Unlike the “baby blues,” postpartum depression can last for months or even a year or longer after the birth of a child.
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, anxious, or depressed.
As many as 50 to 75 percent of new mothers feel some degree of unhappiness, worry, and fatigue after having a baby. This is known as the “baby blues.” Although it may take more time for a mom to “feel like herself again” after having a baby, the feelings of sadness associated with the 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 (also known as perinatal depression), a condition that can persist for months or even a year or longer after giving birth. An estimated 1 in 8 women in the United States experience this mental health condition. But research suggests the actual number may be higher because many cases go undetected.
While postpartum depression can be debilitating, with time and treatment most women can recover and bond with their baby.
Symptoms usually develop within the first few weeks after giving birth but may begin earlier (such as during pregnancy, which is referred to as peripartum depression) or later (up to a year after giving birth).
“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 Willoughby Hills Family Health Center in Ohio.
Postpartum depression may result from a combination of different factors. Researchers believe that, in general, genetics, hormonal changes, and emotional issues are key contributors.
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, the 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.
Periods of hormonal fluctuation, such as menstrual cycles or perimenopause, are associated with major depressive episodes, adds Dr. Wisner. 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,” Wisner says.
Risk Factors for Postpartum Depression
Postpartum depression can affect any woman regardless of age, race, ethnicity, or economic status, though some people may be more susceptible than others. The following may increase your odds of developing postpartum depression:
Symptoms of depression during or after a previous pregnancy
Having family member who’s been diagnosed with depression, postpartum depression, or another mood disorder like premenstrual dysphoric disorder
Having a stressful life event within the past year, 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 conflict or relationship issues with your spouse or partner
Having an unwanted or unplanned pregnancy
Having mixed feelings about the pregnancy
A lack of strong emotional support from others
Having financial difficulties
Being younger than 20
Being a single parent
Having a baby with medical needs
Having a baby who cries very often
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 research review.
Postpartum depression is less understood in men, but one study suggests that feelings of inadequacy and powerlessness appear to be contributing factors. These feelings can sometimes turn into frustration and anger.
Other research has found that unemployment, financial strain, history of mental illness, and low social support are associated with an increased risk in men.
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, it is paramount for maintaining good mental health during the first year of a baby’s life. Research 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 they believe “should” be a time of joy. But a proactive approach to treating depression is best for everyone concerned.
Research in the United States has shown that routine postpartum depression screenings can improve outcomes for pregnant parents and their families. 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 (ACOG), the American Psychiatric Association (APA), and the American Academy of Pediatrics (AAP). It’s generally covered by insurance and 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 AAP now recommends that pediatricians screen mothers at the one-, two-, four-, and six-month well-child visits.
To be diagnosed with postpartum depression, symptoms must begin during pregnancy or within a year of giving birth.
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.
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 Options for Postpartum Depression
Breastfeeding mothers may be reluctant to take psychotropic (psychiatric) drugs like antidepressants, for fear of the potential effects on their child. But the levels of antidepressants found in breast milk are generally very low and have little or no effect on milk supply or well-being of the baby.
Given the potential long-lasting negative effects of untreated postpartum depression, research suggests that for some women, taking medication is better for both mother and baby than forgoing treatment.
Each mother should make that decision personally, in consultation with their doctor, considering factors like medical history and personal circumstances.
Your healthcare provider can prescribe an antidepressant 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.
Zuranolone (Zurzuvae), the first oral medication indicated to treat postpartum depression (PPD) in adults, may be another option. It was approved by the FDA in August 2023 and is taken once daily over a two-week period. Zuranolone is not safe to take during pregnancy and its risk is unclear during breastfeeding. If you’re breastfeeding, ACOG recommends speaking to your doctor about your options, as it may be possible to continue during the treatment or pause breastfeeding and go back to it one week after your last dose.
Electroconvulsive Therapy for Postpartum Depression
For women with severe postpartum depression who experience postpartum psychosis — a rare but serious medical condition that can cause hallucinations, delusions, and paranoia — a doctor may recommend electroconvulsive therapy (ECT) if their symptoms aren’t improving with medicine.
During this treatment, small electrical currents are passed through the brain, intentionally triggering a brief seizure. This is thought to alter brain chemistry and, in turn, reduce symptoms of depression and psychosis.
Although ECT is generally safe and effective for pregnant people who need it, it’s not completely without risk. But most risks appear to be low, and the benefits of the treatment often outweigh the risks for people who need it.
It’s not entirely possible to prevent postpartum depression, but knowing the warning signs, symptoms, and risk factors can help.
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 health conditions, 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.
Depending on risk factors, your doctor may recommend medication, either during pregnancy or immediately after you give birth.
In addition to professional treatment, the following lifestyle tips can help alleviate symptoms of postpartum depression:
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 and rest. 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 or take time to rest.
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.
Untreated postpartum depression can last for months — and sometimes longer. One study of nearly 4,900 women found that about 25 percent of the participants reported elevated depression symptoms for three years after giving birth.
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. Stopping treatment too early can cause depressive symptoms to come back.
Untreated postpartum depression can get in the way of bonding with the new baby and lead to problems for the whole family. As mentioned, without treatment, postpartum depression can go on for months or longer and can lead to chronic depression. But even with treatment, postpartum depression increases a woman’s risk of experiencing depressive episodes in the future.
Left untreated, postpartum depression can harm the mother’s health and could negatively affect social, emotional, cognitive, language, and behavioral development in children, according to a research review of 191 studies on the topic. The review found that these effects can span well beyond infancy into childhood and adolescence.
In rare cases — involving one or two in 1,000 births — 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. They may also hallucinate — hearing voices or seeing things that aren’t there — and they may have recurring, intrusive thoughts of harming themselves or their baby.
In some cases of postpartum psychosis, there may be a previous history of mental health conditions, such as bipolar disorder, major depressive disorder, or schizophrenia spectrum disorders.
One study found that the rate of suicidal thoughts or behaviors in women in the year before or after giving birth nearly tripled between 2006 and 2017.
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, roughly 10 percent of pregnant women and 13 percent of women who’ve just given birth are affected by a mental health condition, mainly depression.
Countries with higher rates of maternal and infant deaths, income inequality, and women of childbearing age working over 40 hours a week also have higher rates of postpartum depression, research shows.
As mentioned, 1 in 8 women experience postpartum depression in the United States. With more than 3.6 million births occurring in the United States in 2022, the latest year for which data is available, that means nearly half a million women experience postpartum depression every year.
While postpartum depression can affect anyone of any race, some research suggests that members of Black, Indigenous, and People of Color (BIPOC) communities are especially vulnerable.
Black Americans and Postpartum Depression
Black women have an increased risk for maternal mental health conditions like depression due to higher levels of trauma exposure during their lifetimes and the period during and after pregnancy than the general population. Black women are also three to four times more likely to experience dangerous birth complications. Other factors that increase their risk of maternal mental health issues include chronic stress, gendered racism, and exposure to negative drivers of health.
Black women with postpartum depression are also more likely to report more severe symptoms than the general population. The reasons for these disparities are complex, but the researchers note that Black women are less likely to receive treatment for postpartum depression than the general population. Other barriers that affect Black women include stigma around mental health treatment, language or cultural barriers, lack of available resources, and unclear policies.
One study of more than 2,000 postpartum women found that Black new mothers experience higher rates of bipolar disorder. The study also found that their depression symptom profiles are not always the same when compared to white women. In addition, Black women have been found to have higher rates of childbirth trauma, increasing the risk of postpartum depression.
Hispanic Americans and Postpartum Depression
According to one study, Hispanic women are twice as likely to experience postpartum depression as white women and are less likely to seek treatment for depressive symptoms. The study authors found that discrimination, negative life events, and exposure to domestic violence are predictors of postpartum depression in this population.
American Indian and Alaska Native Women and Postpartum Depression
Research has found that in the United States, 14 to 29.7 percent of women of American Indian or Alaska Native heritage experience perinatal depression, compared with 11 percent of women in the general population.
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. Related conditions include:
While complicated emotions, including sadness, can be normal after pregnancy, some women experience more debilitating depressive symptoms, known as postpartum depression.
Genetics, hormonal changes, emotional issues, and life circumstances can all play a role in causing postpartum depression.
Symptoms of postpartum depression usually improve with treatment, which can include talk therapy, medications, and lifestyle changes.
