During your pregnancy, your head was likely filled with daydreams about your baby’s arrival and the flood of emotions you expected to feel the first time you held your bundle of joy in your arms—happiness, pride, joy, a sense of relief after counting fingers and toes, and an outpouring of unconditional love for the tiny human you just brought into the world.

But reality doesn’t always live up to expectations. Instead, you might feel sad, hopeless, or depressed after giving birth, and upset, confused, and even guilty about having such feelings. It’s important to be aware of how common these feelings are and why getting help is vital.

A majority of women go through what’s called the “baby blues” within a few days of giving birth. This rush of emotion may cause mood swings, crying spells, anxiety, and difficulty sleeping, but these symptoms typically go away in two weeks.1 But women who continue to experience negative emotions and possibly a host of other distressing symptoms may have a more serious but still common condition called postpartum depression.2

It can be difficult for new mothers to seek treatment—many mistakenly think that their symptoms are just a part of adjusting to motherhood or feel ashamed that things aren’t going as expected. But postpartum depression, like other types of depression, should be treated. What’s more, getting help benefits both mom and baby.

What exactly is postpartum depression (PPD)?

“Postpartum” refers to the period following childbirth. Postpartum depression is a severe and long-lasting type of depression linked to this time.2, 10 While postpartum depression, or PPD, is frequently described as depression that starts within four weeks of baby’s birth, symptoms can arise at any time within the first year postpartum, and possibly even before delivery.2, 3, 10 Without treatment, there’s no telling how long it will last, but it will not necessarily go away on its own or by wishing it would, and it can have serious consequences for mom and baby.3

How does postpartum depression differ from the baby blues?

After childbirth, a woman’s body undergoes a massive hormonal shift. The female hormones estrogen and progesterone peak during the last trimester of pregnancy, and then plummet back to normal pre-pregnancy levels after delivery.2 New mothers also undergo dramatic changes to their lifestyle (altered schedules to accommodate feeding and the baby’s sleep needs; adjusting to the new family dynamic; maternity leave, etc.)  The difficulties of this transition and the hormonal changes in the body are thought to play a role in the development of baby blues and postpartum depression.1

The baby blues is a short-term effect of the hormonal fluctuations that begin in the days immediately following childbirth. As many as 50 to 75% of new moms experience it. The baby blues can cause mood swings, feelings of sadness and anxiety, crying spells, loss of appetite, and trouble sleeping, but these feelings usually start to subside within 3 to 5 days and are gone in two weeks.

Unlike the baby blues, postpartum depression is a severe, more persistent condition that needs treatment.2, 10 By various estimates, it affects between 15 and 20% of new moms.3, 6, 10 Causes likely go deeper than the usual range of hormonal and lifestyle changes (see more on this below).

What are the signs and symptoms of postpartum depression?

Postpartum depression (PPD) symptoms may differ from person to person and can range from mild to moderate to severe.

Many common symptoms of PPD are similar to other types of depression:5

  • Feeling down or depressed for most of the day for several weeks or longer
  • Feeling distant and withdrawn from family and friends
  • A loss of interest in activities (including sex)
  • Changes in eating and sleeping habits
  • Feeling tired most of the day
  • Feeling angry or irritable
  • Having feelings of anxiety, worry, panic attacks, or racing thoughts

Postpartum depression may also cause:6

  • Crying more often than usual
  • Feelings of anger
  • Withdrawing from baby
  • Feeling numb or disconnected from the baby
  • Worry that you will hurt the baby
  • Feeling guilty about not being a good mom or doubting your ability to care for the baby

Postpartum Depression by the Numbers 

While the Centers for Disease Control and Prevention (CDC) estimates that up to 20% of new mothers experience one or more symptoms of postpartum depression, that number may be higher or lower based on where you live, your age, your risk factors, and your race/ethnicity.6

In some states, as many as one in five women experience PPD. You can view your state’s prevalence using the CDC’s Pregnancy Risk Assessment Monitoring System (PRAMS).

According to another CDC study, postpartum depression may be more common among:4

  • Black women
  • Native American women
  • Asian women
  • Women younger than 19 years old

What may be even more of a surprise is that men can develop postpartum depression, too (though the causes aren’t hormonal). According to a study of several thousand people in the UK, and published in JAMA Pediatrics, one study, an estimated 4% of fathers experience depression in the first year after their child is born. Fathers who are young or have a history of depression may be more at risk. Both men and women need treatment to alleviate depression in the postpartum period, and the potential treatments are similar for both genders.

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Did you know men can develop postpartum depression?

Read more about PPD in men here.

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What causes postpartum depression?

Like other types of depression, postpartum depression is a complex disorder that is likely caused by numerous factors. There isn’t just one cause of PPD—or any type of depression, for that matter. But there are two factors that make PPD different and that don’t necessarily apply to other types of depression:1,2

  • Hormonal changes that peak the third trimester of pregnancy and then drop dramatically.1, 2
  • Lifestyle changes from having a newborn that can be physically and emotionally taxing—sleep deprivation, new responsibilities, stress, and anxiety can all contribute to postpartum depression.

Beyond these, however, there are genetic and environmental underpinnings that may make you more vulnerable to developing PPD, including:1, 6

  • Previous history of depression or postpartum depression
  • Family history of depression or postpartum depression
  • Depression during pregnancy
  • Difficulty becoming pregnant
  • Being a mom to multiples, like twins or triplets
  • Being a teen mom
  • Preterm (before 37 weeks) labor and delivery
  • Pregnancy and birth complications
  • Having a baby who has been hospitalized

Of these, two risk factors stand out: Having a prior episode of postpartum depression and experiencing depression during pregnancy, says Katherine Taljan, MD, a psychiatrist at the Cleveland Clinic in Ohio. About half of women who are later diagnosed with PPD begin showing symptoms during pregnancy, according to the American Psychological Association.3

Of course, having risk factors doesn’t mean getting PPD is a foregone conclusion. And because postpartum depression can affect any woman, regardless of her mental health history and circumstances, current guidelines suggest that every expectant and new mother should undergo regular screening for depression symptoms—ask for this if your doctor hasn’t brought it up.3

The fact is that, despite the prevalence of PPD, many women are never screened for depression during or after pregnancy. That same CDC “Vital Signs” study reported that  13% of women reported symptoms of depression following childbirth. Still, one in eight said that their healthcare provider never asked them about their mental health during postpartum checkups.6 Having such a discussion with your doctor is one of the best things you can do for yourself.

You can also take proactive steps to reduce your risk of PPD if you have had past experiences with depression or the risk of a recurrence if you had PPD after a prior pregnancy. That’s why it’s important to talk to your doctor about your mental health history, even before you notice any concerning symptoms.

It’s also important to acknowledge social stigma as a contributing factor. The ideal of the unselfish, happy mother of a new baby is not realistic and drives feelings of guilt and self-loathing. Motherhood is challenging even on the best days and a huge adjustment. Women should be permitted and encouraged, to acknowledge that every day isn’t Shangri-La.

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How long does postpartum depression last, and what are the risks of not getting treated? 

There’s no telling how long postpartum depression will last without treatment. It could persist for months or longer, and it can turn into a chronic depressive disorder. Postpartum depression is not something to be taken lightly, and new mothers should never feel like their depression is just a part of being a new mother. Suicidal and homicidal thoughts can sometimes arise in women with PPD and postpartum psychosis. Get emergency help if necessary.

Left untreated, PPD can have lasting effects on the baby as well as the mom. It can weaken the bond between mother and child and potentially hinder the child’s healthy development.4 Specifically, it increases the child’s risk for emotional and behavioral problems later on. Research indicates that the children of mothers with untreated PPD are more likely to cry excessively, experience delays in their language development, and have difficulty sleeping and eating.1

When should I seek professional help, and who should I talk to?

It’s smart self-care to closely monitor how you feel during this new stage of your life and keep your doctor updated on any emotional changes you’re going through. If you’re within the first two weeks postpartum, your doctor may wait to see if your symptoms resolve because it’s more likely a short-lived case of the baby blues.

It’s important to know that while the baby blues are temporary, they can still be distressing and take away from your ability to care for your baby during those important early days. Although your doctor may advise you to wait two weeks before being evaluated for PPD, that doesn’t mean that you shouldn’t reach out for support from family and friends right away and ask them for whatever help you need.

Working with a therapist might be helpful even at this point. Says Anna Glezer, MD, a psychiatrist specializing in reproductive issues and an associate professor at the University of California, San Francisco, “Reaching out for help doesn’t mean you have to take medication. Psychotherapy can help a lot with the transition as well.”

All things considered, don’t wait on the calendar to reach out right away to your doctor or another professional if:2

  • You start feeling hopeless or deeply sad.
  • Your symptoms of depression intensify.
  • You are unable to care for yourself or your baby.
  • You have thoughts about hurting yourself or your baby.

Getting a PPD diagnosis as soon as possible means you can discuss beginning treatment right away. This is especially important if you’ve had depression or PPD before. Whether you experience depression symptoms two weeks or two months after having a baby, and regardless of how severe your symptoms are, reaching out to a professional can help you decide what the best course of treatment is for you.

How is postpartum depression diagnosed? 

Your doctor will likely ask you questions about your feelings and thoughts to make a diagnosis. To help distinguish between the stresses of being a new mother and PPD, the questions may be very specific, says Nicole Perras, MD, medical director for the Women’s Mental Health Program at Georgetown University Hospital in Washington, D.C. For example, because having an infant in the house is apt to disrupt your sleep, instead of asking “Are you sleeping well?,” it might be more along the lines of, “Are you able to sleep when the baby sleeps?”

Lack of appetite can be a sign of depression, but many new breastfeeding mothers need to eat regularly, whether or not they are hungry. Instead of asking, “Do you have an appetite?,” your doctor may ask, “Are you eating but not enjoying the taste of food?”

It can be helpful to your doctor for you to share details about the frequency and nature of your symptoms, other mental and physical health concerns you have, and any observations about what helps your depression and what makes it worse.

You might have questions, too, that need to be answered, such as:

  • Could anything other than PPD be causing my symptoms?
  • What treatments have your patients found helpful in the past?
  • Would you recommend a mental health provider in the community?
  • Are there any behavioral changes I can make today to help my mood?
  • Are there any written resources you’d recommend?

How is postpartum depression treated? 

Some of the treatment options for postpartum depression are similar to the treatments for other types of depression, with one important advance. The best choice for you depends on your symptoms, their severity, and your personal preferences. What works for one person may not work for another, and some treatments require patience.

The main treatments for PPD are:1, 2

  • Therapy. Talking to a psychiatrist, psychologist, or another mental health professional can help you cope with your feelings. Certain therapy types, such as cognitive-behavioral therapy (CBT), can teach you to identify negative thoughts and patterns that contribute to your depression and learn ways to break that negative thought cycle.
  • Antidepressants. This class of prescription medications works to balance certain chemicals in the brain called neurotransmitters. For example, a common type of antidepressant called a selective serotonin reuptake inhibitor (SSRI) helps your brain maintain adequate serotonin levels. This neurotransmitter regulates mood and is often imbalanced in people with depression. Antidepressants may take several weeks to start working.
  • Zulresso (brexanolone). The Food and Drug Administration (FDA) approved this first-ever drug specifically for postpartum depression treatment. Brexanolone is administered via IV infusion over a 60-hour period under medical supervision in a special setting where you can be monitored (baby can go with you, but you’ll need another adult there as well because side effects include drowsiness). While this might seem like an unusual form of treatment, it is very effective at relieving depression by restoring hormone levels that shifted following pregnancy. Plus, the majority of women in the clinical trial were so desperate for relief they described the challenges surrounding the medicine’s administration as a minor inconvenience.
  • In serious cases of PPD, electroconvulsive therapy can also be considered.

These approaches may be used alone or in combination, depending on your doctor’s advice and your preferences. There are many factors to weigh before deciding on a treatment course, including the severity of your symptoms and the level of disruption they are causing in your life. A mild case of PPD may be adequately managed with therapy, for example, while a more moderate to severe case of PPD may require medication.

Antidepressants such as SSRIs are often the first line of treatment for moderate to severe cases of PPD, says Dr. Taljan. But because most antidepressants take weeks to kick in, your doctor may recommend brexanolone if you have a more severe case—some patients feel better immediately after the course of treatment.8

There are also lifestyle strategies you can adopt at home that may improve your ability to cope with PPD and potentially reduce some of the symptoms, including:5

  • Sleeping when you can
  • Finding time to exercise
  • Asking family and friends for help
  • Making time to do things for yourself
  • Eating regular, healthy meals
  • Joining a support group (ask your doctor for recommendations and see “Helpful Resources” below for some options)

While all of these strategies play a role in maintaining a healthy body and mind in the postpartum period, the truth is that it can be challenging to find time to engage in healthy habits when you have a newborn baby. That’s why it’s important to seek help from a medical professional—who can direct you to a treatment option that fits best with your symptoms, lifestyle, and preferences—and from loved ones who can help you with personal responsibilities.

If medication is prescribed, will it affect my breastmilk? 

Most antidepressants are considered safe to take while breastfeeding, with little risk of side effects for the baby. Your doctor can explain which medications are safe to take while breastfeeding and which may not be.9

It’s important to remember that having untreated PPD can potentially put your baby at risk of behavioral and developmental delays. Breastfeeding should not inhibit you from seeking treatment for PPD, just as getting treatment for PPD should not stop you from breastfeeding.

What is Postpartum Psychosis?

Postpartum psychosis is a much rarer and more severe condition than PPD that may cause delusions and hallucinations. An estimated 4 out of every 1,000 new mothers experience it, and it usually begins in the first two weeks after childbirth.2

Symptoms may include:2

  • Seeing or hearing things that aren’t there
  • Feeling confused
  • Having rapid mood swings
  • Trying to hurt yourself or your baby or having obsessions/ruminations about doing so
  • Paranoia
  • Restlessness or agitation
  • Behaving recklessly or abnormally

Postpartum psychosis is a medical emergency that requires immediate treatment, usually in a hospital setting. Treatment may involve antidepressants, antipsychotics, or mood stabilizers. Electroconvulsive therapy (ECT), a procedure that sends small electrical currents through the brain, may also be recommended for severe psychosis and depression symptoms.1, 2

How can I help my wife?

If you are the partner of a woman suffering from PPD, you can help by encouraging her to seek help from a medical professional. Your goal should be to reduce her stress and anxiety in any way you can, while also paying attention to your own mental health. Taking on extra responsibilities can help—whatever will allow her to make more time for sleep.

“It’s hard when you have a newborn, but if you can strategize to help with feedings overnight to make sure that mom is able to get enough sleep, that can be a way to try to protect against some of those mood disturbances,” Dr. Taljan says.

FAQS

How long does postpartum depression last?

There's no telling how long postpartum depression will last without treatment. It could persist for months or longer, and it can turn into a chronic depressive disorder. Even with treatment, there is no guarantee that PPD will resolve entirely, and there is always a risk of relapse. Some medications, such as antidepressants, can take several weeks to kick in.

What causes postpartum depression?

There is no one cause of postpartum depression. A dramatic drop in female hormones following childbirth and the stresses of having a newborn baby are thought to be among the leading causes, as well as a past history of depression or PPD. Social stigma is also a contributing factor and drives a false narrative of motherhood being a perpetual state of bliss.

When does postpartum depression start?

Postpartum depression can begin within days of giving birth or anytime within the first year after childbirth. Many women experience a milder condition called the baby blues in the first two weeks after giving birth, and it typically resolves on its own. Women who experience depression symptoms that last longer than two weeks postpartum should reach out to a medical professional for help.

Can you prevent postpartum depression?

Because depression during pregnancy or a past incident of postpartum depression are two of the main risk factors for PPD, your doctor may recommend that you continue treatment for depression throughout pregnancy if you have a history of either condition to help reduce your risk of developing postpartum depression.

Helpful Resources

  • Postpartum Support International (PSI) has a helpline at 1-800-944-4PPD(4773) that you can call or text for information, support, and resources. There are also free live phone sessions with experts available weekly that you can join. See the schedule.
  • Postpartum Progress has a list of PPD support groups and resources by state.
  • Behavioral Health Treatment Services Locator: The Substance Abuse and Mental Health Services Administration (SAMHSA) has an online resource for locating mental health treatment facilities and programs in your state.
  • National Institute of Mental Health: As the lead federal agency for research on mental disorders, here you’ll find the latest research, news, and statistics on postpartum depression.
  • 1-800-PPD-MOMS(773-6667): This is the National Perinatal Hotline.
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Last Updated: Mar 31, 2021