such as sleeplessness, agitation, or withdrawal from normal social situations. The warning adds that families and caregivers should also be told of the need for close monitoring and report any changes to the physician. The latest information from the FDA can be found on their Web site at www.fda.gov.

Results of a comprehensive review of pediatric trials conducted between 1988 and 2006 suggested that the benefits of antidepressant medications likely outweigh their risks to children and adolescents with major depression and anxiety disorders. The study was funded in part by the National Institute of Mental Health.

Also, the FDA issued a warning that combining an SSRI or SNRI antidepressant with one of the commonly-used “triptan” medications for migraine headache could cause a life-threatening “serotonin syndrome,” marked by agitation, hallucinations, elevated body temperature, and rapid changes in blood pressure. Although most dramatic in the case of the MAOIs, newer antidepressants may also be associated with potentially dangerous interactions with other medications.

Psychotherapy

Several types of psychotherapy—or “talk therapy”— can help people with depression.

Some regimens are short-term (10 to 20 weeks) and other regimens are longer-term, depending on the needs of the individual. Two main types of psychotherapies-cognitive-behavioral therapy (CBT) and interpersonal therapy (IPT)-have been shown to be effective in treating depression. By teaching new ways of thinking and behaving, CBT helps people change negative styles of thinking and behaving that may contribute to their depression. IPT helps people understand and work through troubled personal relationships that may cause their depression or make it worse.

For mild to moderate depression, psychotherapy may be the best treatment option. However, for major depression or for certain people, psychotherapy may not be enough. Studies have indicated that for adolescents, a combination of medication and psychotherapy may be the most effective approach to treating major depression and reducing the likelihood for recurrence. Similarly, a study examining depression treatment among older adults found that patients who responded to initial treatment of medication and IPT were less likely to have recurring depression if they continued their combination treatment for at least two years.

Electroconvulsive Therapy

For cases in which medication and/or psychotherapy does not help alleviate a person’s treatment-resistant depression, electroconvulsive therapy (ECT) may be useful. ECT, formerly known as “shock therapy,” used to have a negative reputation. But in recent years, it has greatly improved and can provide relief for people with severe depression who have not been able to feel better with other treatments.

Before ECT is administered, a patient takes a muscle relaxant and is put under brief anesthesia. She does not consciously feel the electrical impulse that is administered. A person typically will undergo ECT several times a week, and often will need to take an antidepressant or mood stabilizing medication to supplement the ECT treatments and prevent relapse. Although some people will need only a few courses of ECT, others may need maintenance ECT, usually once a week at first, then gradually decreasing to monthly treatments for up to one year.

ECT may cause some short-term side effects, including confusion, disorientation and memory loss. But these side effects typically clear shortly after treatment. Research has indicated that after one year of ECT treatments, patients showed no adverse cognitive effects. A person should weigh the potential risks and benefits of ECT and discuss them with her doctor before deciding to undergo ECT treatment.

• Schedule outings and visits with friends and family, and ask them to call you regularly. Isolation feeds depression, especially when combined with the stresses of caring for a newborn.
• Eat a balanced diet. If you have little appetite, eat small snacks throughout the day. Nutritional supplement shakes are also useful for keeping up your energy.
• Get regular daily exercise, such as outdoor stroller walks. Exercise helps improve mood.
• Get as much sunlight as possible—keep your shades and curtains open, and get outside as much as you can.
• Ask for help with food preparation and other daily tasks. Family and friends are often happy to help a mother with newborn demands.
• Avoid alcohol and caffeine. Avoid using alcohol or other substances to feel better (self-medicating). Talk to your health professional if you’re having symptoms that need treatment.
• Don’t overdo it, and get as much rest and sleep as possible. Fatigue can increase depression.
• Join a support group of new mothers. No one can better understand and support the challenges of caring for a new baby than other postpartum women. For more information on support groups, talk to your health professional or see the Web site of Postpartum Support International at http://www.postpartum.net.

The potential for domestic violence increases during a woman’s pregnancy and when a couple is adjusting to a new baby. If your partner is violent or emotionally abusive, you and your baby are physically at risk, and you have an higher risk of postpartum depression. Now more than ever, it’s crucial that you protect yourself and your baby—seek support and help. For more information, see the topic Domestic Violence.

• Taking your medications regularly as prescribed. Depression often returns if medications are stopped too early or are not taken as directed.
• Continuing to take medications after your symptoms improve. Taking your medicine for at least 6 months after you feel better can help keep you from getting depressed again. If this is not the first time you have been depressed, your doctor may want you to take these medicines even longer.
• Continuing with cognitive-behavioral therapy even after medications have been stopped. Research shows those who continued this type of counseling for 2 years after medications were stopped had lower rates of relapse.
• Eating a balanced diet.
• Getting regular exercise.
• Seeking treatment immediately when you first notice new symptoms of depression—or symptoms that are getting worse—such as feelings of hopelessness or sadness or loss of interest or pleasure in most activities.
• Maintaining a regular sleep pattern.
• Avoiding drugs and alcohol.

It is difficult to prevent all recurrences of depression. However, you may be able to prevent or reduce the severity of future episodes. If you are on a maintenance dose of medication to treat ongoing depression, be sure to take all of your medications as directed by your health professional. Keep your counseling appointments. Seek help when you notice the first symptoms of depression, especially if your depressive episodes are moderate to severe.

Family therapy may help you and those who care about you deal with depression.

Electroconvulsive therapy (ECT) may be used for those who cannot take antidepressant medications, who have not responded to other treatments, or whose depression is severe and includes symptoms of psychosis, suicidal behavior, or an inability to eat.⁸

Other Treatment Choices

Counseling is an important part of the treatment for depression. The types of counseling most often used for treatment of depression include:

• Cognitive-behavioral therapy, which teaches a person how to become healthier by modifying certain thought and behavior patterns. This type of therapy can be provided individually or in a group setting.
• Interpersonal therapy, which focuses on social and personal relationships and related problems.
• Problem-solving therapy, which focuses on the problems you are currently facing and on helping you find solutions to those problems.
• Family therapy, which involves the entire family.

Electroconvulsive therapy (ECT) may be used to treat severe depression or depression that has not responded well to medications and counseling. ECT also may be a treatment choice for someone who cannot tolerate the side effects of antidepressant medications. Modern ECT treatments consist of mild electric brain stimulation while you are unconscious (under general anesthetic) and are an effective treatment for depression. Side effects of ECT include memory loss and confusion.

Complementary therapies

• The herb St. John’s wort has been shown to work for mild to moderate depression, but it can interact with other medications.
• Fish oil containing omega-3 fatty acids is currently being studied for possible antidepressant effects.
• SAM-e ( S-adenosylmethionine), a substance that occurs naturally in plant and animal cells, is sometimes used to treat depression. Some studies show SAM-e may help with symptoms of depression, but more studies are needed to determine its safety and effectiveness.

What To Think About

ECT

Deciding whether to try electroconvulsive therapy (ECT) can be difficult. Although ECT can be a very effective treatment for depression, you may experience short-term memory loss, confusion, nausea, headaches, and jaw pain for several hours—and sometimes even several days—after the procedure. For some people, ECT may cause long-term memory loss. For more information, see electroconvulsive therapy (ECT).

St. John’s wort

St. John’s wort is being tested in the United States to determine its safety and effectiveness. So far, the results have been mixed. Some negative and dangerous interactions between St. John’s wort and certain medications have been discovered. Make sure your doctor has a complete list of all the medicines you are taking.

• Let your health professional know if you are using St. John’s wort, especially if you are taking other medications.
• Avoid taking St. John’s wort along with other antidepressants, because you could overmedicate yourself and have serious side effects.

Because St. John’s wort is not currently regulated by the U.S. Food and Drug Administration (FDA), its quality—and effectiveness—may vary.

Omega-3 fatty acids

There is limited evidence that a small daily dose of omega-3 fatty acids may be beneficial either alone or when combined with an antidepressant. Although benefits for depression are still inconclusive, research does show that taking omega-3 fatty acids can help fight other health problems, including arthritis and cardiovascular disease.

The American Heart Association (AHA) recommends eating fish at least twice per week, plus other omega-3 rich foods. For people with heart disease, the AHA suggests additional fish oil supplements if your health professional thinks it is a good idea.

• Set realistic goals for yourself, and take on a reasonable amount of responsibility.
• Break large tasks into small ones, and set priorities. Do what you can when you are able.
• Postpone major life decisions (such as changing jobs, moving, or getting married or divorced) when you are depressed.
• Try to share your feelings with someone. It is usually better than being alone and secretive.
• Let your family and friends help you.
• Even if you don’t feel motivated, try to participate in religious, social, or other activities.
• Get regular exercise.
• Eat a balanced diet. If you lack an appetite, eat small snacks rather than large meals.
• Avoid drinking alcohol or using illegal drugs or medications that have not been prescribed to you. They may interfere with your medications or make your depression worse.
• Get adequate sleep. If you have problems sleeping:
  • Go to bed at the same time every night and, more importantly, get up at the same time every morning.
  • Keep your bedroom dark and free of noise.
  • Don’t exercise after 5:00 p.m.
  • Avoid caffeinated beverages after 5:00 p.m.
  • Avoid the use of nonprescription sleeping pills or alcohol, because they can make your sleep restless and may interact with your depression medications.
• Be patient and kind to yourself. Remember that depression is not your fault and is not something you can overcome with willpower alone. Treatment is necessary for depression, just like for any other illness.
• Try to maintain a positive attitude—remember that feeling better takes time, and your mood will improve little by little.

Helping someone who is depressed

If you know someone who is depressed, it is important to be supportive and encouraging. If you have never experienced it, it is difficult to understand just how hopeless and discouraged depression can make you feel. Remember that depression can be as disabling as other major illnesses and can make it difficult to fulfill social, family, and work obligations. Like other illnesses, depression requires treatment, time, and patience.

Avoid offering advice, but encourage the person to seek and continue treatment. You do not need to take responsibility for the person’s depression. However, if you notice any warning signs of suicide, such as talking about suicide or harming someone else, signs of detachment from reality (psychosis), or excessive use of alcohol or drugs, you should seek professional help immediately by calling the person’s health professional. If you feel the person is in immediate danger, call 911 or other emergency services immediately.

Depression can lead to suicide. The warning signs of suicide change with age.

• Warning signs of suicide in children and teens may include preoccupation with death or suicide or a recent breakup of a relationship.
• Warning signs of suicide in adults may include alcohol or substance abuse, recent job loss, or divorce.
• Warning signs of suicide in older adults may include the recent death of a partner or diagnosis of a life-limiting illness.

Depression is a serious mood disorder that can take the joy from a child’s life. It is normal for a child to be moody or sad from time to time. You can expect these feelings after the death of a pet or a move to a new city. But if these feelings last for weeks or months, they may be a sign of depression.

Experts used to think that only adults could get depression. Now we know that even a young child can have depression that needs treatment to improve. As many as 3 in 100 young children and 9 in 100 teens have serious depression.

Still, many children don’t get the treatment they need. This is partly because it can be hard to tell the difference between depression and normal moodiness. Also, depression may not look the same in a child as in an adult.

If you are worried about your child, learn more about the symptoms in children. Talk to your child to see how he or she is feeling. If you think your child is depressed, talk to your doctor or a counselor. The sooner a child gets treatment, the sooner he or she will start to feel better.

What are the symptoms?

A child may be depressed if he or she:

• Is grumpy, sad, or bored most of the time.
• Does not take pleasure in things he or she used to enjoy.

A child who is depressed may also:

• Lose or gain weight.
• Sleep too much or too little.
• Feel hopeless, worthless, or guilty.
• Have trouble concentrating, thinking, or making decisions.
• Think about death or suicide a lot.

The symptoms of depression are often overlooked at first. It can be hard to see that symptoms are all part of the same problem.

Also, the symptoms may be different depending on how old the child is.

• Very young children may lack energy and become withdrawn. They may show little emotion, seem to feel hopeless, and have trouble sleeping.
• Grade school children may have a lot of headaches or stomachaches. They may lose interest in friends and activities that they once liked. Some children with severe depression may see or hear things that aren’t there (hallucinate) or have false beliefs (delusions).
• Teens may sleep a lot or move or speak more slowly than usual. Teens with severe depression may hallucinate or have delusions.

Depression can range from mild to severe. A child who feels a little “down” most of the time for a year or more may have a mild, ongoing form of depression called dysthymia (say “dis-THY-mee-uh”). In its most severe form, depression can cause a child to lose hope and want to die.

Whether depression is mild or severe, there are treatments that can help.

What causes depression?

Just what causes depression is not well understood. But it is linked to an imbalance of brain chemicals that affect mood. Things that may cause these chemicals to get out of balance include:

• Stressful events, such as changing schools, going through a divorce, or having a death in the family.
• Some medicines, such as steroids or narcotics for pain relief.
• Family history. In some children, depression seems to be inherited.

How is depression diagnosed?

To diagnose depression, a doctor may do a physical exam and ask questions about the child’s past health. You may be asked to fill out a form about your child’s symptoms. The doctor may ask your child questions to learn more about how the child thinks, acts, and feels.

Some diseases can cause symptoms that look like depression. So the child may have tests to help rule out physical problems, such as a low thyroid level or anemia.

It is common for children with depression to have other problems too, such as anxiety, attention deficit hyperactivity disorder (ADHD), or an eating disorder. The doctor may ask questions about these problems to help your child get the right diagnosis and treatment.

How is it treated?

Usually one of the first steps in treating depression is education for the child and his or her family. Teaching both the child and the family about depression can be a big help. It makes them less likely to blame themselves for the problem. Sometimes it can help other family members see that they are also depressed.

Counseling may help the child feel better. The type of counseling will depend on the age of the child. For young children, play therapy may be best. Older children and teens may benefit from cognitive-behavioral therapy. This type of counseling can help them change negative thoughts that make them feel bad.

Medicine may be an option if the child is very depressed. Combining antidepressant medicine with counseling often works best. A child with severe depression may need to be treated in the hospital.

There are some things you can do at home to help your child start to feel better.

• Urge your child to get regular exercise, eat a healthy diet, and get enough sleep.
• See that your child takes any medicine as prescribed and goes to all follow-up appointments.
• Make time to talk and listen to your child. Ask how he or she is feeling. Express your love and support.
• Remind your child that things will get better in time.

What should you know about antidepressant medicines?

Antidepressant medicines often work well for children who are depressed, but there are some important things you should know about them.

• Children who take antidepressants should be watched closely. These medicines may increase the risk that a child will think about or try suicide, especially in the first few weeks of use. If your child takes an antidepressant, learn the warning signs of suicide, and get help right away if you see any of them. Common warning signs include:
  • Talking, drawing, or writing about death.
  • Giving away belongings.
  • Withdrawing from family and friends.
  • Having a way to do it, such as a gun or pills.
• Your child may start to feel better within 1 to 3 weeks of taking antidepressant medicine. But it can take as many as 6 to 8 weeks to see more improvement. Make sure your child takes antidepressants as prescribed and keeps taking them so they have time to work.
• A child may need to try several different antidepressants to find one that works. If you notice any questions or have concerns about the medicine, or if you do not notice any improvement by 3 weeks, talk to your child’s doctor.
• Do not let a child suddenly stop taking antidepressants. This could be dangerous. Your doctor can help you taper off the dose slowly to prevent problems.

Key points in making your decision

You may be taking medicine for depression and are wondering if you should stop because you are pregnant or planning to become pregnant. Or maybe you just found out that you have depression and are wondering if you should start taking medicine, even though you are pregnant. Consider the following when making your decision:

• Certain types of antidepressants are less likely to harm your baby than others. More research is needed before doctors can say for sure that any antidepressant is completely safe for the baby.
• If you don’t treat your depression, it could harm your baby. People who are depressed can have a hard time caring for themselves. And after your baby is born, you may be more likely to suffer from postpartum depression, which can cause serious problems for both you and your newborn.
• The decision about whether to take antidepressants while you are pregnant depends a lot on how bad your symptoms are. Talk to your doctor, and compare the risks of taking the medicine with the risks of living with your symptoms.
• If you were taking medicine for depression before you got pregnant, stopping now could cause your symptoms to come back. Also, quitting antidepressants suddenly can cause you to feel like you have the flu. Talk to your doctor first.

Wise Health Decision

Use this worksheet to help you make your decision. After completing it, you should have a better idea of how you feel about taking antidepressants while pregnant. Discuss the worksheet with your doctor.

Circle the answer that best applies to you.

Use the following space to list any other important concerns you have about this decision.

What is your overall impression?

Your answers in the above worksheet are meant to give you a general idea of where you stand on this decision. You may have one overriding reason to use or not use antidepressants during your pregnancy.

Check the box below that represents your overall impression about your decision.

If your depressed feelings have lasted more than 2 weeks, your body isn’t recovering from childbirth as expected. Postpartum depression:

• Is very common, affecting 1 in every 8 women during the first months of their babies’ lives.
• Is a serious medical condition that can be prolonged and disabling without treatment and can affect a baby’s development.
• Is best treated with counseling and an antidepressant medication.
• Can further improve when you take some home treatment measures.

To prevent serious problems for you and your baby, now is the time to work with your health professional to treat your symptoms.

If you are having thoughts of hurting yourself, your baby, or anyone else, see your health professional immediately or call 911 for emergency medical care.

What is postpartum depression?

Postpartum depression is more than a temporary feeling of sadness or lack of energy—it is a medical condition that develops some time in the first several months after childbirth. It seems to be triggered by the normal hormonal changes that occur after pregnancy. These hormonal changes are especially likely to lead to postpartum depression if you’ve had depression before; have poor support from your partner, friends, or family; or are under significant additional stress.

You probably have postpartum depression if you’ve had five or more of the following symptoms (including at least one of the first two symptoms) for most of each day over the past 2 weeks:

1. Depressed mood—tearfulness, hopelessness, and feeling empty inside, possibly with severe anxiety
2. A significant loss of pleasure in either all or almost all of your daily activities
3. Appetite and weight change—usually a drop in your appetite and weight, but sometimes the opposite
4. Sleep problems—usually insomnia, even when your baby is sleeping
5. Noticeable changes in how you walk and talk—usually restlessness, but sometimes sluggishness
6. Extreme fatigue or loss of energy
7. Feeling worthless or having inappropriate guilt
8. Difficulty concentrating and making decisions
9. Thinking a lot about death or suicide

If you think you have postpartum depression after reviewing this list, print the list and circle those symptoms that apply to you, then take the list to your health professional.

• Call your doctor.
• Call 911 or go to a hospital emergency room to get immediate help or ask a friend or family member to help you do these things.
• Call the toll-free, 24-hour hotline of the National Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-8255); TTY: 1-800-799-4TTY (4889) to talk to a trained counselor.
• Make sure you or the suicidal person is not left alone.

Mental Health Resources:

• Mental health specialists, such as psychiatrists, psychologists, social workers, or mental health counselors
• Health maintenance organizations
• Community mental health centers
• Hospital psychiatry departments and outpatient clinics
• Mental health programs at universities or medical schools
• State hospital outpatient clinics
• Family services, social agencies or clergy
• Peer support groups
• Private clinics and facilities
• Employee assistance programs
• Local medical and/or psychiatric societies
• You can also check the phone book under “mental health,” “health,” “social services,” “hotlines,” or “physicians” for phone numbers and addresses. An emergency room doctor also can provide temporary help and can tell you where and how to get further help.