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

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, Cleveland Clinic experts say. Although it may take more time for a mom to “feel like herself again” after having a baby, the feelings of sadness associated with these so-called “baby blues” rarely last more than two weeks, and they typically go away on their own.

When the symptoms last longer — or seem more serious — the diagnosis may be postpartum depression, a condition that can persist for months, according to the Cleveland Clinic. An estimated 1 in 8 women in the United States experience this mental health condition, according to the Centers for Disease Control and Prevention (CDC).

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 combination of different factors, but researchers believe that, in general, genetics, hormones, neurochemistry, and life circumstances are key contributors, according to the National Institute of Mental Health (NIMH).

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

The risk of postpartum depression is higher among women who have a history of mental health issues such as depression and anxiety, according to a review published in 2019 in Frontiers in Neuroendocrinology. An earlier study, published in 2017 in Depression and Anxiety, found that the risk was more than 20 times higher in women with a history of depression. One episode of postpartum depression increases the likelihood that a woman will have another in a future pregnancy, say NIMH experts.

Postpartum depression symptoms vary from person to person, according to Mayo Clinic, 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 loss of energy or fatigue
• Restlessness
• Reduced ability to concentrate, think clearly, or make decisions
• Sense of guilt, shame, worthlessness, or inadequacy
• Hopelessness
• Excessive crying

Symptoms usually develop within the first few weeks after giving birth but may begin earlier (during pregnancy, say, which is referred to as peripartum depression) or later (up to a year after giving birth), say Mayo Clinic experts.

“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.

Note that, formally speaking, the symptoms must begin within four weeks of giving birth; nevertheless, it’s still debated whether this time frame should be extended, because many women do not recognize their symptoms until later.

Learn More About Signs and Symptoms of Depression

Hormonal fluctuations that occur after giving 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 a hundredfold within a matter of days,” says Katherine Wisner, MD, 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 a prior history of depression or anxiety, as noted above.

Periods of hormonal fluctuation, such as menstrual cycles or 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 (chemical messengers in the brain) 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 of developing depression,” she adds.

The aforementioned study published in 2017 in Depression and Anxiety suggests that women who have pregestational and gestational diabetes may also have a modestly increased risk of developing postpartum depression.

Risk Factors for Postpartum Depression

The following may increase the 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, according to the Mayo Clinic.

• 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 another mood disorder
• 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
• Having twins, triplets, or other multiple births
• Having mixed feelings about the pregnancy, whether it was planned or unplanned
• A lack of strong emotional support from others
• Financial difficulties

Men and Postpartum Depression

Men can also develop mood disorders because of a new baby: If one parent develops depression, the other parent is more likely to develop depressive symptoms, according to a review published in 2020 in Midwifery.

A report published in JAMA 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, which looked at more than 1,700 fathers with 1-year-old children, found that depression had a negative effect on parenting: Dads with depression were more likely to spank their children and less likely to read to them.

Sleep Deprivation and Postpartum Depression

Those middle-of-the night feedings may be to blame for some of the symptoms. But although sleep can be difficult to come by with a newborn, research suggests that it is paramount for maintaining good mental health during the first year of a baby’s life. The aforementioned review published in Midwifery suggests that lack of sleep is both a predictor and a consequence of postpartum depression in mothers and fathers.

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

Trials in the United States have shown that routine postpartum depression screenings can improve outcomes for families, according to a systematic review published in 2020 by the Cleveland Clinic. It’s important to follow up on any recommendations from your doctor after a screening.

Screening for postpartum depression in pregnant and postpartum women is now recommended by the American College of Obstetricians and Gynecologists, the American Psychiatric Association, and the American Academy of Pediatrics. It’s also covered by insurance, and it can begin with a simple questionnaire that gets filled 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 also make a provisional diagnosis of postpartum depression, and they 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 a chronic depressive disorder, so it’s important to continue treatment even after you start to feel better, Mayo Clinic experts say.

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 published in 2017 in the Maternal and Child Health Journal, a mother’s mood disorder can lead to a range of emotional and behavioral problems for children at around age 8. Studies are ongoing, according to a systematic review and meta-analysis published in 2020 in Systematic Reviews.

Regardless of the extent of your 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, according to the Office on Women’s Health at the U.S. Department of Health and Human Services.

Talk Therapy for Postpartum Depression

A mental health provider, such as a therapist, psychologist, or social worker, can teach you strategies for changing how depression makes you feel, think, and behave.

You can seek counseling in your local area or opt for online postpartum depression therapy.

Medication for Postpartum Depression

Breastfeeding mothers may be reluctant to take psychotropic (psychiatric) drugs, for fear of the 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 would be, according to a review published in 2019 in Psychopharmacology in Pregnancy and Breastfeeding.

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

There are a number of medications 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 brexanolone (Zulresso) as the first medication specifically for postpartum depression. It is administered through an intravenous 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 esketamine (Spravato) for treatment-resistant depression in adults. Derived from ketamine, a widely used anesthetic, it is only administered 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 has 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 published in 2018 in the Journal of Affective Disorders. 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, according to the Mayo Clinic:

Make healthy lifestyle decisions. Although it’s definitely a challenge to focus on yourself with a new baby, it’s important for mothers who have postpartum depression to take time to do things like eat healthfully, exercise, get enough sleep, and avoid alcohol, which can exacerbate mood swings.

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

Set realistic expectations for yourself. 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 partner or friends and family members can help around the house, watch the baby so you can sleep, run errands, and be there to listen when you need to talk.

Don’t isolate yourself. Talk with your partner, friends, or family members 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.

If you’re planning to become pregnant, or as soon as you do, it’s important to tell your doctor if you have a personal or family history of any mental disorders, 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 for preventing postpartum depression among mothers with an increased risk of the condition, according to a systematic review by the U.S. Preventive Services Task Force published in JAMA in 2019.

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

Untreated postpartum depression can get in the way of bonding with the new baby and lead to problems for the whole family, according to the Mayo Clinic. Without treatment, postpartum depression can go on for months or longer and can lead to a chronic depressive disorder, as noted previously. But even with treatment, postpartum depression increases a woman’s risk of experiencing depressive episodes in the future.

When new mothers are depressed, it can increase the risk of paternal postpartum depression 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, Mayo Clinic experts add.

In rare cases — involving one or two in 1,000 births, according to the American Psychiatric Association — a new mother will experience postpartum psychosis. The symptoms of postpartum psychosis are more severe than those of postpartum depression, and they come on rapidly, usually within the first few days of giving birth.

Those with postpartum psychosis may have bizarre, grandiose thoughts and delusions, and their moods may swing from one extreme to another, according to the National Health Service in England. They may also hallucinate — hearing voices or seeing things that aren’t there — and they 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 or schizophrenia, NHS experts say.

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

Worldwide, about 18 percent of mothers experience postpartum depression, according to a meta-analysis of almost 300 studies from 56 countries, published in 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 authors of the analysis noted.

The latest figures from the CDCshow 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 nearly tripled between 2006 and 2017, according to a study published in 2021 in JAMA Psychiatry.

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 that the prevalence is about the same across racial and ethnic groups, according to a study published in 2016 in the Journal of Racial and Ethnic Health Disparities.

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, the authors of the study noted.

Women of color and low-income mothers are also less likely to seek or receive treatment for depressive symptoms. According to a study in 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 baby taken away by child 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

The aforementioned study of 3,317 mothers enrolled in a Healthy Start program in Pennsylvania, published in 2016 in the Journal of Racial and Ethnic Health Disparities, 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 their communities.

American Indian, Alaska Native, and Native Hawaiian Women

In the United States, 14 to 29 percent of women of American Indian, Alaska Native, or Native Hawaiian heritage experience perinatal depression, 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.

Postpartum depression overlaps with most symptoms of major depression. Other kinds of mental health conditions can also 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 include:

• Persistent depressive disorder
• Generalized anxiety disorder
• Postpartum psychosis
• Postpartum post-traumatic stress disorder
• Obsessive-compulsive disorder

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.

988 Suicide and Crisis Lifeline

As of July 16, 2022, the National Suicide Prevention Lifeline is now known as the 988 Suicide and Crisis Lifeline. Dial 988 to be connected with a trained crisis counselor. The 988 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

1-800-662-HELP (4357) | TTY: 1-800-487-4889

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)

Call 1-800-944-4PPD (4773) for answers to questions in English and Spanish and for 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 parents, including online support groups, bilingual helplines, and links to local providers.

National Alliance on Mental Illness (NAMI)

NAMI Helpline: 800-950-NAMI (6264)

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

CDC: Depression During and After Pregnancy

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 and More During Pregnancy and 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.