Q: “What Causes Postpartum Depression?”

Q: “What are the causes of postpartum depression? As an expectant parent with ADHD, what should I know about factors that increase risk for postpartum mood disorders? How can I protect myself after I have my baby?”

---

The causes of postpartum depression (PPD) and postpartum mood disorders are complex and combine differing sources for different people. These sources are not always fully understood. Genetic and biological factors, including dramatic hormonal fluctuations after birth, are thought to play a major role. However, hormones or biology alone do not fully explain why someone might develop a postpartum mood distress or disorder. While no parent is immune to developing PPD or other postpartum mood disorders, the following psychological and psychosocial factors are known to increase risk for these conditions: ^{1 2 3 4}

• a history of depression or anxiety
• experiencing depressive/anxious/high stress symptoms during pregnancy
• a history of trauma
• a history of significant mood changes during menstruation
• a history of significant reactions to sleep deprivation
• an unwanted pregnancy
• a lack of social supports, particularly stress in a primary parenting partner relationship
• social isolation
• a lack of access to basic needs
• low socioeconomic status

[Take This Self-Test: Signs of Postpartum Depression]

Black women and individuals of other ethnic and racial groups who have been historically under-resourced and overlooked also face higher risk for postpartum depression, largely because of expressed concerns not being adequately tended to by the helping professions. ^{5 6}

The ADHD-Postpartum Depression Link

Recent studies show that ADHD is a risk factor for PPD. A 2023 study found that mothers with ADHD, even those without a history of depression, are 24% more likely to be diagnosed with PPD than are mothers without ADHD.⁷ This link may be partly explained by increasing rates of first-time diagnosis of ADHD among adults, and among women in particular of childbearing age ⁸, which is likely contributing to better identification of individuals with ADHD who have developed postpartum depression.

Another 2023 study of more than 773,000 women who gave birth found that about 25% of women with ADHD were diagnosed with anxiety disorders postpartum compared to 4.6% of women without ADHD. In addition, about 17% of women with ADHD had PPD compared to 3.3% of women without ADHD.⁹ Researchers are still working to understand what underscores the disproportionate link between postpartum depression and ADHD. Both ADHD and postpartum depression and anxiety disorders represent challenges in self-regulation.

Frequent Screenings Are Key for Postpartum Parents

Though about one in eight women or birthing parents — and as many as one in 10 fathers or caregiving partners — develop a postpartum mood disorder, ^{6 10} these conditions are still largely overlooked. In a live ADDitude webinar poll, about 70% of respondents said their doctor missed their symptoms of postpartum depression. In a separate poll, about 45% of ADDitude readers said they wouldn’t be able or aren’t sure if they’d be able to identify postpartum depression in themselves or in others.

[Free Download: The Facts About Major Depressive Disorder in Women]

Frequent screenings are the most powerful tool for early detection of PPD and other postpartum mood disorders. Early detection is important to curb the development of severe forms of postpartum mood disorders. While postpartum mood disorders typically onset within three weeks of a child’s birth, they can develop through the first postpartum year. Screenings, therefore, should occur all through the first year after childbirth. Like most women and birthing parents, you likely won’t see your OB-GYN after your six-week postpartum appointment. In that case, your primary care provider and pediatrician should screen you.

At the same time, it’s critical that you know the signs of PPD and other postpartum mood disorders. Do not wait to talk to your doctor(s) if you think you show any of the signs. Insist on formal screeners, especially if you have a risk factor for PPD.

Postpartum Depression: Next Steps

• Free Download: Hormones & ADHD in Women
• Read: Postpartum Care for Mothers with ADHD
• Read: Healing Through Parenting — The Key to Postpartum Depression Recovery

The content for this article was derived from the ADDitude ADHD Experts webinar titled, “The Unspoken Truths of Postpartum Depression: Help for Women With and Without ADHD” [Video Replay & Podcast #470] with Jayne Singer, Ph.D., IECMH-E®, which was broadcast on September 7, 2023.

---

SUPPORT ADDITUDE
Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.

Sources

¹ Stewart, D. E., & Vigod, S. N. (2019). Postpartum Depression: Pathophysiology, Treatment, and Emerging Therapeutics. Annual Review of Medicine, 70, 183–196. https://doi.org/10.1146/annurev-med-041217-011106

² Beck C. T. (2002). Revision of the postpartum depression predictors inventory. Journal of Obstetric, Gynecologic, and Neonatal Nursing : JOGNN, 31(4), 394–402. https://doi.org/10.1111/j.1552-6909.2002.tb00061.x

³ Buttner, M. M., Mott, S. L., Pearlstein, T., Stuart, S., Zlotnick, C., & O’Hara, M. W. (2013). Examination of premenstrual symptoms as a risk factor for depression in postpartum women. Archives of Women’s Mental Health, 16(3), 219–225. https://doi.org/10.1007/s00737-012-0323-x

⁴ Choi, K. W., Houts, R., Arseneault, L., Pariante, C., Sikkema, K. J., & Moffitt, T. E. (2019). Maternal depression in the intergenerational transmission of childhood maltreatment and its sequelae: Testing postpartum effects in a longitudinal birth cohort. Development and psychopathology, 31(1), 143–156. https://doi.org/10.1017/S0954579418000032

⁵ Onyewuenyi, T. L., Peterman, K., Zaritsky, E., Ritterman Weintraub, M. L., Pettway, B. L., Quesenberry, C. P., Nance, N., Surmava, A. M., & Avalos, L. A. (2023). Neighborhood Disadvantage, Race and Ethnicity, and Postpartum Depression. JAMA network open, 6(11), e2342398. https://doi.org/10.1001/jamanetworkopen.2023.42398

⁶ Bauman, B. L., Ko, J. Y., Cox, S., D’Angelo Mph, D. V., Warner, L., Folger, S., Tevendale, H. D., Coy, K. C., Harrison, L., & Barfield, W. D. (2020). Vital Signs: Postpartum Depressive Symptoms and Provider Discussions About Perinatal Depression – United States, 2018. MMWR. Morbidity and mortality weekly report, 69(19), 575–581. https://doi.org/10.15585/mmwr.mm6919a2

⁷ Bartelt K, Piff A, Vitek G, Barkley E. Maternal ADHD Correlated with Increased Risk of Postpartum Depression. Epic Research. https://epicresearch.org/articles/maternal-adhd-correlated-with-increased-risk-of-postpartum-depression.

⁸ Russell J, Franklin B, Piff A, Allen S, Barkley E. Number of ADHD Patients Rising, Especially Among Women. Epic Research. https://epicresearch.org/articles/number-of-adhd-patients-rising-especially-among-women. Accessed on March 18, 2024.

⁹ Andersson, A., Garcia-Argibay, M., Viktorin, A., Ghirardi, A., Butwicka, A., Skoglund, C., Bang Madsen, K., D’onofrio, B.M., Lichtenstein, P., Tuvblad, C., and Larsson, H. (2023). Depression and Anxiety Disorders During the Postpartum Period in Women Diagnosed with Attention Deficit Hyperactivity Disorder. Journal of Affective Disorders. https://doi.org/10.1016/j.jad.2023.01.069

¹⁰ Paulson, J. F., & Bazemore, S. D. (2010). Prenatal and postpartum depression in fathers and its association with maternal depression: a meta-analysis. JAMA, 303(19), 1961–1969. https://doi.org/10.1001/jama.2010.605

Removed