What Is Postpartum Depression? Symptoms, Causes, Diagnosis, Treatment, and Prevention

Medically Reviewed
a woman with young children
Unlike the “baby blues,” postpartum depression can last for months.Stocksy

Pregnancy and giving birth are intensely emotional experiences. And while these life-changing events can bring joy, they can also present challenges that make you feel sad, tired, and anxious.

As many as 50 to 75 percent of new mothers feel some degree of unhappiness, worry, and fatigue after having a baby. These so-called baby blues rarely last beyond a week or two, and typically go away on their own.

When symptoms last longer — or seem more serious — the diagnosis may be postpartum depression, a condition that can persist for months.

While postpartum depression can be debilitating, with time and treatment most women can recover and bond with their baby.

Any case of postpartum depression may result from a different combination of factors, but researchers believe that, in general, hormones, neurochemistry, and life circumstances explain why an estimated 1 in 8 women in the United States experience this mental health disorder.

And the true numbers may be even higher. As noted in an article published in April 2017 in Maternal Child and Health Journal, experts believe that postpartum depression is underreported.

The risk of postpartum depression is higher among people who have a history of mental health issues such as depression and anxiety, according to a January 2019 review published in the journal Frontiers in Neuroendocrinology.

An earlier study, published in 2017 in the journal Depression & Anxiety, also found that the risk was more than 20 times higher for women with a history of depression.

One episode of postpartum depression increases the likelihood that the person will have another.

Signs and Symptoms of Postpartum Depression

Symptoms of postpartum depression vary from person to person, and may include:

  • Severe anxiety and panic attacks
  • Depressed mood or severe mood swings
  • Fear of being a bad mother
  • Sleep problems, such as insomnia or excessive sleep
  • Appetite changes (hardly eating or eating much more than usual)
  • Recurrent thoughts of suicide or death
  • Intense irritability or anger
  • Difficulty bonding with the baby
  • Thoughts of harming yourself or the baby
  • Overwhelming fatigue or loss of energy
  • Restlessness
  • Diminished ability to think clearly, concentrate, or make decisions
  • Sense of guilt, shame, worthlessness, or inadequacy
  • Hopelessness
  • Excessive crying
Symptoms usually develop within the first few weeks after a woman gives birth but may begin earlier (during pregnancy, say, referred to as prepartum depression) or later (up to a year after giving birth). Note that formally speaking, the symptoms must begin within four weeks of giving birth; nevertheless, it's debatable whether this timeframe should be extended, because many people do not recognize their symptoms until later.

“If symptoms go beyond a two-week period, and the mother is still experiencing problems, that will usually lead to a diagnosis of postpartum depression,” says Diane Brown-Young, MD, a staff physician in the department of obstetrics and gynecology at the Cleveland Clinic and at the Willoughby Hills Family Health Center in Ohio.

Learn More About Signs and Symptoms of Depression

Causes and Risk Factors of Postpartum Depression

Hormonal fluctuations that occur after birth can play a big role in a new mother’s mood changes. During pregnancy, estrogen and progesterone levels increase to fortify both the uterus and the placenta. But delivery alters the levels of those and other hormones.

“After giving birth, hormone concentrations drop by 100-fold within a matter of days,” says Katherine Wisner, MD, the director of the Asher Center for the Study and Treatment of Depressive Disorders at Northwestern Medicine in Chicago. The sudden plunge may create disturbances in mood, particularly in women who have prior histories of depression or anxiety, as noted above.

Periods of hormonal fluctuation, such as menstrual cycles and perimenopause, are associated with major depressive episodes, says Dr. Wisner. It could be that the fluctuations that occur during and after pregnancy may affect certain neurotransmitters or brain function in other ways.

“This massive drop in hormones, along with the initiation of breastfeeding, disrupted sleep, and adapting to motherhood all contribute to the risk for developing depression,” she adds.

There is also research suggesting that women who have pregestational and gestational diabetes may have a modestly increased risk of postpartum depression.

Risk Factors for Postpartum Depression

The following may increase a person's chances of developing postpartum depression. Whatever the symptoms, the condition can affect any woman regardless of age, race, ethnicity, or economic status, though certain people may be more susceptible.

  • Symptoms of depression during or after a previous pregnancy
  • Previous experience with depression or bipolar disorder
  • A family member who has been diagnosed with depression or other mental illness
  • A stressful life event during pregnancy or shortly after giving birth, such as job loss, death of a loved one, domestic violence, or personal illness
  • Medical complications during childbirth, such as premature delivery or having a baby with medical problems
  • Twins, triplets, or other multiple births
  • Mixed feelings about the pregnancy, whether it was planned or unplanned
  • lack of strong emotional support from others
  • Alcohol or other drug abuse problems
  • Past experiences of trauma
  • Financial difficulties

Men and Postpartum Depression

Surprisingly, men can also suffer mood disorders because of a new baby: If one parent develops depression, the other parent is more likely to develop depressive symptoms.

A report in the Journal of the American Medical Association found that 10 percent of men showed signs of depression from the first trimester of a partner’s pregnancy through six months after the child was born, with the number jumping to 26 percent during the three- to six-month period after delivery.

And a study in the journal Pediatrics that looked at more than 1,700 fathers with 1-year-old children found that depression had a negative effect on parenting: Depressed dads were more likely to spank their children and less likely to read to them.

Sleep Deprivation and Postpartum Depression

Blame those middle-of-the night feedings for some of these symptoms. But though sleep can be difficult to come by with a newborn, research suggests it’s paramount for maintaining good mental health during the first year of a baby’s life. Research shows that lack of sleep is both a predictor and a consequence of postpartum depression for mothers and fathers.

Studies also suggest that seeking out education from healthcare providers on improving infant sleep can in turn improve sleep for parents, thus reducing the risk of postpartum depression.

How Is Postpartum Depression Diagnosed?

Postpartum depression often goes unaddressed, in part because parents may feel shame for feeling down during what “should” be a time of joy. But a proactive approach to treatment is best for everyone concerned.

Trials in the United States have shown that routinely screening for depression in expectant and new parents can improve outcomes for families, according to a 2020 systematic review from the Cleveland Clinic.

It’s important to follow up on any recommendations from your doctor after screening.

Screening for postpartum depression in pregnant and postpartum individuals is now recommended by the American College of Obstetricians and Gynecologists, the American Psychiatric Association, and the American Academy of Pediatrics. It is also covered by insurance, and can begin with a simple questionnaire that parents fill out in the waiting room.

That’s why it’s so crucial to open up about any feelings you may be experiencing during prenatal visits or during the typical six-week follow-up appointment with your ob-gyn after your baby is born.

Your baby’s pediatrician may make a provisional diagnosis of postpartum depression, and may refer you to a mental health professional. The American Academy of Pediatrics now recommends that pediatricians screen mothers at the one-, two-, four-, and six-month well-child visits.

Prognosis for Postpartum Depression

With treatment, symptoms of postpartum depression usually improve. In some cases, postpartum depression can become chronic depression, so it’s important to continue treatment even after you start to feel better.

Left untreated, postpartum depression can harm the mother’s health and could lead to sleeping, eating, or behavioral problems for the child. According to a study in a 2017 issue of Maternal and Child Health Journal, a mother’s mood disorder can lead to a range of emotional and behavioral problems for children at 8 years of age.

Studies are ongoing.

Duration of Postpartum Depression

Untreated postpartum depression can last for months — sometimes longer. If symptoms persist after the first year, postpartum depression can become chronic depression.

Treatment and Medication Options for Postpartum Depression

Regardless of the extent of symptoms, it’s important to get proper treatment during this important time in your life and the life of your baby. The first step is talking to your healthcare provider.

One or more treatment options may help.

Talk Therapy for Postpartum Depression

A therapist, psychologist, or social worker can teach you strategies to change how depression makes you feel, think, and behave.

Medication for Postpartum Depression

Breastfeeding parents may be reluctant to take psychotropic (psychiatric) drugs, for fear of potential effects on their child. But given the potential long-lasting negative effects of untreated postpartum depression, the consensus among reproductive psychiatrists is that, for some women, taking medication is better for both mother and baby than forgoing treatment.

Each parent should make that decision personally, in consultation with their doctor, considering factors like medical history and circumstances.

There are a number of drugs to treat postpartum depression, starting with antidepressants. Your healthcare provider can prescribe one that is safe to take while breastfeeding. Note that these medicines may take several weeks to become effective.

In March 2019, the U.S. Food and Drug Administration (FDA) approved Zulresso (brexanolone) as the first medication specifically for postpartum depression. It is administered through an IV line continuously for two and a half days (60 hours). It may not be safe to take while pregnant or breastfeeding.

In 2019, the FDA also approved the nasal spray Spravato (esketamine) for treatment-resistant depression in adults. Derived from ketamine, a widely used anesthetic, it is administered only at certified treatment centers. The drug works very quickly, usually within hours. It is not safe to take while pregnant or breastfeeding.

Electroconvulsive Therapy for Postpartum Depression

Known as ECT, electroconvulsive therapy helped some women with postpartum depression or psychosis, with a higher response rate in the postpartum group than those not postpartum, according to a report in the Journal of Affective Disorders published in 2018.

 Small electrical currents are passed through the brain, intentionally triggering a brief seizure and altering brain chemistry.

Strategies for Coping With Postpartum Depression

In addition to professional treatment, the following tips can help alleviate symptoms of postpartum depression.

Make healthy lifestyle choices. Although it is definitely a challenge to focus on yourself with a new baby, it’s important for people who have postpartum depression to take time to do things like eating healthy meals, exercising, getting enough sleep, and avoiding alcohol, which can exacerbate mood swings.

Practice self-care. Enlist a partner, friend, or other family member to watch the baby or hire a sitter, then get out of the house and do something for yourself.

Set realistic expectations. Treatment can help, but it may take some time before you feel like yourself again. In the meantime, don’t feel pressured to check off everything on your to-do list.

Say yes to caregiving help. Take people up on their offers to help. Your friends and family members can help around the house, watch the baby so you can sleep, run errands, or be there to listen when you need to talk.

Avoid isolation. Talk with your partner, friends, or family about how you’re feeling. You may want to join a support group with other mothers who’ve experienced postpartum depression and can share experiences and coping skills.

Prevention of Postpartum Depression 

If you’re planning to become pregnant, or as soon as you do, it’s important to tell your doctor about any history of mental illness, especially previous episodes of postpartum depression. Your doctor can then be sure to check in with you throughout your pregnancy for signs or symptoms of depression.

Counseling and group therapy during pregnancy and after giving birth can be effective in preventing postpartum depression among at-risk mothers, according to a systemic review by the U.S. Preventive Services Task Force published in JAMA in February 2019.

Depending on risk factors, your doctor may recommend medication, either during pregnancy or immediately after you give birth.

Complications of Postpartum Depression

Untreated postpartum depression can get in the way of bonding with the new baby and lead to problems for the whole family.

Without treatment, postpartum depression can go on for months or longer, and can lead to a chronic depressive disorder. But even with treatment, postpartum depression increases a woman’s risk of experiencing depressive episodes in the future.

When a new mother is depressed, it can increase the risk of depression for the father as well, as mentioned earlier. And if a mother's postpartum depression goes untreated, newborns are more likely to have problems like excessive crying, difficulty with sleeping and eating, and delays in language development.

In rare cases — involving 1 or 2 in 1,000 births, according to the American Psychiatric Association — a new mother will experience postpartum psychosis.

The symptoms are more severe than in postpartum depression, and they come on rapidly, usually within the first few days of giving birth.

Those suffering from postpartum psychosis may have bizarre, grandiose thoughts and delusions, and their moods may swing from one extreme to another. They may also hallucinate — hearing voices or seeing things that aren’t there — and may have recurring thoughts of harming themselves or their baby.

In some cases of postpartum psychosis, there may be a previous history of mental illness, such as bipolar disorder, schizophrenia, or schizoaffective disorder.

If you notice any of these changes in someone you love or are close to, it’s important to seek help right away so both mother and child remain safe.

Research and Statistics: How Many People Experience Postpartum Depression?

Worldwide, about 18 percent of women experience postpartum depression, according to a meta-analysis of almost 300 studies from 56 countries published in the journal Frontiers in Psychiatry in 2018.

Countries with higher rates of maternal and infant mortality, income inequality, and women of childbearing age working over 40 hours a week also have higher rates of postpartum depression.

The latest figures from the U.S. Centers for Disease Control and Prevention show that 1 in 8 women experience postpartum depression in the United States.

With 3.7 million births occurring in the United States in 2019, the latest year for which data is available, that means nearly half a million women experience postpartum depression every year.
If left untreated, severe postpartum depression can lead to thoughts of harming oneself or the newborn. Alarmingly, the rate of suicide in women in the year before or after giving birth has nearly tripled, according to a study published in February 2021 in JAMA Psychiatry.

BIPOC and Postpartum Depression

Some studies suggest that members of Black, Indigenous, and People of Color (BIPOC) communities report much higher rates of postpartum depression symptoms than white women, while others report the prevalence is about the same across racial and ethnic groups.

But the research is clear that women of color are more likely to experience poverty and negative maternal health outcomes, both of which can exacerbate stress and depression.

Women of color and low-income mothers are less likely to seek or receive treatment for depressive symptoms. According to a study in the journal Psychiatric Services, Black and Latina women were about half as likely to initiate treatment for postpartum depression as white women. Among those who did begin treatment after delivery, Black and Latina women were less likely than white women to receive follow-up treatment or continued care, and less likely to refill an antidepressant prescription.

Black Americans and Postpartum Depression

Black mothers, in particular, may avoid seeking treatment for fear of having their children taken away by welfare services, according to maternal health experts interviewed by Kaiser Health News.

Additionally, a study in the International Journal of Culture and Mental Health showed that African Americans are less likely to use the term “depression,” and more likely to say they’re having trouble sleeping or just don’t feel like themselves.

That makes it important for doctors to read between the lines, continuing to ask more questions, even if the word “depression” isn’t used.

Hispanic Americans and Postpartum Depression

A study in a 2016 issue of the Journal of Racial and Ethnic Health Disparities of 3,317 mothers enrolled in a Healthy Start program in Pennsylvania found that Latina mothers had a 40 percent higher risk of postpartum depression compared with white mothers.

The study attributed the heightened risk to stress over immigration status, higher rates of unemployment, lack of health insurance, and lack of resources in minority communities.

American Indian/Alaska and Hawaii Native Women

In the United States, women of American Indian and Alaska and Hawaii Native heritage experience rates of perinatal depression from 14 to 29 percent, compared with 11 percent of women in the general population, according to a study published in January–February 2021 in MCN: The American Journal of Maternal/Child Nursing.

Related Conditions and Causes of Postpartum Depression

Postpartum depression overlaps with most symptoms of major depressive disorder. There are also other mental illnesses that can be triggered by pregnancy or the arrival of a new child: Women may experience symptoms of anxiety or new obsessive-compulsive behaviors, according to the Massachusetts General Hospital Center for Women’s Mental Health.

Other related conditions may include:

Resources We Love

If you are thinking about harming yourself or your baby, or if you are concerned about someone you love, get the support you need. These resources can help.

National Suicide Prevention Lifeline

800-273-TALK (8255) | TTY: 800-799-4889

The Lifeline provides 24/7 free and confidential support for people in distress, prevention and crisis resources for you or your loved ones, and best practices for professionals.

Substance Abuse and Mental Health Services Administration's National Helpline

800-662-HELP (4357) | TTY: 800-487-4889

The National Helpline offers free, confidential 24/7 information and referrals in English and Spanish to local mental health and substance use disorder treatment facilities, support groups, and community-based organizations.

Postpartum Support International (PSI)

800-944-4PPD (4773) for answers in English and Spanish to questions and information on resources in your area.

This organization raises awareness of the emotional changes women may experience during pregnancy and postpartum. It has dozens of resources for new and expecting mothers and fathers, including an online support group, bilingual helplines, and links to local providers.

NAMI, the National Alliance on Mental Illness

NAMI Helpline 800-950-NAMI (6264)

The nation’s largest grassroots mental health organization dedicated to building better lives for the millions of Americans affected by mental illness.

CDC: Maternal Depression

From the Maternal and Child Health Division of the U.S. Health Resources and Services Administration, these links provide great info: Depression During and After Pregnancy and La Depresión Durante y Despues del Embarazo: Un Informe Para Mujeres, Sus Familias y Amigas.

Additional Resources

MotherToBaby: Medications & More During Pregnancy & Breastfeeding

A service of the nonprofit Organization of Teratology Information Specialists, this site is dedicated to providing evidence-based information for mothers, healthcare professionals, and the general public about medications and other exposures during pregnancy and while breastfeeding.

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