Postpartum depression (PPD) is a complex mix of physical, emotional, and behavioral changes that happen in some women after giving birth. According to the DSM-5, a manual used to diagnose mental disorders, PPD is a form of major depression that begins within 4 weeks after delivery. The diagnosis of postpartum depression is based not only on the length of time between delivery and onset but on the severity of the depression.
Postpartum depression is linked to chemical, social, and psychological changes that happen when having a baby. The term describes a range of physical and emotional changes that many new mothers experience. PPD can be treated with medication and counseling.
The chemical changes involve a rapid drop in hormones after delivery. The actual link between this drop and depression still not clear. But what is known is that the levels of estrogen and progesterone, the female reproductive hormones, increase tenfold during pregnancy. Then, they drop sharply after delivery. By 3 days after a woman gives birth, the levels of these hormones drop back to what they were before pregnancy.
In addition to these chemical changes, the social and psychological changes of having a baby create an increased risk of depression.
Most new mothers experience the “baby blues” after delivery. About 1 out of every 10 of these women will develop a more severe and longer-lasting depression after delivery. About 1 in 1,000 women develop a more serious condition called postpartum psychosis.
Dads aren’t immune. Research shows that about 1 in 10 new fathers get depression during the year their child is born.
Signs and symptoms of depression after childbirth vary, and they can range from mild to severe.
Baby blues symptoms
Signs and symptoms of baby blues — which last only a few days to a week or two after your baby is born — may include:
- Mood swings
- Feeling overwhelmed
- Reduced concentration
- Appetite problems
- Trouble sleeping
Postpartum depression symptoms
Postpartum depression may be mistaken for baby blues at first — but the signs and symptoms are more intense and last longer, and may eventually interfere with your ability to care for your baby and handle other daily tasks. Symptoms usually develop within the first few weeks after giving birth, but may begin earlier ― during pregnancy ― or later — up to a year after birth.
Postpartum depression signs and symptoms may include:
- Depressed mood or severe mood swings
- Excessive crying
- Difficulty bonding with your baby
- Withdrawing from family and friends
- Loss of appetite or eating much more than usual
- Inability to sleep (insomnia) or sleeping too much
- Overwhelming fatigue or loss of energy
- Reduced interest and pleasure in activities you used to enjoy
- Intense irritability and anger
- Fear that you’re not a good mother
- Feelings of worthlessness, shame, guilt or inadequacy
- Diminished ability to think clearly, concentrate or make decisions
- Severe anxiety and panic attacks
- Thoughts of harming yourself or your baby
- Recurrent thoughts of death or suicide
Untreated, postpartum depression may last for many months or longer.
With postpartum psychosis — a rare condition that typically develops within the first week after delivery — the signs and symptoms are severe. Signs and symptoms may include:
- Confusion and disorientation
- Obsessive thoughts about your baby
- Hallucinations and delusions
- Sleep disturbances
- Excessive energy and agitation
- Attempts to harm yourself or your baby
Postpartum psychosis may lead to life-threatening thoughts or behaviors and requires immediate treatment.
Postpartum depression in new fathers
New fathers can experience postpartum depression, too. They may feel sad or fatigued, be overwhelmed, experience anxiety, or have changes in their usual eating and sleeping patterns ― the same symptoms mothers with postpartum depression experience.
Fathers who are young, have a history of depression, experience relationship problems or are struggling financially are most at risk of postpartum depression. Postpartum depression in fathers ― sometimes called paternal postpartum depression ― can have the same negative effect on partner relationships and child development as postpartum depression in mothers can.
If you’re a new father and are experiencing symptoms of depression or anxiety during your partner’s pregnancy or in the first year after your child’s birth, talk to your health care professional. Similar treatments and supports provided to mothers with postpartum depression can be beneficial in treating postpartum depression in fathers.
When to see a doctor
If you’re feeling depressed after your baby’s birth, you may be reluctant or embarrassed to admit it. But if you experience any symptoms of postpartum baby blues or postpartum depression, call your doctor and schedule an appointment. If you have symptoms that suggest you may have postpartum psychosis, get help immediately.
It’s important to call your doctor as soon as possible if the signs and symptoms of depression have any of these features:
- Don’t fade after two weeks
- Are getting worse
- Make it hard for you to care for your baby
- Make it hard to complete everyday tasks
- Include thoughts of harming yourself or your baby
The exact cause isn’t clear, but there are some factors that may contribute to postpartum depression. Postpartum depression may be triggered by a combination of physical changes and emotional stressors.
One of the biggest physical changes after giving birth involves hormones. While you’re pregnant, your levels of estrogen and progesterone are higher than usual. Within hours of giving birth, hormone levels drop back to their previous state. This abrupt change may lead to depression.
Some other physical factors may include:
- low thyroid hormone levels
- sleep deprivation
- inadequate diet
- underlying medical conditions
- drug and alcohol misuse
You may be more likely to develop postpartum depression if you’ve had a mood disorder in the past or if mood disorders run in your family.
Emotional stressors may include:
- recent divorce or death of a loved one
- you or your child having serious health problems
- social isolation
- financial burdens
Any new mom can experience postpartum depression and it can develop after the birth of any child, not just the first. However, your risk increases if:
- You have a history of depression, either during pregnancy or at other times
- You have bipolar disorder
- You had postpartum depression after a previous pregnancy
- You have family members who’ve had depression or other mood disorders
- You’ve experienced stressful events during the past year, such as pregnancy complications, illness or job loss
- Your baby has health problems or other special needs
- You have twins, triplets or other multiple births
- You have difficulty breast-feeding
- You’re having problems in your relationship with your spouse or significant other
- You have a weak support system
- You have financial problems
- The pregnancy was unplanned or unwanted
Left untreated, postpartum depression can interfere with mother-child bonding and cause family problems.
- For mothers. Untreated postpartum depression can last for months or longer, sometimes becoming a chronic depressive disorder. Even when treated, postpartum depression increases a woman’s risk of future episodes of major depression.
- For fathers. Postpartum depression can have a ripple effect, causing emotional strain for everyone close to a new baby. When a new mother is depressed, the risk of depression in the baby’s father may also increase. And new dads are already at increased risk of depression, whether or not their partner is affected.
- For children. Children of mothers who have untreated postpartum depression are more likely to have emotional and behavioral problems, such as sleeping and eating difficulties, excessive crying, and delays in language development.
If you have a history of depression — especially postpartum depression — tell your doctor if you’re planning on becoming pregnant or as soon as you find out you’re pregnant.
- During pregnancy, your doctor can monitor you closely for signs and symptoms of depression. He or she may have you complete a depression-screening questionnaire during your pregnancy and after delivery. Sometimes mild depression can be managed with support groups, counseling or other therapies. In other cases, antidepressants may be recommended — even during pregnancy.
- After your baby is born, your doctor may recommend an early postpartum checkup to screen for signs and symptoms of postpartum depression. The earlier it’s detected, the earlier treatment can begin. If you have a history of postpartum depression, your doctor may recommend antidepressant treatment or psychotherapy immediately after delivery.
Managing after childbirth
Here are some tips that can help you cope with bringing home a newborn:
- Ask for help. Let others know how they can help you.
- Be realistic about your expectations for yourself and baby.
- Exercise , within the limits of any restrictions your doctor may place on your level of activity; take a walk, and get out of the house for a break.
- Expect some good days and some bad days.
- Follow a sensible diet; avoid alcohol and caffeine.
- Foster the relationship with your partner — make time for each other.
- Keep in touch with family and friends — don’t isolate yourself.
- Limit visitors when you first go home.
- Screen phone calls.
- Sleep or rest when your baby sleeps.
Treatment and recovery time vary, depending on the severity of your depression and your individual needs. If you have an underactive thyroid or an underlying illness, your doctor may treat those conditions or refer you to the appropriate specialist. Your doctor may also refer you to a mental health professional.
The baby blues usually fade on their own within a few days to one to two weeks. In the meantime:
- Get as much rest as you can.
- Accept help from family and friends.
- Connect with other new moms.
- Create time to take care of yourself.
- Avoid alcohol and recreational drugs, which can make mood swings worse.
Postpartum depression is often treated with psychotherapy (also called talk therapy or mental health counseling), medication or both.
- Psychotherapy. It may help to talk through your concerns with a psychiatrist, psychologist or other mental health professional. Through therapy, you can find better ways to cope with your feelings, solve problems, set realistic goals and respond to situations in a positive way. Sometimes family or relationship therapy also helps.
- Antidepressants. Your doctor may recommend an antidepressant. If you’re breast-feeding, any medication you take will enter your breast milk. However, most antidepressants can be used during breast-feeding with little risk of side effects for your baby. Work with your doctor to weigh the potential risks and benefits of specific antidepressants.
With appropriate treatment, postpartum depression symptoms usually improve. In some cases, postpartum depression can continue, becoming chronic depression. It’s important to continue treatment after you begin to feel better. Stopping treatment too early may lead to a relapse.
Postpartum psychosis requires immediate treatment, usually in the hospital. Treatment may include:
- Medication. Treatment may require a combination of medications — such as antipsychotic medications, mood stabilizers and benzodiazepines — to control your signs and symptoms.
- Electroconvulsive therapy (ECT). If your postpartum depression is severe and you experience postpartum psychosis, ECT may be recommended if symptoms do not respond to medication. ECT is a procedure in which small electrical currents are passed through the brain, intentionally triggering a brief seizure. ECT seems to cause changes in brain chemistry that can reduce the symptoms of psychosis and depression, especially when other treatments have been unsuccessful.
Treatment for postpartum psychosis can challenge a mother’s ability to breast-feed. Separation from the baby makes breast-feeding difficult, and some medications used to treat postpartum psychosis aren’t recommended for women who are breast-feeding. If you’re experiencing postpartum psychosis, your doctor can help you work through these challenges.
- Depressive disorders. In: Diagnostic and Statistical Manual of Mental Disorders DSM-5. 5th ed. Arlington, Va.: American Psychiatric Association; 2013. https://dsm.psychiatryonline.org. Accessed June 7, 2018.
- Postpartum depression. Office of Women’s Health. https://www.womenshealth.gov/mental-health/mental-health-conditions/postpartum-depression. Accessed July 1, 2015.
- Depression among women. Centers for Disease Control and Prevention. https://www.cdc.gov/reproductivehealth/depression/index.htm. Accessed June 7, 2018.
- What is postpartum depression? American Psychiatric Association. https://www.psychiatry.org/patients-families/postpartum-depression/what-is-postpartum-depression. Accessed June 7, 2018.
- Viguera A. Postpartum unipolar depression: Epidemiology, clinical features, assessment, and diagnosis. https://www.uptodate.com/contents/search. Accessed June 7, 2018.
- Viguera A. Mild to moderate postpartum unipolar major depression: Treatment. https://www.uptodate.com/contents/search. Accessed June 7, 2018.
- Viguera A. Severe postpartum unipolar major depression: Treatment. https://www.uptodate.com/contents/search. Accessed June 7, 2018.
- Viguera A. Postpartum depression: Risk of abnormal child development. https://www.uptodate.com/contents/search. Accessed June 7, 2018.
- Frequently asked questions. Labor, delivery, and postpartum care FAQ091. Postpartum depression. American College of Obstetricians and Gynecologists. https://www.acog.org/-/media/For-Patients/faq091.pdf?dmc=1&ts=20180608T0030489211. Accessed June 7, 2018.
- Postpartum depression facts. National Institute of Mental Health. https://www.nimh.nih.gov/health/publications/postpartum-depression-facts/index.shtml. Accessed June 7, 2018.
- Postpartum depression. Merck Manual Professional Version. https://www.merckmanuals.com/professional/gynecology-and-obstetrics/postpartum-care-and-associated-disorders/postpartum-depression. Accessed June 7, 2018.
- AskMayoExpert. Depression during pregnancy and postpartum. Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2017. Accessed June 7, 2018.
- American Academy of Pediatrics. Postpartum care of the mother. In: Guidelines for Perinatal Care. 8th ed. Elk Grove Village, Ill.: American Academy of Pediatrics; Washington, D.C.: American College of Obstetricians and Gynecologists; 2017.
- Kumar SV, et al. Promoting postpartum mental health in fathers: Recommendations for nurse practitioners. American Journal of Men’s Health. 2018;12:221.
- Berg AR, et al. Paternal perinatal depression: Making a case for routine screening. The Nurse Practitioner. 2016;20:1.
- Bergink V, et al. Postpartum psychosis: Madness, mania, and melancholia in motherhood. American Journal of Psychiatry. 2016;173:1179.
- Bobo WV, et al. Concise review for physicians and other clinicians: Postpartum depression. Mayo Clinic Proceedings. 2014;89:835.
- Yogman M, et al. Fathers’ roles in the care and development of their children: The role of pediatricians. Pediatrics. 2018;138:e20161128.
- Campolong K, et al. The association of exercise during pregnancy with trimester-specific and postpartum quality of life and depressive symptoms in a cohort of healthy pregnant women. Archives of Women’s Mental Health. 2018;21:215.