Although postpartum depression is a common complication after childbirth, it can be one of the most isolating experiences a new parent faces.
“Here was this precious baby I had wanted for so long, and I didn’t even feel like I liked him,” says Sammy Bohannon, an online business manager and homeschool mom of two in Vicksburg, Mississippi.
Before Bohannon got pregnant, she was diagnosed with clinical depression.
“I did not know there were medications that were safe to take while pregnant, so I went through my pregnancy unmedicated,” she adds.
Right after birth, Bohannon learned she could have been taking certain depression medications during pregnancy. She restarted medication immediately after birth, but postpartum depression still crept up on her.
“I felt like a bad mother because my son was beautiful, healthy and one of the happiest babies I had ever met. But I felt strangely disconnected from him and felt horrible about it,” she recalls.
After four months of therapy and medication, Bohannon’s postpartum depression faded.
“After that, I felt so connected to my baby and had that maternal instinct I had always expected to have,” she says.
Learn more about postpartum depression, the causes of postpartum depression and postpartum depression treatment options.
[See: Best Hospitals for Maternity Care.]
What Is Postpartum Depression?
Postpartum depression is a mood disorder that can cause deep sadness and hopelessness after childbirth, caused by a mix of hormonal, emotional and lifestyle factors. Most of the discourse on postpartum depression centers around birth mothers, but birth partners and adoptive parents are also susceptible. Postpartum depression affects about 13% of women, according to the Centers for Disease Control and Prevention.
Baby blues vs. postpartum depression
The baby blues, or postpartum blues, are often confused with postpartum depression. Nearly 80% of women experience this normal emotional shift one to two weeks after childbirth, according to the American Pregnancy Association.
Baby blue symptoms are short-lived, often starting two to three days after childbirth and subsiding by 14 days postpartum. Baby blues symptoms include:
— Tearfulness or frequent crying
— Frustration
— Anxiety
— Feeling overwhelmed
— Fatigue
[READ: Burnout vs. Depression: How to Tell the Difference]
Signs and Symptoms of Postpartum Depression
Postpartum depression is more serious and long-lasting than baby blues and affects a parent’s physical, emotional and mental well-being.
Common signs and symptoms include:
— Physical symptoms, such as ongoing changes in sleep patterns, fatigue, changes in weight or appetite or new aches and pains that do not go away on their own
— Emotional symptoms, including persistent sadness, tearfulness, anger, hopelessness or irritability
— Mental symptoms, such as difficulty concentrating, difficulty bonding with the baby, excessive anxiety or loss of interest or pleasure in activities once enjoyed
Some cases of postpartum depression are subtle.
To catch these subtle cases, Dr. TraShawn Thornton-Davis, an OB-GYN with Kaiser Permanente Mid-Atlantic in Silver Spring, Maryland, evaluates patients every trimester and again after delivery by:
— Discussing changes in mood and energy levels that may be impacting daily functions
— Asking open-ended questions about sleep patterns, appetite and interest in daily activities that new moms might otherwise attribute to fatigue
— Checking on a mother’s support network, as social isolation tends to worsen symptoms and slow down recovery
— Inquiring about a family history of postpartum depression
It’s important to identify postpartum depression at its early stages so we can start treatment before it affects either parent’s health or their relationship with their baby, Thornton-Davis says.
Onset and timeline
When does postpartum depression start? Perinatal depression may start as depressive symptoms in pregnancy, and the average time of onset of postpartum depression is about three months after delivery.
Others may develop postpartum depression after the first year and sometimes up to two years after giving birth, Thornton-Davis says.
Thornton-Davis says late-onset postpartum depression can be triggered by:
— Breastfeeding difficulties
— Returning to work
— Relationship tension
— Insufficient social support
How long does postpartum depression last? Some postpartum depression may fluctuate, with periods of improvement followed by relapses. Other cases will steadily improve over time. Up to 25% of individuals with perinatal depression may have symptoms for three years after giving birth, according to a study in Obstetrics & Gynecology.
Impact on daily life
Postpartum depression impacts the daily life of both the mother and the baby, including challenges with:
— Bonding with the baby, which in severe cases can impact the way the mother treats the child
— Breastfeeding
— Low self-esteem and confidence
— Daily self-care
Causes and Biological Factors Behind Postpartum Depression
There is no singular cause of postpartum depression. Rather, researchers believe it is caused by a combination of social, mental and biological factors, as mentioned above.
Key factors of postpartum depression include:
— Hormonal changes. Shifts in the pregnancy hormones, progesterone and estrogen, affect mood. Progesterone and estrogen rise throughout pregnancy and then dramatically drop after birth.
— Lack of sleep. Sleep deprivation, which is common for new parents, can exacerbate depressive symptoms and diminish emotional regulation.
— Stress. The stress of social pressure and caring for a newborn can make new parents more susceptible to postpartum depression.
— Inflammation in the brain. Research shows that women have higher levels of inflammation in the brain, called neuroinflammation. Dr. Sharon Batista, an assistant clinical professor of psychiatry at Mount Sinai Hospital in New York City, says that these inflammatory markers are linked to postpartum depression symptoms.
— Structural and functional brain changes. Batista says research shows that certain brain areas involved in emotion, stress and memory may work differently in people who have postpartum depression.
— Genetic factors. A family history of postpartum depression and how these genes are expressed can affect your risk for postpartum depression.
[Read: Stress-Relieving Exercises to Help You Feel More Relaxed and Empowered]
Risk Factors
Many people don’t realize that some experiences during pregnancy and postpartum increase risk for postpartum depression, even if you’ve never had a mental health condition before, Thornton-Davis says.
Risk factors for postpartum depression include:
— Personal or family history of depression, anxiety or other mental health conditions
— Complications during pregnancy or delivery, such as delivering a premature infant
— Challenges with breastfeeding
— Having a baby admitted to the neonatal intensive care unit
— A limited social support network, such as being a single parent, a young parent or living far from loved ones
— A history of mood disorders in the luteal phase of the menstrual cycle (also known as premenstrual disorder)
— Any other stressors, such as financial stressors, major recent life events or complex family dynamics
Who is affected and how is it understood today?
Postpartum depression is more common in minority populations and those from lower socioeconomic groups, says Dr. Jennifer Payne, a professor, vice chair of research and the director of the Reproductive Psychiatry Research Program at the University of Virginia School of Medicine in Charlottesville, Virginia.
“It is thought that the stress of being from a minoritized group and the stress due to lower socioeconomic status increase the risk of postpartum depression,” says Dr. Payne.
Some research suggests that postpartum depression is also more prevalent for individuals living in urban areas.
In recent years, health care providers and researchers have shifted from using “postpartum depression” to the broader term “perinatal depression.”
“The shift to perinatal depression was made for good clinical reasons,” Payne says.
About half of postpartum depression cases can begin during pregnancy, and Payne elaborates that the new terminology has brought attention to the importance of screening during pregnancy.
Diagnosis
To diagnose postpartum depression and its severity, health care providers consider:
— The timing of a depressive episode, such as whether it occurred during pregnancy or within four weeks of delivery
— Whether symptoms of postpartum depression are present
— Questionnaires, such as the Edinburgh Postnatal Depression Scale, or other general depression questionnaires
— The severity of the symptoms, such as thoughts of harming oneself or their baby
Treatment
Postpartum depression treatment usually combines different kinds of support.
Postpartum depression treatment may include a combination of:
— Psychotherapy, such as talk therapy or cognitive behavioral therapy with a therapist or mental health counselor
— Social support, which can range from informal social support to formalized talk therapy groups
— Lifestyle modifications, such as prioritizing postpartum nutrition, sleep, exercise and stress management, as much as possible for a new parent in the midst of an overwhelming circumstance
— General oral antidepressant medications, including selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors and tricyclic antidepressants for perinatal depression
— Postpartum-specific medications, such as zuranolone, a new oral medication approved specifically for postpartum depression, or brexanolone, a multi-day, inpatient intravenous medication for postpartum depression.
— Nonpharmacological treatments, such as transcranial magnetic stimulation.
Taking antidepressant medications during pregnancy
Some antidepressants, particularly SSRIs, are generally safe to take during pregnancy and breastfeeding under the direction of your health care provider. Health care providers often recommend antidepressant medications preemptively to those who have personal history of depression or other mental health disorders or who report perinatal depression symptoms during pregnancy.
In 2025, the Food and Drug Administration is considering issuing the most serious type of warning, called a Black Box warning, on antidepressant use during pregnancy. The FDA has concerns that antidepressant use may pose risks to fetal development. ACOG refuted these claims, stating that the risk of untreated mental health conditions is higher than potential complications from perinatal SSRI use.
Batista states that a Black Box warning on SSRI use during pregnancy would have heavy implications, such as:
— Increasing the risk of untreated maternal depression, which is also a serious pregnancy complication
— Heightening the already present stigma on maternal mental health treatment
— Creating a downstream effect that can cause an increased incidence of postpartum depression due to untreated depression during pregnancy
Red flags
Intervening early with postpartum depression can prevent symptoms from progressing and allow you to take care of yourself and your baby.
If you experience any of the following red flag signs, it’s time to seek emergency care for your postpartum depression by calling 911 or heading to your local emergency department:
— Thoughts of harming yourself
— Thoughts of harming your baby
— Inability to care for yourself or your baby
— Feeling completely detached from the world or your baby
Pathways to support and resources
You don’t need to struggle with postpartum depression alone. Hundreds of thousands of individuals are affected by postpartum depression each year, and there are resources available to help.
— If you want to screen yourself for postpartum depression now, take the Edinburgh Postnatal Depression Scale. This is a 10-question multiple-choice self-assessment.
— Find online resources through reputable organizations such as the Office on Women’s Health and ACOG.
— Schedule an appointment with your birth provider, whether it’s an OB-GYN, midwife or family medicine OB, and ask to talk about postpartum depression. For many cases of postpartum depression, you can start treatment through a primary care provider or OB-GYN, though you may additionally receive a referral to a psychiatrist or therapist.
— Look for online support groups, such as support groups through Postpartum Support International, Postpartum Health Alliance or through various social media groups.
— Find in-person postpartum depression support groups in your area through therapy offices, religious institutions or community services.
— Call a postpartum depression support hotline, such as PPD Moms at 1-800-PPD-MOMS (800-773-6667), Postpartum Support International at 1-800-994-4PPD (1-800-944-4773) or the National Maternal Mental Health Hotline at 1-833-TLC-MAMA (1-833-852-6262) for 24/7 free confidential support for pregnant and new moms.
— If you are having suicidal thoughts, call or text the 988 Suicide and Crisis Lifeline.
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A Patient’s Guide to Postpartum Depression originally appeared on usnews.com
