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Postpartum Depression & Anxiety: who to see and what helps

Postpartum Depression & Anxiety · Kitchener, Waterloo & Cambridge

Postpartum depression is depression in the first year after a birth: deeper and longer-lasting than the “baby blues”, and often mixed with anxiety. Canada’s 2024 guideline makes talking therapies such as cognitive behavioural therapy (CBT) a first-line treatment; medication is typically needed when depression is severe, and moderate depression can go either way. At CARESPACE you start with a counsellor, a Registered Psychotherapist or Registered Social Worker, alongside your physician, midwife or nurse practitioner. If you have thoughts of harming yourself or your baby, go to the urgent section now.

What postpartum depression is

The baby blues are common: a few days after the birth you may feel restless and tense, sad and teary, or overwhelmed, and those feelings usually ease within a couple of weeks. Postpartum depression usually starts within the first month, can appear at any time in the first year, and for some people begins during pregnancy.

Postpartum depression is common too. The Canadian guideline puts clinically significant depressive symptoms after a birth at up to 19%, and a major depressive episode at 7%.

Anxiety can come with the depression or on its own, often as recurring intense worry or a disabling fear that is hard to control. See Anxiety, and Trauma & PTSD if a difficult birth keeps coming back to you.

Symptoms of postpartum depression

You may:

  • Feel like you cannot get out of bed
  • Feel sad, worthless, anxious or guilty
  • Cry more than usual
  • Have trouble concentrating
  • Feel irritable or numb
  • Have frequent mood swings
  • Feel very tired or restless
  • Sleep more or less than usual, including being unable to sleep when you get the chance
  • Eat more or less than usual
  • Lose interest in things you used to care about
  • Have difficult feelings about your baby, or trouble bonding
  • Have nightmares or scary thoughts
  • Have thoughts of death or suicide

Tiredness and broken sleep are hard to judge on their own, because both are normal with a newborn.

What causes postpartum depression

There is no single cause. The strongest risk factor is having had depression before, including in an earlier pregnancy, and a lack of social support and stressful life events are major ones. A premature or unwell baby, twins or more, relationship problems, and domestic violence or abuse also raise the risk.

How it is diagnosed

A physician or nurse practitioner can make the diagnosis, and the symptoms have to meet the same criteria as depression at any other time of life. You may be given a short questionnaire such as the Edinburgh Postnatal Depression Scale, and a thyroid test and a blood count or ferritin level can help rule out thyroid disease or low iron.

You do not have to wait to be asked. If something does not feel right, talk to your health care provider as soon as you can.

When it is urgent

Call 911 if you have thoughts of harming yourself or your baby, or if your life or someone else’s life is in danger. Frightening thoughts or images of harm coming to the baby are common after a birth, and Canada’s guideline says that in most cases they are intrusive and unwanted, with no intent or desire to harm the baby, and do not represent a safety concern: tell your physician, nurse practitioner, midwife or counsellor about those. If you think you might act on a thought, or you cannot tell which kind it is, call 911.

Call 911 as well if you have shortness of breath, chest pain or a seizure, if you cough up blood, or if you faint or pass out. The other physical warning signs after a birth, and what to do about each, are set out on Postpartum Recovery.

Postpartum psychosis is a medical emergency. It is rare, about one or two in every 1,000 births, and usually starts suddenly in the first two weeks after the birth. The signs are hallucinations (hearing, seeing, smelling or feeling things that are not there); delusions (suspicions, fears or beliefs that are unlikely to be true); mania (feeling very “high” or overactive, talking and thinking too much or too quickly); a low mood, being withdrawn or tearful; lacking energy, loss of appetite, anxiety, agitation or trouble sleeping; a mixture of high and low mood; and feeling very confused. The person may not realise they are ill. If you or someone close to you suspects it, go to an emergency department right away. The person should not be left alone, or alone with the baby.

If you are thinking about suicide, or you do not feel safe, do not wait for an appointment: use the numbers below.

If you are in crisis or thinking about suicide, help is available right now.

  • Call or text 9-8-8, the Suicide Crisis Helpline, at any hour.
  • Call Here 24/7 at 1-844-437-3247 for addictions, mental health and crisis services in Waterloo Region, at any hour. here247.ca
  • Call 911 or go to the nearest emergency department if you or someone else is in immediate danger.

The emergency departments in Waterloo Region are:

  • WRHN @ Midtown (formerly Grand River Hospital), 835 King St. W., Kitchener
  • WRHN @ Queen’s Blvd. (formerly St. Mary’s General Hospital), 911 Queen’s Blvd., Kitchener
  • Cambridge Memorial Hospital, 700 Coronation Blvd., Cambridge

If you cannot get there safely, call 911.

What the evidence says about treating postpartum depression

  • The source and its labels. Most of this comes from the 2024 guideline of the Canadian Network for Mood and Anxiety Treatments (CANMAT) for pregnancy and the first year after a birth. “First-line” means good trial evidence plus the panel’s support; second-line and third-line rest on weaker evidence.
  • Talking therapy first. CBT, interpersonal therapy, behavioural activation and mindfulness-based therapies are all first-line, typically weekly and often for 4 to 16 sessions. Peer support is first-line too. For anxiety in this period, CBT and mindfulness-based therapies are first-line as well.
  • Severity decides about medication. Mild depression can often be managed without it, and severe depression will not generally respond adequately to psychological treatment alone. Moderate depression can go either way: the guideline makes psychological treatment a first-line option for it and also says medication is typically needed, so that choice is made with a prescriber.
  • Antidepressants and breastfeeding. During breastfeeding the guideline’s first-line choices are citalopram, escitalopram and sertraline.
  • Exercise helps, with supervision. Low to moderate intensity exercise is first-line: aerobic exercise has brought small to medium reductions in symptoms, in trials of low to moderate quality, and the guideline says it should be supervised. Canada’s postpartum activity guideline recommends beginning or returning to moderate-to-vigorous activity in the first 12 weeks to support mental health.
  • Sleep and light. Protecting sleep is recommended on expert opinion, the lowest level of evidence: a partner, relative, doula or night nurse takes some or all of the night feeds. Bright light therapy is first-line after a birth, with a small-to-moderate effect.
  • Supplements: mostly no. St John’s wort is not recommended in pregnancy or while breastfeeding. Folic acid, iron and other micronutrients are not recommended as a way to prevent or treat depression, whatever their other uses. Omega-3 trials have had mixed results, vitamin D is second-line on the strength of a single positive trial, and saffron is third-line on one small trial at very high risk of bias.

What a doctor may offer

Antidepressants, the mainstay of medication after a birth, are prescribed and monitored by a physician, nurse practitioner or psychiatrist. The guideline also recommends repetitive transcranial magnetic stimulation as an add-on, and electroconvulsive therapy for severe cases; CARESPACE provides neither.

How each CARESPACE service helps with postpartum depression

Counselling & Psychotherapy

CARESPACE counsellors offer cognitive behavioural therapy (CBT), one of the four first-line therapies. Interpersonal therapy, behavioural activation and mindfulness-based therapy are separate methods, so if you want one of those, ask when you book for a counsellor trained in it. Partners can book as well: the guideline asks clinicians to be attentive to a co-parent’s mental health, although it found no trials of treatment for depression in fathers.

See our counselling team →

Nurse Practitioner

In Ontario a Nurse Practitioner can take a full health history, make a diagnosis, order laboratory tests and prescribe. For postpartum depression that covers the diagnosis itself, the thyroid and iron checks, and an antidepressant when one is needed, including while you are breastfeeding.

See our nurse practitioner team →

Physiotherapy

A physiotherapist does not treat depression. The guideline says exercise for depression should be supervised, without saying by whom; a physiotherapist can supervise it. A pelvic health physiotherapist can assess the pelvic floor and abdominal wall after a birth and set out a gradual return to activity that follows your symptoms. An internal examination is always your choice.

About pelvic health physiotherapy →

See our physiotherapy team →

Other services people ask about

Acupuncture. Second-line in the Canadian guideline, as an addition to standard care and not a replacement for it. Yoga. Also second-line. Massage Therapy. The guideline’s evidence for massage in depression comes from pregnancy, for mild episodes. Naturopathic Medicine. A Naturopathic Doctor can assess and help with sleep problems. Talk to a pharmacist, physician or nurse practitioner before taking any supplement, particularly if you are breastfeeding or taking an antidepressant. Nutrition. No diet or nutrient is recommended as a treatment.

Where most people start

With a counsellor, and with a word to your physician, midwife or nurse practitioner: the federal guide for new parents calls getting medical help the most important thing you can do to feel better. If your symptoms are severe, do not wait for counselling to begin before seeing one of them.

How your team works together

Mild postpartum depression may need only a counsellor and more support at home. Severe depression needs a prescriber as well, either a Nurse Practitioner or your own physician, and moderate depression may. A physiotherapist comes in when you are ready to get moving again.

Browse by service: counselling, nurse practitioner and physiotherapy.

What to expect at your first visit

A counsellor is your first visit. They work to understand what you are dealing with and come up with a plan. Share as much as you are comfortable with. Questions may cover:

  • How you have been feeling, and for how long.
  • Sleep, appetite and energy.
  • The birth and since, and who is helping at home.
  • Before this. Any earlier depression or anxiety, and what helped.

If you would like to bring your baby, ask when you book.

What you can do at home

  • Talk about your feelings and concerns with friends and family.
  • Ask for help with the nights, housework, meals and other children.
  • Eat well, rest, take breaks and do something fun or relaxing.
  • Try a peer-led or nurse-led postpartum support group, in person or online; these may help when symptoms are mild.
  • Keep a sleep routine: a dark, quiet room and no screens before bed.

In Waterloo Region, Public Health’s Healthy Babies Healthy Children program is free for pregnant people and families with children up to age six: a public health nurse and a family visitor see eligible families at home. Call 519-575-4400 and ask for a referral.

Outlook

Left untreated, postpartum depression can last months or longer, and it is harmful to the parent’s health and can disrupt family relationships. The sources give no single figure for how long recovery takes with treatment. Having had it once is the strongest risk factor for having it again, so tell your care provider early in any later pregnancy.

Postpartum depression support in Kitchener, Waterloo and Cambridge

Kitchener. Counselling in Kitchener and Physiotherapy in Kitchener. Locations: Victoria North, Fischer-Hallman, Westmount East and Deer Ridge.

Waterloo. Counselling in Waterloo, Nurse Practitioner in Waterloo and Physiotherapy in Waterloo. Locations: Weber North, Uptown Waterloo and Waterloo GoodLife.

Cambridge. Counselling in Cambridge and Physiotherapy in Cambridge. Location: Hespeler Road.

The city pages linked above show the locations and practitioners for each service, with their next availability.

Common questions

Is it the baby blues or postpartum depression?

The baby blues start a few days after the birth and usually ease within a couple of weeks; postpartum depression is more severe and lasts longer. If the feelings have not eased by then, or they are severe, talk to your health care provider.

Can I take an antidepressant while breastfeeding?

Often, yes. The Canadian guideline names three first-line choices during breastfeeding and says that, in general, antidepressants do not have significant adverse effects on infants exposed through breast milk. Decide with your physician or nurse practitioner.

Can fathers and partners get postpartum depression?

Yes. Fathers and partners can also have depression after a baby arrives. See Depression for how it is treated.

Are scary thoughts about my baby normal?

Thoughts of harm coming to the baby are common after a birth, and Canada’s guideline says that in most cases they are intrusive and unwanted and do not represent a safety concern. Tell your care provider or counsellor about them, and see Intrusive Thoughts. If you think you might act on one, or you cannot tell, call 911.

Where can I get help for postpartum depression in Cambridge?

CARESPACE offers Counselling in Cambridge. Book online or call 519-208-2273 and our Central Reception Team will find the closest location with an opening.

Do I need a referral?

No. Book online or call 519-208-2273. You pay at each visit and receive a receipt for your extended health plan. More on fees and insurance →

Sources

Related conditions

Depression
Anxiety
Postpartum Recovery
Intrusive Thoughts
Colic

The CARESPACE Central Reception Team

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