6 Potential Triggers for Your Postpartum Depression

Paying attention to what’s happening on your better and worse days can help make those fluctuations feel less mysterious. Once you start noticing patterns, you can bring them to your healthcare provider and work together on ways to address triggers that may be making your symptoms worse.

Common Triggers to Look Out For

There usually isn’t one single factor behind PPD. Instead, a combination of biological, psychological, and social factors may increase your risk or aggravate existing symptoms, says Lulu Zhao, MD, an obstetrician-gynecologist and a codirector of women's behavioral health at Cleveland Clinic in Ohio, where she specializes in mood disorders during key reproductive transitions, such as pregnancy and postpartum.

“PPD isn't like you broke your leg. There's not one thing that happened that caused you to become depressed or anxious. It usually is an accumulation of these various risk factors that cause it to happen,” Dr. Zhao says. “Certainly, the more stressors you have, the more symptomatic you are likely to become. We all have some level of natural coping ability, but sometimes when the stressors we have overwhelm that, we're going to have symptoms.”

Here are some potential contributing factors.

1. History of Depression or Anxiety

A history of depression, anxiety, or other mental health conditions is one of the strongest risk factors for PPD, says Milicent Fugate, MD, a reproductive psychiatrist and the director of the day program at the Motherhood Center in New York City, where she specializes in treating people who are pregnant, postpartum, or trying to become pregnant.

2. Difficult Pregnancy or Traumatic Childbirth

“If you had a significant medical issue — you became septic, you went to the ICU, or you developed a serious medical complication, that is a huge risk factor for developing a postpartum [depressive] episode. Not only because of just the stress of knowing that you were critically ill and could die, but also just the physical illness itself can make you more prone to a mood disorder,” Zhao says.

Perception is key. While your pregnancy and childbirth may have been relatively routine according to medical standards, your experience is what matters, Dr. Fugate says. “It can bring up feelings of like, ‘Am I safe? Is my baby safe?’ This chronically elevated sense of fear, fight or flight — that can be quite difficult in the postpartum period.”

3. Hormonal Changes

4. Sleep Deprivation

“When you have that chronic lack of sleep because you’re caring for an infant, it impairs your emotional regulation and it makes your ability to cope with stress even [less effective].”

5. Isolation, Loneliness or Lack of Social Support

Fugate says having a “village” — whether that includes a partner, relatives, friends, or paid help — can make a meaningful difference in how someone fares during the postpartum period.

“You're not going to get better unless you have that practical help, or it’s going to take longer. We need assistance with the feeding, the diaper changes, the chores,” a board member of Postpartum Support International and the associate director of social work in the women’s and children’s division at Mount Sinai Hospital in New York City.

A lack of support is also a compounding factor that overlaps with other stressors, such as financial difficulties or caring for multiple children, Zhao says.

6. Major Life Stressors

“If you’re someone that's having financial problems, you're moving, you lost your job, you're having issues with your partner or other family members, that can increase those feelings of loneliness and also emotional exhaustion,” Burgos says.

Track Your Triggers

Keeping track of your symptoms, sleep, and stress levels can give you useful information to share with your therapist, psychiatrist, obstetrician-gynecologist, or another healthcare provider, Burgos says.

Burgos suggests tracking your daily activities and symptom severity at several points throughout the day for three days. This will give you an idea of when symptoms are worse, versus when they’re better, which she says is important because any information gathered by tracking makes it easier for your doctor to figure out the best way to help.

Burgos says she asks her patients about whether symptoms are worse in the morning or evening, what they were doing that day, and whether they had any support or stressful interactions. That snapshot may help your healthcare team notice practical patterns, such as symptoms that consistently worsen when you’re alone or improve when someone comes over to help, for example.

How to Avoid Your Triggers

Some PPD risk factors, such as hormonal sensitivity or a traumatic birth, can’t be avoided. But once you identify factors that appear to worsen your symptoms, you and your healthcare team can look for ways to reduce their impact.

If sleep is a problem, Fugate says that may mean finding someone who can care for the baby so you can get a longer stretch of rest, or discussing persistent insomnia with your healthcare provider. If you’re forgetting to eat and stay hydrated, strategies may be as simple as setting phone reminders for yourself or having easy-to-reach-for foods readily available.

“I can give you all the meds in the world, but if you're not sleeping, and if you're not getting food and water in you, we're really not going to see the results that we want,” Fugate says.

If isolation is a trigger for you, practical support can matter just as much. Burgos recommends looking for opportunities for someone else — a partner, family member, friend, or paid caregiver — to care for the baby while you eat, nap, take a walk, call a friend, or simply get some uninterrupted time to yourself.

Questions to Ask Your Doctor

Talk to your healthcare provider instead of trying to interpret potential triggers on your own. Together, you can determine whether certain things, such as a difficult pregnancy, lack of sleep, or relationship difficulties, are factors, and whether your treatment plan, support system, or daily routine needs to change.