Postpartum Depression

What Is Postpartum Depression?

There is also a free 53-page Hope Guide covering everything on this page in one downloadable book, written for mothers and for the people around them.
Feeding is one of the places this shows up most sharply — see breastfeeding and postpartum depression.
Postpartum depression is a depressive episode that begins during pregnancy or in the weeks and months after a baby arrives. It is not a mood you should be able to talk yourself out of, and it is not a verdict on whether you love your child. It is a medical condition, it is common, and it responds to treatment.

It affects about 1 in 8 women who give birth in the United States — more than 430,000 mothers a year. It also affects fathers, adoptive parents, and partners in same-sex relationships, which is why you will find those covered on this page rather than treated as footnotes.

If you are reading this at 3am with a baby on your chest, wondering whether what you feel is normal: the fact that you are asking is not evidence that you are failing. It is the most common reason people find this page.

Becoming a Mother Is Hard Without Being an Illness

There is a word for the transition into motherhood: matrescence. It describes the hormonal, physical and identity upheaval of becoming a mother — the parallel of adolescence, and about as disorienting. It is not a disorder, and knowing it has a name helps a great deal.

It also is not protection. Around one in eight mothers develops postpartum depression, and every one of them is going through matrescence too. If you are trying to work out which one you are in, the comparison here is the clearest way to tell them apart.

The Name Is Misleading, and That Matters

“Postpartum” means after birth. But according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR), about half of postpartum major depressive episodes actually begin before delivery — during pregnancy.

That is why clinicians increasingly use the term peripartum rather than postpartum. The DSM’s specifier is “with peripartum onset,” and it applies when mood symptoms begin during pregnancy or within four weeks of giving birth.

This is not a technicality. It changes two things for you:

• If you felt this way while pregnant, it counts. Many women assume that what they felt during pregnancy was separate, or was just pregnancy. It was often the same episode, already underway.
• Waiting for it to start after birth is the wrong thing to watch for. Screening during pregnancy catches what waiting does not.

The DSM’s own prevalence estimates make the same point. About 9% of women experience a major depressive episode between conception and birth. The best estimate for the period between birth and 12 months postpartum is just under 7%.

Postpartum Depression Is Not the Only Condition After Birth

Most of what gets called “postpartum depression” is one of several distinct conditions. They overlap, they are often mistaken for each other, and the treatment is not the same. This is the part most people never get explained.

If you are not sure which of these describes you, that is normal and it is not something you need to work out alone. A screening questionnaire takes a few minutes and gives a clinician something concrete to work from.

Postpartum Depression Is Not Postpartum Psychosis

Almost everything the public believes about postpartum mental illness comes from the rarest and most extreme version of it. When a case reaches the news, the coverage rarely distinguishes between a common, treatable depression and a rare psychiatric emergency.

The distinction is real and it is documented. Postpartum mood episodes with psychotic features occur in roughly 1 in 500 to 1 in 1,000 deliveries. The DSM-5-TR notes that infanticide — which it describes as a rare occurrence — is most often associated with postpartum psychotic episodes involving command hallucinations or delusions about the infant, not with postpartum depression.

We say this plainly because the fear is so common and so rarely addressed:

• Having a frightening thought does not mean you will act on it. In postpartum OCD, intrusive thoughts about harm are a symptom of anxiety, not intent. They distress the person having them precisely because they are so far from what she wants.
• Postpartum depression does not turn into psychosis. They are different conditions with different onsets.
• Psychosis looks different from the outside. It comes on fast, usually within the first two weeks, and involves confusion, not sleeping for days, paranoia, or beliefs that are not true.

If someone is showing signs of psychosis, treat it as an emergency. Call 911 or go to an emergency room. Call or text 988 for the Suicide & Crisis Lifeline. Do not leave the person alone with the baby while you wait.

Symptoms of Postpartum Depression

Symptoms vary, and they do not always look like sadness. Anger, numbness, and a flat absence of feeling are as common as crying. For some people postpartum rage is the most prominent symptom of all.

• Persistent low mood, emptiness, or hopelessness
• Loss of interest in things that used to matter
• Difficulty bonding with the baby, or feeling nothing toward them
• Anger, irritability, or rage that feels disproportionate
• Sleep problems beyond what the baby causes — unable to sleep when the baby sleeps
• Appetite changes in either direction
• Overwhelming guilt, or a conviction that you are a bad parent
• Trouble concentrating or making decisions
• Withdrawing from people who care about you
• Thoughts of harming yourself, or that your family would be better off without you

If you are having thoughts of suicide or self-harm, do not wait. Call or text 988, or call the National Maternal Mental Health Hotline at 1-833-852-6262. Both are free and available 24 hours a day.

For a fuller breakdown, see postpartum depression symptoms and the signs other people may notice.

Depression After Pregnancy Loss

Depression after a miscarriage or stillbirth is real and is often missed, because the pregnancy that would have explained it is gone. See postpartum depression after miscarriage.

Some of It Can Be Prevented

If you have a history of depression or other risk factors, counseling during pregnancy measurably lowers the odds of a perinatal depressive episode. See what the evidence supports on preventing postpartum depression.

Depression That Starts Before the Birth

About half of episodes labeled postpartum depression actually begin during pregnancy. If yours started before the birth, it has its own name — depression during pregnancy, also called prenatal or antenatal depression — and it is treatable while you are still pregnant rather than something to endure until delivery.

The umbrella term covering both sides of the birth is perinatal depression, which is increasingly what clinicians use.

When It Starts and How Long It Lasts

There is no single timeline. Symptoms can begin during pregnancy, in the days after birth, or several months later — cases are recognized up to a year postpartum and sometimes beyond.

Untreated, a postpartum depressive episode commonly lasts three to six months, but it can persist far longer. Treated, most people improve substantially and most feel better.

The variable that changes the timeline most is how quickly treatment starts. See the postpartum depression timeline for what recovery typically looks like month by month.

What Causes Postpartum Depression

No single cause explains it. The current understanding is that a steep hormonal drop after delivery interacts with sleep deprivation, pain, life circumstances, and individual vulnerability.

Risk is higher if you have a personal or family history of depression, experienced depression or anxiety during pregnancy, had a difficult or traumatic birth, have limited practical support, are facing financial strain, or had an unplanned pregnancy. Having had postpartum depression before raises the risk of it recurring.

None of these are things you did. Read more on causes and risk factors.

It Is Not Only Mothers

• Fathers and partners — around 10% of new fathers experience depression in the postpartum period. It is rarely screened for and often shows up as irritability or withdrawal rather than sadness.
• Adoptive parents — post-adoption depression is real and does not require having given birth.
• Relationships — postpartum depression puts strain on a partnership, and that strain is treatable too.

How Postpartum Depression Is Diagnosed

A screening questionnaire flags risk; a psychiatric evaluation is the longer conversation where a diagnosis is actually made or ruled out.
There is no blood test. Diagnosis comes from a conversation with a clinician, usually supported by a screening questionnaire such as the Edinburgh Postnatal Depression Scale.

A screening score is not a diagnosis. It is a way of turning something difficult to describe into something a clinician can act on. You can take the PHQ-9 depression test or the GAD-7 anxiety test right now — both are free, score themselves, and save nothing — or read about how screening works and what an EPDS score means.

More detail on the diagnostic process.

Treatment

Postpartum depression responds well to treatment. Most people are offered one or a combination of the following:

• Therapy — cognitive behavioral therapy and interpersonal therapy both have strong evidence in the postpartum period.
• Medication — including antidepressants and zuranolone (Zurzuvae), the first oral medication approved specifically for postpartum depression.
• Support groups — being around other people who have been through it does something that individual treatment cannot.

Breastfeeding does not rule out treatment. It changes which options are considered, and that is a conversation to have with a prescriber rather than a reason to go without help. See all treatment options.

What to Do Right Now

• If you are in danger — call or text 988, or call 911.
• If you are struggling but safe — tell one person today. A partner, a friend, your OB, your baby’s pediatrician. Pediatricians screen for this and are a legitimate route in.
• If you are not sure — take a screening questionnaire and bring the result to an appointment.
• If you are ready for help — find a therapist who treats postpartum depression.

Recovery and Outlook

Most people recover. With treatment most people feel better, and many begin to notice a difference within weeks.

Recovery is rarely a straight line. A bad week after a good month is ordinary and is not a sign that treatment failed. Having had postpartum depression once does raise the chance of it happening again with a subsequent birth — which is useful information, because it means it can be planned for and caught early rather than discovered late.

See what recovery involves. If you have a risk factor and are still pregnant, preventive counseling has real evidence behind it.

Postpartum Depression Statistics

The rate varies considerably by where you live, from 7.2% in Louisiana to 17.1% in Mississippi. Roughly half of affected mothers are never formally diagnosed.

Full figures, including international rates and breakdowns by race and ethnicity, are on the postpartum depression statistics page.

Frequently Asked Questions

How common is postpartum depression?

About 1 in 8 women who give birth in the United States experience it — more than 430,000 mothers a year. Rates vary by state from roughly 9% to 21%.

Can postpartum depression start during pregnancy?

Yes. About half of postpartum depressive episodes begin before delivery, which is why clinicians use the term peripartum.

How long does postpartum depression last?

Untreated, commonly three to six months, sometimes much longer. With treatment, most people improve substantially and most feel better.

Does having intrusive thoughts mean I am dangerous?

No. Intrusive thoughts about harm are a recognized symptom of postpartum anxiety and OCD. They are distressing precisely because they are unwanted. They are not intent, and they are treatable. Tell a clinician — this is something they have heard before.

Can postpartum depression go away on its own?

Sometimes, but it commonly persists for months and can worsen. Treatment shortens it and improves the outcome for both parent and baby. There is no benefit to waiting it out.

Is postpartum depression preventable?

Not entirely, but risk can be lowered. If you have had it before or had depression during pregnancy, tell your care team before you give birth. Planning ahead is the single most effective thing you can do.