Labor, Birth & Postpartum
Postpartum Depression: Signs, Causes and Treatment
Postpartum depression is a common, treatable mood disorder that can start during pregnancy or anytime in the first year after birth. Unlike the baby blues, which fade within about two weeks, it lasts longer, feels heavier and makes it hard to function. The CDC reports that about 1 in 8 people who recently gave birth have symptoms of postpartum depression. Treatment, including therapy and medicine, works.
If you're thinking about harming yourself or your baby, call or text 988 or call 911 now.
If you're reading this at 3 a.m. with a baby on your chest, wondering whether what you feel is "normal": the fact that you're asking is a good reason to tell someone. You don't have to be sure it's depression to bring it up.
Baby blues or postpartum depression?
| Baby blues | Postpartum depression | |
|---|---|---|
| How common | Very common; affects most new parents | About 1 in 8 |
| When it starts | First few days after birth | Pregnancy through the first year |
| How long it lasts | Usually gone within about 2 weeks | More than 2 weeks; can last months without treatment |
| What it feels like | Tearful, moody, anxious, overwhelmed, but still able to function | Persistent sadness, hopelessness, loss of interest, trouble functioning |
| What helps | Rest, support, reassurance | Therapy, medicine, support; needs a provider |
A useful question to ask yourself: is it getting better each week, or staying the same or getting worse? The blues lift. Depression tends to settle in.
What it can look like
You might notice:
- Feeling sad, empty, hopeless or numb most of the day
- Crying often, or for no clear reason
- No interest or pleasure in things you used to enjoy
- Feeling disconnected from your baby, or not wanting to be with them
- Heavy guilt or shame, or feeling like a "bad mother"
- Irritability or anger, sometimes at your partner or older kids
- Trouble sleeping even when the baby sleeps, or sleeping too much
- Big changes in appetite
- Trouble concentrating or making simple decisions
- Pulling away from friends and family
- Thoughts of harming yourself or your baby, or that your family would be better off without you
Here's the part people don't say out loud: many new parents with depression feel numb, not sad. Or they love their baby and still feel nothing when they look at them. Or they snap at everyone. Those count.
Many people with postpartum depression also have strong anxiety: racing thoughts, constant checking on the baby, scary "what if" images. That can happen on its own too; see postpartum anxiety.
Partners can get postpartum depression as well. If your partner seems withdrawn, irritable or hopeless after the baby arrives, encourage them to get help.
Why it happens
There's no single cause, and it isn't a character flaw. Contributors include:
- Hormone shifts. Estrogen and progesterone drop sharply after birth.
- Sleep deprivation and physical recovery.
- Stress: money, relationship strain, little support, going back to work.
- Hard events: a difficult birth, a NICU stay, feeding struggles.
Who's at higher risk
- A personal or family history of depression, anxiety or bipolar disorder
- Depression or anxiety during pregnancy
- Past postpartum depression
- Limited social or financial support
- A history of trauma or intimate partner violence
- A baby with health problems
- An unplanned pregnancy or a traumatic birth
The USPSTF recommends that clinicians refer people at increased risk to counseling during pregnancy and after birth, because it can help prevent perinatal depression. If several of these apply to you, ask about it before the baby comes.
How it's diagnosed
ACOG recommends screening for depression and anxiety during pregnancy and after birth, including at the postpartum visit, using a validated questionnaire like the Edinburgh Postnatal Depression Scale (EPDS) or PHQ-9. It's a short form, about ten questions, often on a tablet in the waiting room. Your baby's pediatrician may also screen you at well-baby visits.
A very common worry is that answering honestly will get your baby taken away. Screening is there to get you help. Having depression, even thoughts that scare you, is not the same as being unsafe, and clinicians know the difference. If your score is high, your provider will talk with you, ask more questions, and check for other causes like thyroid problems or anemia.
If the form feels too hard, you can just say it: "I haven't felt like myself since the baby was born, and it's not getting better."
Treatment
Treatment depends on how severe your symptoms are and what you prefer.
Therapy. Cognitive behavioral therapy (CBT) and interpersonal therapy (IPT) are well studied for perinatal depression. Many therapists offer telehealth, so you can do a session during a nap without packing a diaper bag.
Medicine.
- Antidepressants such as SSRIs are commonly used, and many are considered compatible with breastfeeding. Your provider will help choose one and set the dose. They usually take a few weeks to work.
- Zuranolone is an oral medicine the FDA approved in 2023 specifically for postpartum depression. Ask whether it's an option for you.
- Don't stop or change a psychiatric medicine on your own; talk to your prescriber first.
Support and self-care. These don't replace treatment, but they help:
- Protecting one longer stretch of sleep, by sharing night feeds or having someone give a bottle
- Saying yes to meals and help with chores
- Getting outside and moving gently, even a walk around the block
- A peer support group, in person or online
Postpartum psychosis: an emergency
Postpartum psychosis is rare but serious, and it usually starts within the first few weeks after birth. Signs:
- Seeing or hearing things that aren't there
- Strong beliefs that aren't true (paranoia, delusions)
- Severe confusion
- Extreme agitation, or barely needing sleep
- Rapid mood swings
Call 911 or go to the nearest emergency room right away. People with bipolar disorder or a past episode are at higher risk.
For partners and family
- Say what you notice, gently: "You seem really down lately. I'm worried about you."
- Offer to come to the appointment, or to make the call together.
- Take a night feeding so the new parent can sleep.
- Handle meals, chores and visitors.
- Skip "just relax" and "enjoy every moment." This is a medical condition, not a lack of effort.
- Know the emergency signs and when to call 911 or 988.
When to call your provider
Call your OB/GYN, midwife or primary care provider if:
- Sadness, anxiety or irritability lasts more than two weeks
- Symptoms are getting worse
- It's hard to take care of yourself or your baby
- You can't sleep even when you have the chance
- You feel disconnected from your baby
Get help immediately (988, 911 or an emergency room) if you have thoughts of harming yourself or your baby, or signs of psychosis.
Help in New York
- National Maternal Mental Health Hotline: call or text 1-833-TLC-MAMA (1-833-852-6262), free and available 24/7 in English and Spanish.
- 988 Suicide & Crisis Lifeline: call or text 988.
- Postpartum Support International has a helpline and online support groups.
- Project TEACH, a New York State Office of Mental Health program, helps New York prenatal and postpartum providers diagnose and treat perinatal mood disorders. That means your OB/GYN or midwife may be able to start treatment without a long wait for a psychiatrist.
- NY Medicaid and Child Health Plus cover postpartum care, including mental health care, for 12 months after pregnancy ends. If you got Medicaid because you were pregnant, you don't lose it at six weeks.
To find a provider who can screen for and treat postpartum depression, search the directory, or read what's covered at your postpartum checkup. For other urgent symptoms after birth, see postpartum warning signs.
Frequently asked questions
How do I know if it is postpartum depression or the baby blues?
The baby blues usually start in the first few days after birth and fade within about two weeks. Postpartum depression lasts longer than two weeks, is more intense, and makes it hard to function or care for yourself or your baby.
When does postpartum depression start?
It can start during pregnancy or at any point in the first year after birth. Many cases begin in the first few weeks to months.
Can I take antidepressants while breastfeeding?
Many antidepressants are considered compatible with breastfeeding. Your provider can help you weigh the benefits and risks and choose a medicine that fits you.
Who can I call right now if I am struggling?
Call or text the National Maternal Mental Health Hotline at 1-833-TLC-MAMA (1-833-852-6262), available 24/7. If you're in crisis or thinking of harming yourself, call or text 988 or call 911.
Sources
- ACOG — Screening and Diagnosis of Mental Health Conditions During Pregnancy and Postpartum (Clinical Practice Guideline 4)
- ACOG — Treatment and Management of Mental Health Conditions During Pregnancy and Postpartum (Clinical Practice Guideline 5)
- CDC — Depression Among Women
- USPSTF — Perinatal Depression: Preventive Interventions
- HRSA — National Maternal Mental Health Hotline
- NIMH — Perinatal Depression
- New York State Office of Mental Health — Perinatal Mental Health (Project TEACH)
This article is for general education and is not medical advice. It does not replace an evaluation by a licensed clinician who knows your history. If you think you have a medical emergency, call 911.