Postpartum Depression: Signs and Symptoms

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Postpartum depression (PPD) is a form of major depressive disorder that occurs following pregnancy. Childbirth is a very physically stressful experience, and caring for a newborn while recovering from birth is difficult.

Additionally, hormonal changes can lead to mood issues and instability. According to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), approximately 3% to 6% of people experience a depressive episode following childbirth. About 13% to 20% of women in the United States are estimated to experience postpartum depression.

It's also worth noting that one-third of women have depression when they get pregnant, one-third develop depression during pregnancy, and one-third develop postpartum depression after giving birth.

Symptoms of Postpartum Depression

According to the DSM-5, PPD occurs when a person experiences a major depressive episode within four weeks of giving birth.

The symptoms of a major depressive episode are:

  • Depressed mood (feeling sad, empty, hopeless, et cetera) most of the day every day or almost every day
  • Lowered ability to experience pleasure or interest in activities previously enjoyed, most or all of the day, every day or nearly every day
  • Significant weight loss or gain not attributed to dieting
  • Insomnia or hypersomnia (i.e., sleeping too much)
  • Movement changes, noted as either a significant increase or decrease in movement or speed of movement
  • Low energy most days
  • Feeling worthless or guilty
  • Difficulty concentrating or making decisions
  • Thoughts of death or suicide

To meet criteria for a depressive episode, a person must experience five or more of these symptoms.

Additionally, those with PPD might experience:

  • Frequent episodes of crying
  • High anxiety or panic attacks
  • Physical aches and pains
  • Sudden, intense mood swings
  • Negative feelings towards the baby
  • Feelings of guilt about not feeling “happy enough” about the baby
  • Intrusive thoughts about harming yourself or your baby

If you are having suicidal thoughts, contact the National Suicide Prevention Lifeline at 988 for support and assistance from a trained counselor. If you or a loved one are in immediate danger, call 911.

For more mental health resources, see our National Helpline Database.

Diagnosing Postpartum Depression

A physician might screen for PPD in follow up appointments. If you think that you or a loved one might have symptoms of PPD, ask the physician about screening for a diagnosis and for treatment resources.

Screening measures like the Edinburgh Postnatal Depression Scale and the Postpartum Depression Screening Scale can determine the severity of symptoms and provide insight into helpful treatment options.

A therapist might also be able to diagnose PPD. If you already see a therapist, they may notice changes in your mood or behavior following childbirth and diagnose you with a postpartum mood episode.

If you think that you or a loved one might have symptoms of PPD, ask the physician about screening for a diagnosis and for treatment resources.

Causes of Postpartum Depression

Although people experience significant hormonal changes and fluctuations during and after pregnancy, these shifts alone do not cause PPD. There is not one set cause of PPD, but certain factors may put an individual at higher risk for developing these symptoms:

  • Genetics. Having a family history of PPD puts you at increased risk for developing this condition. In addition, a family history of depression and/or anxiety (especially maternal history), increases the risk.
  • History of mental health issues. If you have previously experienced a depressive, manic, or psychotic episode, you might be more likely to experience these symptoms following childbirth.
  • A previous pregnancy loss. Of course, someone who has lost a wanted pregnancy will experience grief about their loss. In addition, research has shown that those who have had a stillbirth or late-term miscarriage are more likely to experience PPD following a subsequent pregnancy.

There is no one cause for PPD, and even those without these risk factors can develop symptoms. If you are struggling, or you notice that a loved one is struggling, there is no threshold for seeking support.

Types of Postpartum Depression

PPD can take on many forms, and knowing the different types can help you identify if you or a loved one needs additional support following a pregnancy. It is possible to have more than one set of symptoms related to PPD, especially if you experienced trauma during childbirth or have a genetic predisposition to this condition.

  • Perinatal Depression: Many think of PPD as occurring exclusively following a birth. However, approximately 33% of individuals who experience PPD will experience symptom onset during the pregnancy. A mood episode during pregnancy is called perinatal depression.
  • Postpartum Anxiety: Marked by anxiety or panic attacks, postpartum anxiety manifests as severe, intense anxious distress. It can include fear about something happening to the baby and sometimes intrusive, distressing thoughts that you will harm your baby or yourself.
  • Postpartum Depression: A depressive episode following childbirth; this is probably the most commonly discussed form of postpartum depression.
  • Postpartum Trauma: Childbirth is stressful on the mind and body under the best of circumstances, but some experience trauma during childbirth and develop post-traumatic stress symptoms as a result, including flashbacks, hypervigilance, and intrusive thoughts related to the traumatic aspects of the birth.

Treatment for Postpartum Depression

Although the symptoms can be scary and challenging to live with, PPD is treatable. There is not one set treatment protocol, and your care team can provide information to help you make the best decision for you and your family.

Many physicians will prescribe antidepressant medication to treat the mood symptoms of PPD. If you are experiencing manic or psychotic symptoms, your physician may also recommend a mood stabilizer or antipsychotic medication to manage these symptoms.

Some medications can be taken while chestfeeding, but others are not recommended. Your physician can tell you what is safe for you and your baby. Remember that your baby needs you present and healthy, and pressuring someone to chestfeed when it is not the best option for them can exacerbate postpartum mental health issues.

Both individual and group therapy can also help those struggling with PPD. A therapist can help you work through your symptoms, and peer support in group therapy can connect you with others going through similar experiences to help you feel less alone.

Coping With Postpartum Depression

If you are struggling with mood issues following childbirth, it can feel impossible to cope. In addition to treating the symptoms of your PPD, additional support is invaluable.

  • If you have a partner, they can help you cope by taking the lead in childcare and housekeeping responsibilities as much as possible so that you can rest.
  • If you have friends or family in your local area, they can prepare meals, support you with childcare, and be available to listen when you need to talk.
  • Although being new to parenting is a huge adjustment, finding time to do things you enjoyed before the baby was born can help you both engage in self-care and remind you of your identity outside of the parenting role.

A Word From Verywell

If you or a loved one are struggling with postpartum depression, contact Postpartum Support International at 1-800-944-4773 for information on support and treatment facilities in your area.

For more mental health resources, see our National Helpline Database.

If you are struggling following childbirth, especially if you are having thoughts of hurting yourself or your baby, contact your physician immediately and share your concerns. If your loved one is showing symptoms of PPD, let them know that you are there to support them and check in on them. Asking what they need from you can be overwhelming, so identify something specific that you can do and offer to help. For example, instead of, “What do you need today?” tell them you will take care of dinner.

11 Sources
Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Diagnostic and Statistical Manual of Mental Disorders: DSM-5. 5th ed., American Psychiatric Association, 2013.

  2. Centers for Disease Control and Prevention. Depression among women.

  3. Fisher SD, Wisner KL, Clark CT, Sit DK, Luther JF, Wisniewski S. Factors associated with onset timing, symptoms, and severity of depression identified in the postpartum periodJ Affect Disord. 2016;203:111-120. doi:10.1016/j.jad.2016.05.063

  4. Cox JL, Holden JM, Sagovsky R. Detection of postnatal depression: development of the 10-item edinburgh postnatal depression scale. Br J Psychiatry. 1987;150(6):782-786.

  5. Beck CT, Gable RK. Postpartum depression screening scale: development and psychometric testingNursing Research. 2000;49(5):272-282.

  6. Miller LJ. Postpartum depression. JAMA. 2002;287(6):762.

  7. Guintivano J, Krohn H, Lewis C, et al. PPD ACT: an app-based genetic study of postpartum depressionTransl Psychiatry. 2018;8(1):260.

  8. Antoniou E, Orovou E, Politou K, et al. Postpartum Psychosis after Traumatic Cesarean Delivery. Healthcare (Basel). 2021;9(5):588.

  9. Gravensteen IK, Jacobsen EM, Sandset PM, et al. Anxiety, depression and relationship satisfaction in the pregnancy following stillbirth and after the birth of a live-born baby: a prospective studyBMC Pregnancy Childbirth. 2018;18(1):41.

  10. Rivi V, Petrilli G, Blom JMC. Mind the mother when considering breastfeeding. Front Glob Womens Health. 2020;1:3.

  11. Amani B, Merza D, Savoy C, et al. Peer-delivered cognitive-behavioral therapy for postpartum depression: a randomized controlled trial. J Clin Psychiatry. 2021;83(1).

By Amy Marschall, PsyD
Dr. Amy Marschall is an autistic clinical psychologist with ADHD, working with children and adolescents who also identify with these neurotypes among others. She is certified in TF-CBT and telemental health.