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This website is made possible by third party financial support from Sage Therapeutics, Inc. and Biogen Inc.

Understanding Postpartum Depression

Understanding Postpartum Depression

December 1, 2022

Editorially reviewed by Dr Saundra Jain

Big life changes such as the birth of a baby can be exciting, but they can also be daunting. Add hormonal changes to the mix, and it's no surprise that many women experience "baby depression."

Stressed Mother of Baby

For most women, having a baby is a very exciting, joyful, and sometimes nervous time. However, it can be very distressing and difficult for women who develop postpartum depression. Perinatal, or postpartum, depression refers to depression that occurs after childbirth. Postpartum depression is a serious but treatable medical condition associated with feelings of extreme sadness, apathy, and/or anxiety as well as with changes in energy, sleep, and appetite.1

Postpartum depression is a common and serious condition. Using the Pregnancy Risk Assessment and Monitoring System (PRAMS), a Centers for Disease Control and Prevention (CDC) study found that about 1 in 8 women who recently gave birth experience symptoms of postpartum depression.2 The estimated number of women affected by postpartum depression varies by age, race/ethnicity, and country.2 

Types of Postpartum Depression

Postpartum Blues or Baby Blues

Baby blues affects 50% to 75% of people after birth. Baby blues can often manifest as constant crying, sadness, or anxiety for no apparent reason.3 The condition usually begins within a week (days 1-4) after giving birth.3 Although uncomfortable, the condition usually resolves within 2 weeks without treatment.3

Postpartum Depression 

Postpartum depression, which is a much more serious condition compared to baby blues, affects 1 in 7 new parents.3 Women who previously had postpartum depression have a 30% increased risk with each subsequent pregnancy.3 Affected individuals can experience mild to severe symptoms that may appear within the first week after giving birth or gradually over the next year.3 Symptoms can last for months, but treatment with psychotherapy and antidepressants is very effective.3

Postpartum Psychosis

Postpartum psychosis is a serious form of postpartum depression that requires urgent medical attention. The condition is relatively rare and affects only 1 in 1,000 people after birth.3 Symptoms usually appear soon after delivery, are severe, and last weeks to months; they include hyperexcitability, confusion, hopelessness and shame, insomnia, paranoia, delusions or hallucinations, hyperactivity, rapid talking, and mania.3 Postpartum psychosis requires immediate medical attention because it increases the risk of suicide or harm to the baby; treatment usually includes hospitalization, psychotherapy, and medication.3

Who Is at Risk?

Any woman who has given birth may experience symptoms of postpartum depression and other mood disorders.1 In addition, women are at higher risk of depression during or after pregnancy if they are experiencing a particularly stressful life event or if they are not receiving the support of family members and friends.1 New fathers – approximately 4% - can also experience depression during the first year after their child is born.1

Other factors can increase the chances of postpartum depression, including3
•    History of depression
•    Limited social support
•    Relationship conflict 
•    Complications during pregnancy or delivery
•    Being a single parent
•    Having a baby that requires extra attention

Symptoms of Postpartum Depression

The frequency, duration, and presentation of symptoms of postpartum depression vary from person to person.2 The symptoms of postpartum depression are like those of depression2 and can include1:

•    Feeling sad 
•    Lack of interest or pleasure in activities once enjoyed
•    Appetite changes
•    Trouble sleeping or sleeping too much
•    Low energy or increased fatigue
•    Increased purposeless physical activity or slowed movements or speech 
•    Feeling worthless or guilty
•    Having trouble thinking, concentrating, or making decisions
•    Thoughts of death or suicide 
•    Crying for “no reason”
•    Lack of interest in the baby, not feeling bonded to the baby, or feeling very anxious about and/or around the baby
•    Feelings of being a bad mother
•    Fear of harming the baby or oneself

A woman suffering from postpartum depression will usually have several of these symptoms, and the severity of the symptoms will vary.1 These symptoms can make new mothers feel lonely, guilty, or ashamed. Symptoms of postpartum depression must appear during pregnancy or within four weeks of delivery to be diagnosed.1

Anxiety symptoms are common in women suffering from postpartum depression. According to one study, nearly two-thirds of women suffering from postpartum depression also had an anxiety disorder.4

Screening and Diagnosing Postpartum Depression

The Edinburgh Postnatal Depression Scale (EPDS) is the most used screening tool for depression related to childbearing.5 This self-report instrument includes 10 items ranked from 0 to 3 that reflect the patient's experience in the previous week. An EPDS of 13 or more is an acceptable score for identifying women at risk of postpartum depression.5

Treatment of Postpartum Depression

Peripartum depression, like other types of depression, can be treated with psychotherapy, medication, lifestyle changes, a supportive environment, or a combination of these.1 When the depression or anxiety is mild, APA guidelines for treating pregnant or breastfeeding women with major depressive disorder recommend psychotherapy without medication as a first-line treatment.1 Antidepressants should be considered for women suffering from moderate to severe depression.1

Postpartum depression is not a weakness. Sometimes it's simply a complication of giving birth. When you think patients may have postpartum depression, prompt treatment can help them manage their symptoms and help mothers bond with their baby.

1.    What is peripartum depression (formerly postpartum)?. Reviewed October 2020. Accessed September 26, 2022.
2.    Depression among women. Centers for Disease Control and Prevention. Reviewed May 23, 2022. Accessed September 26, 2022.
3.    Postpartum depression: causes, symptoms & treatment. Cleveland Clinic. Accessed September 26, 2022.
4.    Wisner KL, Sit DKY, McShea MC, et al. Onset timing, thoughts of self-harm, and diagnoses in postpartum women with screen-positive depression findings. JAMA Psychiatry. 2013;70(5):490-498. doi:10.1001/jamapsychiatry.2013.87
5.    Sit DKY, Wisner KL. Identification of postpartum depression. Clin Obstet Gynecol. 2009;52(3):456-468. doi:10.1097/GRF.0b013e3181b5a57c