Understanding postpartum depression

What Is Postpartum Depression?

Postpartum depression is a term encompassed by the term perinatal depression (PND), which is a depressive episode that occurs during pregnancy or within one year following delivery. Though people might recognize the term PPD and associate it with mood struggles after giving birth, PND is now the diagnosis recognized in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). 

PPD is an intense but common complication of childbirth. While it can affect both birthing and non-birthing parents, PPD most frequently impacts those who give birth.

Symptoms of Postpartum Depression

It can be hard to distinguish PPD and PND from normal postnatal symptoms because both can involve drastic changes in daily functioning. Postpartum depression shares symptoms of major depressive disorder, with the additional requirement of occurring within one year after childbirth. These symptoms include:

• Severe, lingering sadness
• Anhedonia (loss of pleasure and interest)
• Extreme feelings of guilt or worthlessness
• Changes in sleep patterns (aside from caring for an infant)
• Suicidality

In PPD, the loss of interest that often characterizes major depression may apply to a parent’s feelings toward their newborn. A new parent could have trouble with acute caregiving demands due to feelings of sadness, emptiness, or extreme fatigue, which can contribute to overwhelm and prevent parents from bonding with their infant. 

Whether these symptoms are definitively tied to PPD or not, if you are feeling depressed, having trouble connecting with your newborn, or are feeling lost and aren’t sure how to move forward in your new role, consider seeking help from a mental health professional. Parenthood involves many difficult emotions that are hard to manage on your own—every parent needs support, and a mental health professional can give you the support and guidance you need to feel like yourself again.

How Common Is Postpartum Depression?

Postpartum depression is common, affecting about 14% of mothers and 10% of fathers in the first year after childbirth. It’s so common that health providers routinely screen for it during and after pregnancy. It’s important to seek medical intervention for PPD to prevent adverse outcomes for parents and babies. 

What Is the Difference Between Postpartum Depression and the "Baby Blues"?

The “baby blues” and the “maternity blues” are synonymous names for mood swings that can occur in the days after childbirth. These moods can involve a mix of sadness, anxiety, irritability, fear, difficulty concentrating, and other forms of emotional distress. 

The majority of new moms experience these episodes. However, baby blues fade or disappear in fewer than two weeks, as the feelings are usually related to fluctuating hormones and the radical transition of having a newborn in the house. If the mood swings are severe and last longer than two weeks, it may be time to go in for a PPD screening. 

Causes and Risk Factors for Postpartum Depression

There is no single cause for postpartum depression, though new parents who have experienced depressive episodes in the past are more at risk. The following biological and environmental factors may also contribute to PPD:

• Sudden change in hormones immediately following childbirth
• Changes in your blood volume, blood pressure, immune system, and metabolism, which can contribute to fatigue and mood swings
• Sleep deprivation
• Anxiety about your role as a new caregiver, perhaps feeling like you’re not up to the task
• Difficulty breastfeeding
• Lack of support from a partner or other loved ones
• Financial difficulties

Being at high risk for postpartum depression doesn’t mean that you’ll develop PPD, but you should take more care with health screening and self-monitoring. The following factors may predispose you to developing PPD:

• Depression during pregnancy (prenatal depression) 
• History of depression (personal or family)
• Low self-esteem
• Stressful life events
• Marital or relationship struggles
• Experiencing domestic abuse
• Poor social support
• Financial or career stressors
• Unrelated life changes (moving, divorce, etc.)
• Unintended pregnancy
• Health issues
• Difficult childbirth (trauma, near-death)
• Having an infant with a challenging temperament (colic, etc.)
• More sensitivity to a sudden drop in estradiol (a female hormone) levels 
• Genetic variations on specific chromosomes

What Are the Diagnostic Criteria for Postpartum Depression?

Major depression disorder (MDD) and perinatal depression (a.k.a. PPD) both have the same diagnostic criteria in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), which psychiatrists use to diagnose and treat mental health conditions. There are nine PND criteria in all, but only five have to be met for a duration of at least two weeks to qualify as clinically depressed:   

• Depressed mood for most of the day, nearly every day. You might burst into tears for no reason or feel incredibly sad, empty, or hopeless. Other people will probably notice your change in mood.
• Markedly diminished interest or pleasure in activities you used to enjoy. In the case of PND, a new mom might not feel interested in bonding with her baby.
• Significant, unintentional weight loss or weight gain, or change in appetite. However, keep in mind that someone who just gave birth is experiencing hormonal changes that can naturally affect weight and appetite.
• Insomnia (inability to sleep) or hypersomnia (sleeping too much). Again, new parents also experience upsets in sleeping patterns due to round-the-clock caregiving, but this symptom will be extenuating and won’t be tied to caring for the infant.
• Psychomotor agitation (sped-up thoughts and actions) or psychomotor hindrance (slowed-down thoughts and actions).
• Fatigue or loss of energy.
• Feelings of worthlessness or excessive or inappropriate guilt. ​​For example, someone with PND might feel like they are a terrible mother, with no evidence to support the belief. 
• Diminished ability to think or concentrate, or indecisiveness.
• Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for suicide. 

A rare variation of PND and PPD is postpartum psychosis, in which a person might hallucinate or imagine harming their child.

Can Men Develop Postpartum Depression?

Fathers develop postpartum depression at lower rates than moms, but yes, they can experience PPD. Interestingly, paternal depression is correlated with maternal PPD, suggesting that dads may get depressed in response to their partner’s moods.

How Long Does Postpartum Depression Last?

As a diagnosis, PND can last up to a year after your child’s birth. However, that isn’t to say that it will go away after that time has passed.

If your postpartum depression symptoms remain past your child’s first birthday, it may then fall into the category of major depressive disorder. That being said, the timeline for PND can vary from person to person. For 38% of mothers, PND and PPD can develop into chronic depression, though these mothers may have already been depressed or dysthymic before pregnancy.  

Treatment Options for Postpartum Depression

Postpartum depression is treated in many of the same ways that major depressive episodes are treated, mainly with psychotherapy and psychiatric medications. The following treatment options have proved extremely beneficial for parents experiencing PPD:

• Interpersonal psychotherapy (IPT): A short-term talk therapy that aims to alleviate the symptoms of depression and assess interpersonal functioning in relationships.
• Cognitive behavioral therapy (CBT): An evidence-based method of modifying maladaptive thoughts and beliefs—mainly through studying the relationship between thoughts, feelings, and behaviors—to relieve the symptoms of depression.
• Medications like SSRIs or hormonal treatments: These can target underlying physiological issues such as hormone imbalances or chemical irregularities in the brain that might contribute to depressive disorders.
• Psychosocial interventions: These will include activities like support groups, tangible assistance, or care coordination.

Remember, getting the help you need is the best thing you can do to help your new family. When parents are treated for postpartum depression, their children benefit, as well as their partner and overall family dynamic.

How Can I Prevent Postpartum Depression?

There are many proactive steps you can take if you’re concerned about postpartum depression. Examples include:

• Counseling. A mental health professional can give you tools to cope with stress, help you manage your expectations, combat negative self-talk, and give you support as you navigate mental health challenges. 
• Medication. Psychiatrists who specialize in reproductive health prioritize working safely with women who experience mental health conditions during pregnancy and breastfeeding. Many women are reluctant to take medication that might cross the placental barrier, but sometimes it’s worse for the baby’s health to have a parent with depression. Antidepressants can take 6-8 weeks to start working, so if you have a history of depression and you’re worried about PPD, it might be wise to talk to your doctor about safe drug treatments before your due date.
• Support system. Establish your support system before giving birth. It can be helpful to delegate future tasks like meal preparation and decide who you’re comfortable being vulnerable with day-to-day, whether it’s your partner, best friend, or neighbor. Be prepared to ask for help—it’s okay to need it. 
• Learn your triggers and stressors. Figure out what or who might be a drain on your mental health and consider placing boundaries around when and how often you’ll interact with them. Keep in mind that your mental energy will likely be low, so things that you can usually deal with might feel overwhelming after you give birth.

How to Support a Loved One With Postpartum Depression

People with PPD often need strong support as they work toward recovery. There are many small but meaningful ways you can help, including:

• Providing physical care: If you live nearby or with them, offer practical help, such as cooking meals, assisting with hygiene, reminding them to take medication, and helping them move around. Depression can diminish a person’s ability to care for themselves, so supporting them in these tasks—without judgment—can be invaluable.
• Asking what they need: Your loved one knows best what will help, but it’s important to be mindful of how you ask. Avoid overwhelming them with open-ended questions like, “What do you need?” Instead, offer choices: “Would you like food or a bath?” or “Do you want to go for a walk?” Keeping options simple can make decision-making easier when their mental energy is low.
• Educating yourself: Learning about PPD will help you better understand what they’re going through and how to provide support without unintentionally reinforcing stigma.
• Listen to them: When they want to talk, actively listen without shifting the focus to your own experiences. While sharing your story may be meant to express understanding, it can sometimes make them feel unheard. Instead, be fully present and engage in conversations about their life beyond parenthood.

Remember to care for your own well-being while supporting a loved one with PPD. Caring for someone with mental health issues can be mentally and emotionally taxing. If you find yourself feeling overwhelmed or needing support, consider reaching out to a mental health professional.

Coping Strategies for New Mothers With Postpartum Depression

Therapy is a helpful and important tool in treating PPD/PND, but there are also things you can do on your own time to take care of yourself. 

• Ask for help: It’s essential to seek and accept support from those close to you. Being a new parent is both rewarding and stressful, so talk about how you’re feeling and take breaks when you can. Even just 10-15 minutes to yourself while a friend or family member cares for your child can make a big difference.
• Learn about PND: Doing your own research and talking with a mental health professional about PPD/PND can help you get a better grasp on what you’re dealing with and how to manage it. Recognizing that your symptoms are part of a real, treatable condition —not a personal failing—can reduce feelings of guilt and self-doubt.
• Support groups: Participating in support groups for parents with PPD can be incredibly validating for new parents. Support groups provide a sense of community in what can otherwise be an isolating time, helping you feel understood and less alone.
• Lean on your support system: People in your support system can provide many different kinds of help. From meals to childcare, friends and family can support you as you adjust to your new life and get the care you need. They can also help keep you accountable. Consider telling them about the symptoms you’ve been experiencing and detailing how best to help you if they notice them, even if it’s through small things like going on walks with you or having honest daily check-ins.

If you’re experiencing postpartum depression, remember that it’s common and treatable. Be gentle with yourself—there’s no perfect or right way to parent. Your well-being matters, and the best thing you can do for your child and family is to prioritize your mental health.