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Any mother who entertains suicidal thoughts after she just had a baby — whether actively or vaguely — is in crisis and needs help right away. How do suicidal thoughts fit into the clinical picture of postpartum depression?

Lots of new mothers go through ups and downs after their babies are born — they'll be tired and unable to catch up on their sleep, might feel like crying all the time, find it difficult to concentrate, and could be both overwhelmed by the everyday responsibilities of new motherhood and worried that they're not a good parent. The hormonal, physical and emotional changes that occur after giving birth mean that as many as seven in 10 mothers experience this "mini depression", known as the Baby Blues [1]. 

 

An estimated 10 to 20 percent will not recover from this trying but nonetheless normal phenomenon that typically passes after a few weeks, and will instead sink into full-blown postpartum depression or anxiety [2]. 

 

One study found that 3.8 percent of women with postpartum depression entertained suicidal thoughts, but only 1.1 percent of that group was identified as being at high risk of attempting it [3]. It is important to recognize that while suicidal thoughts or general thoughts about dying strike a significant minority of women with postpartum depression, those whose thoughts become more targeted — actively planning how and where to commit suicide and obtaining the means to achieve this — are at the highest risk. 

How Do Suicidal Thoughts Fit Into The Clinical Picture Of Postpartum Depression?

In order to meet the diagnostic criteria of major depression, including postpartum depression [4], an individual has to experience at least five of the following symptoms, on most days for a period of at least two weeks:

  • A depressed mood.
  • Feelings of guilt or worthlessness.
  • Loss of motivation, interest or pleasure, including in activities they previously very much enjoyed.
  • Sleep disturbances: insomnia or hypersomnia (sleeping a lot).
  • Appetite changes and accompanied weight fluctuations.
  • Fatigue and low energy.
  • Noticeable changes in physical functions such as speech and movement.
  • A lack of concentration.
  • Feeling suicidal or experiencing intrusive thoughts about death.

Suicidal thoughts in the postpartum period are a definite sign of postpartum depression or even postpartum psychosis, the most severe form of postpartum depression that can cause hallucinations and delusions [5, 6], but these intrusive thoughts can take on different forms.

 

Some mothers are so depressed and exhausted that they do not feel they can carry on in the same way, and their thoughts about death are more the result of utter desperation than of truly wishing to die. Some mothers are caught in the web of anxiety and are so worried about their ability to be a good parent that they start thinking their child might be better off without them, leading to suicidal thoughts.

 

A small subset of women with postpartum depression actively wish to die and make plans to end their lives. 

New mothers who are feeling suicidal are also likely to entertain thoughts about harming their babies, and could be at risk of filicide even without active intent to kill their babies [7]. Many new mothers find it hard to disclose these thoughts to healthcare providers even when they are willing to talk about their suicidal thoughts [8], which is understandable considering the stigma around infanticidal thoughts. However, these thoughts, too, are part of an overall clinical picture and disclosing them will enable healthcare providers to gain deeper insights into the extent of the depression. 

Are You Experiencing Postpartum Suicidal Thoughts, Or Is Someone You Love?

If you are experiencing intrusive thoughts about death or harming your baby, or are actively suicidal, one thing is clear: you need help now. Women with postpartum depression who are at risk of suicide or who are dealing with suicidal thoughts need inpatient treatment for their depression [9], and the same holds true for new mothers are struck by thoughts of harming their babies. 

Navigating referrals may be difficult for women in crisis and their families — in this situation, you need help for suicidal thoughts immediately, rather than thinking about where you or your loved one might get the treatment they need. A suicide or depression hotline, such as the National Suicide Prevention Hotline in the United States (call 1-800-273-8255) is a good place to reach out for help, but calling 911 is also warranted. 

Research shows that inpatient treatment significantly improves postpartum depression signs, anxiety and suicidal thoughts in postpartum mothers [10], and it is also worth noting that mother-baby psychiatric units are available in many countries. Even after discharge, these mothers will almost certainly continue to benefit from a combination of psychotherapy and antidepressant medication, in addition to day-to-day support offered by their social networks. 

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