ConditionMental health & sleep
Postpartum Depression
Postpartum depression (PPD) is depression that starts during pregnancy or within the year after giving birth. It affects about 1 in 8 new mothers in the US and can also affect partners. Unlike the "baby blues," which fade within 2 weeks, PPD causes persistent sadness, anxiety, exhaustion, guilt and difficulty bonding or functioning. It is a medical condition, not a personal failing, and it is very treatable with therapy, medicines safe for breastfeeding, and support.
Also called: Postnatal depression, perinatal depression, peripartum depression, PPD
At a glance
- What it is
- Major depression starting in pregnancy or up to 12 months after birth.
- How common
- About 1 in 8 mothers report symptoms; partners can be affected too.
- Symptoms
- Persistent low mood, anxiety, crying, guilt, exhaustion, sleep and appetite changes, poor bonding, intrusive thoughts.
- Baby blues
- Milder, start in the first days, resolve within 2 weeks.
- Screening
- Edinburgh Postnatal Depression Scale or PHQ-9 at prenatal and postpartum visits.
- Treatment
- Therapy, SSRIs (many compatible with breastfeeding), zuranolone, support.
When to get help
Call 911 or go to the ER
- Thoughts of harming yourself or your baby, or feeling you cannot keep yourself or your baby safe: call or text 988 (US) or call 911 or your local emergency number
- Hallucinations, believing things that are not true, severe confusion, or not sleeping at all for days (possible postpartum psychosis)
See a doctor within a day or two
- Unable to care for yourself or your baby, not eating, or feeling hopeless
- Panic attacks, severe anxiety or intrusive frightening thoughts that are hard to manage
- Symptoms worsening despite treatment
Book a routine appointment
- Low mood, anxiety, tearfulness or irritability lasting more than 2 weeks after birth
- Feeling disconnected from your baby, or that you are a bad parent
- Partners feeling depressed or overwhelmed after the birth
- A history of depression or bipolar disorder and planning pregnancy (plan ahead with your doctor)
Usually safe to manage at home
- Tearfulness, mood swings and feeling overwhelmed in the first 2 weeks after birth that are improving (baby blues), with rest and support
You can also call or text the US National Maternal Mental Health Hotline at 1-833-852-6262 (1-833-TLC-MAMA), available 24 hours a day.
Postpartum depression vs baby blues vs postpartum psychosis
| Baby blues | Postpartum depression | Postpartum psychosis | |
|---|---|---|---|
| How common | Up to 80% of new mothers | About 1 in 8 | About 1 to 2 per 1,000 |
| Onset | Days 2 to 5 | Pregnancy or anytime in the first year | Usually first 2 weeks |
| Duration | Resolves within 2 weeks | Weeks to months without treatment | Requires urgent treatment |
| Symptoms | Weepiness, mood swings, irritability | Persistent sadness, anxiety, hopelessness, guilt | Hallucinations, delusions, confusion, extreme mood changes |
| Treatment | Rest, support | Therapy, medicines | Emergency hospital care |
Symptoms
- feeling sad, empty or hopeless most of the day
- crying more than usual
- severe anxiety, worry or panic attacks
- irritability or anger
- loss of interest or pleasure, including in the baby
- feeling disconnected from the baby, or unable to bond
- excessive guilt or feeling like a bad parent
- trouble sleeping even when the baby sleeps, or sleeping too much
- appetite changes
- exhaustion beyond what is expected
- difficulty concentrating or making decisions
- withdrawal from family and friends
- intrusive, unwanted thoughts of harm coming to the baby (common in perinatal anxiety and OCD; they are distressing, not intentions)
- thoughts of death or suicide
Many people hide symptoms out of shame or fear their baby will be taken away. Seeking help is a sign of good parenting.
Causes and risk factors
PPD results from a combination of factors:
- hormonal changes: the sudden drop in estrogen and progesterone after birth
- sleep deprivation and physical recovery
- previous depression or anxiety, especially in pregnancy
- previous postpartum depression
- bipolar disorder or a family history of perinatal mood disorders
- stressful life events, financial strain, relationship problems
- lack of support
- pregnancy or birth complications, NICU stays, infant health problems
- unplanned pregnancy
- young age
- history of trauma or abuse
- thyroid problems: postpartum thyroiditis can mimic or worsen depression
Screening and diagnosis
ACOG recommends screening for depression and anxiety at the first prenatal visit, later in pregnancy and at postpartum visits. Pediatricians also screen mothers at well-baby visits. Tools include the Edinburgh Postnatal Depression Scale (EPDS) and the PHQ-9.
A clinician will ask about symptoms, how long they have lasted, safety, past mental health, and screen for bipolar disorder, because antidepressants alone can trigger mania. Blood tests may check thyroid function and anemia.
Treatment
Psychotherapy
- Cognitive behavioral therapy (CBT) and interpersonal therapy (IPT) are effective for mild to moderate PPD and are often first-line.
- Telehealth options make therapy easier with a newborn.
Medicines
- SSRIs such as sertraline are widely used and many are considered compatible with breastfeeding. Your doctor will weigh benefits and risks.
- Zuranolone, an oral medicine taken for 14 days, was approved in 2023 specifically for postpartum depression and can work within days. It causes drowsiness, so driving must be avoided for 12 hours after each dose.
- Other antidepressants may be used based on past response.
Support and self-care
- accept help with baby care, meals and household tasks
- protect a block of sleep, for example by sharing night feeds
- gentle physical activity and time outdoors
- connect with other parents and peer support groups such as Postpartum Support International
- eat regularly and stay hydrated
- avoid alcohol
Severe cases
Intensive outpatient programs, inpatient care, and electroconvulsive therapy are options for severe or treatment-resistant depression or psychosis.
Effects on the family
Untreated PPD can affect bonding, breastfeeding, the baby's sleep and development, and relationships. Treatment improves outcomes for the whole family. Partners also experience postpartum depression in about 1 in 10 cases and should seek help too.
Prevention
The US Preventive Services Task Force recommends counseling interventions such as CBT or IPT for pregnant and postpartum people at increased risk. Planning ahead with your care team, arranging support and continuing treatment for existing depression reduce risk.
Frequently asked questions
What are the signs of postpartum depression?
Signs include persistent sadness or emptiness, frequent crying, severe anxiety, irritability, feeling disconnected from your baby, guilt, trouble sleeping even when the baby sleeps, appetite changes, exhaustion and thoughts of self-harm, lasting more than 2 weeks.
What is the difference between baby blues and postpartum depression?
Baby blues are common, mild mood swings and tearfulness that start a few days after birth and fade within 2 weeks. Postpartum depression is more intense, lasts longer than 2 weeks, and interferes with daily life and caring for the baby.
How long does postpartum depression last?
Without treatment, PPD can last months or longer. With treatment, many people feel better within weeks to a few months. Starting treatment early leads to faster recovery and lowers the risk of chronic depression.
Can I take antidepressants while breastfeeding?
Many antidepressants, such as sertraline, pass into breast milk in very small amounts and are considered compatible with breastfeeding. Your doctor will discuss the options. Untreated depression also carries risks for both you and your baby.
Can fathers get postpartum depression?
Yes. About 1 in 10 fathers and non-birthing partners experience depression in the year after a baby's birth. Symptoms may include irritability, withdrawal and increased alcohol use. Treatment is similar and effective.
Sources
This guide was written from current patient and clinical guidance, including:
- American College of Obstetricians and Gynecologists (ACOG): Screening and diagnosis of mental health conditions during pregnancy and postpartum; Treatment and management of perinatal mental health conditions
- CDC: Symptoms of depression among women
- National Institute of Mental Health (NIMH): Perinatal depression
- US Preventive Services Task Force: Perinatal depression, preventive interventions
- HRSA: National Maternal Mental Health Hotline