Your body and mind go through many changes during and after pregnancy. If you feel empty, emotionless, or sad all or most of the time for longer than 2 weeks during or after pregnancy, reach out for help. If you feel like you don’t love or care for your baby, you might have postpartum depression. Treatment for depression, such as therapy or medicine, works and will help you and your baby be as healthy as possible in the future.
What is postpartum depression?
“Postpartum” means the time after childbirth. Most women get the “baby blues,” or feel sad or empty, within a few days of giving birth. For many women, the baby blues go away in 3 to 5 days. If your baby blues don’t go away or you feel sad, hopeless, or empty for longer than 2 weeks, you may have postpartum depression. Feeling hopeless or empty after childbirth is not a regular or expected part of being a mother.
Postpartum depression is a serious mental illness that involves the brain and affects your behavior and physical health. If you have depression, then sad, flat, or empty feelings don’t go away and can interfere with your day-to-day life. You might feel unconnected to your baby, as if you are not the baby’s mother, or you might not love or care for the baby. These feelings can be mild to severe.
Depression is a common problem after pregnancy. One in 9 new mothers has postpartum depression.1
How do I know if I have postpartum depression?
Some normal changes after pregnancy can cause symptoms similar to those of depression. Many mothers feel overwhelmed when a new baby comes home. But if you have any of the following symptoms of depression for more than 2 weeks, call your doctor, nurse, or midwife:
Feeling restless or moody
Feeling sad, hopeless, or overwhelmed
Crying a lot
Having thoughts of hurting the baby
Having thoughts of hurting yourself
Not having any interest in the baby, not feeling connected to the baby, or feeling as if your baby is someone else’s baby
Having no energy or motivation
Eating too little or too much
Sleeping too little or too much
Having trouble focusing or making decisions
Having memory problems
Feeling worthless, guilty, or like a bad mother
Losing interest or pleasure in activities you used to enjoy
Withdrawing from friends and family
Having headaches, aches and pains, or stomach problems that don’t go away
Some women don’t tell anyone about their symptoms. New mothers may feel embarrassed, ashamed, or guilty about feeling depressed when they are supposed to be happy. They may also worry they will be seen as bad mothers. Any woman can become depressed during pregnancy or after having a baby. It doesn’t mean you are a bad mom. You and your baby don’t have to suffer. There is help. Your doctor can help you figure out whether your symptoms are caused by depression or something else.
What causes postpartum depression?
Hormonal changes may trigger symptoms of postpartum depression. When you are pregnant, levels of the female hormones estrogen and progesterone are the highest they’ll ever be. In the first 24 hours after childbirth, hormone levels quickly drop back to normal, pre-pregnancy levels. Researchers think this sudden change in hormone levels may lead to depression.2 This is similar to hormone changes before a woman’s period but involves much more extreme swings in hormone levels.
Levels of thyroid hormones may also drop after giving birth. The thyroid is a small gland in the neck that helps regulate how your body uses and stores energy from food. Low levels of thyroid hormones can cause symptoms of depression. A simple blood test can tell whether this condition is causing your symptoms. If so, your doctor can prescribe thyroid medicine.
Other feelings may contribute to postpartum depression. Many new mothers say they feel:
Tired after labor and delivery
Tired from a lack of sleep or broken sleep
Overwhelmed with a new baby
Doubts about their ability to be a good mother
Stress from changes in work and home routines
An unrealistic need to be a perfect mom
Grief about loss of who they were before having the baby
A lack of free time
These feelings are common among new mothers. But postpartum depression is a serious health condition and can be treated. Postpartum depression is not a regular or expected part of being a new mother.
Are some women more at risk of postpartum depression?
Yes. You may be more at risk of postpartum depression if you:3
Have a personal history of depression or bipolar disorder
Have a family history of depression or bipolar disorder
Do not have support from family and friends
Were depressed during pregnancy
Had problems with a previous pregnancy or birth
Have relationship or money problems
Are younger than 20
Have alcoholism, use illegal drugs, or have some other problem with drugs
Have a baby with special needs
Have difficulty breastfeeding
Had an unplanned or unwanted pregnancy
The U.S. Preventive Services Task Force recommends that doctors look for and ask about symptoms of depression during and after pregnancy, regardless of a woman’s risk of depression.4
What is the difference between “baby blues” and postpartum depression?
Many women have the baby blues in the days after childbirth. If you have the baby blues, you may:
Have mood swings
Feel sad, anxious, or overwhelmed
Have crying spells
Lose your appetite
Have trouble sleeping
The baby blues usually go away in 3 to 5 days after they start. The symptoms of postpartum depression last longer and are more severe. Postpartum depression usually begins within the first month after childbirth, but it can begin during pregnancy or for up to a year after birth.5
Postpartum depression needs to be treated by a doctor or nurse.
What is postpartum psychosis?
Postpartum psychosis is rare. It happens in up to 4 new mothers out of every 1,000 births. It usually begins in the first 2 weeks after childbirth. It is a medical emergency. Women who have bipolar disorder or another mental health condition called schizoaffective disorder have a higher risk of postpartum psychosis. Symptoms may include:
Seeing or hearing things that aren’t there
Feeling confused most of the time
Having rapid mood swings within several minutes (for example, crying hysterically, then laughing a lot, followed by extreme sadness)
Trying to hurt yourself or your baby
Paranoia (thinking that others are focused on harming you)
Restlessness or agitation
Behaving recklessly or in a way that is not normal for you
What should I do if I have symptoms of postpartum depression?
Call your doctor, nurse, midwife, or pediatrician if:
Your baby blues don’t go away after 2 weeks
Symptoms of depression get more and more intense
Symptoms of depression begin within 1 year of delivery and last more than 2 weeks
It is difficult to work or get things done at home
You cannot care for yourself or your baby (e.g., eating, sleeping, bathing)
You have thoughts about hurting yourself or your baby
Ask your partner or a loved one to call for you if necessary. Your doctor, nurse, or midwife can ask you questions to test for depression. They can also refer you to a mental health professional for help and treatment.
What can I do at home to feel better while seeing a doctor for postpartum depression?
Here are some ways to begin feeling better or getting more rest, in addition to talking to a health care professional:
Rest as much as you can. Sleep when the baby is sleeping.
Don’t try to do too much or to do everything by yourself. Ask your partner, family, and friends for help.
Make time to go out, visit friends, or spend time alone with your partner.
Talk about your feelings with your partner, supportive family members, and friends.
Talk with other mothers so that you can learn from their experiences.
Join a support group. Ask your doctor or nurse about groups in your area.
Don’t make any major life changes right after giving birth. More major life changes in addition to a new baby can cause unneeded stress. Sometimes big changes can’t be avoided. When that happens, try to arrange support and help in your new situation ahead of time.
It can also help to have a partner, a friend, or another caregiver who can help take care of the baby while you are depressed. If you are feeling depressed during pregnancy or after having a baby, don’t suffer alone. Tell a loved one and call your doctor right away.
How is postpartum depression treated?
The common types of treatment for postpartum depression are:
Talk therapy. This involves talking to a therapist, psychologist, or social worker to learn strategies to change how depression makes you think, feel, and act.
Medicine. Your doctor or nurse can prescribe an antidepressant medicine. These medicines can help relieve symptoms of depression and some can be taken while you’re breastfeeding. You can enter a medicine into the LactMed® database to find out whether the medicine passes through breastmilk and, if so, whether it has any possible side effects for your nursing baby.
Electroconvulsive therapy (ECT). This can be used in extreme cases to treat postpartum depression.
These treatments can be used alone or together. Your depression can affect your baby. Getting treatment is important for you and your baby. Taking medicines for depression or going to therapy does not make you a bad mother or a failure. Getting help is a sign of strength. Talk with your doctor or nurse about the benefits and risks of taking medicine to treat depression when you are pregnant or breastfeeding.
What can happen if postpartum depression is not treated?
Untreated postpartum depression can affect your ability to parent. You may:
Not have enough energy
Have trouble focusing on the baby’s needs and your own needs
The Office on Women's Health is grateful for the medical review 2016 by:
The National Institute of Mental Health (NIMH)
The Substance Abuse and Mental Health Services Administration (SAMHSA)
Danielle Johnson, M.D., FAPA, Psychiatrist, Medical Staff President, Chief of Adult Psychiatry, Director, Women’s Mental Health Program, Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati
Cassidy Gutner, Ph.D., Assistant Professor, Department of Psychiatry, Boston University School of Medicine; National Center for PTSD, Women’s Health Sciences Division, VA Boston Healthcare System, U.S. Department of Veterans Affairs
Mark A. Lumley, Ph.D., Professor and Director of Clinical Psychology Training, Department of Psychology, Wayne State University, and his Stress and Health Laboratory team: Jennifer Carty, Heather Doherty, Hannah Holmes, Nancy Lockhart, and Sheri Pegram
Mark Chavez, Ph.D., Chief, Eating Disorders Research Program, NIMH
Kamryn T. Eddy, Ph.D., and Jennifer J. Thomas, Ph.D., Associate Professors of Psychology, Department of Psychiatry, Harvard Medical School; Co-Directors of the Eating Disorders Clinical and Research Program, Massachusetts General Hospital
Kendra Becker, M.S., Clinical Fellow in Psychology, Department of Psychiatry, Massachusetts General Hospital
Michael Kozak, Ph.D., Division of Adult Translational Research and Treatment Development, NIMH
Alicia Kaplan, M.D., Assistant Professor of Psychiatry, Temple University School of Medicine and Drexel University College of Medicine, and Staff Psychiatrist, Division of Adult Services, Department of Psychiatry, Allegheny Health Network, Allegheny General Hospital
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