Postpartum Depression: Symptoms, Causes and Treatment

Part of our Women's Mental Health articles. For evaluation and medication management, see women's mental health care at Ridge Way.

Postpartum depression is depression in the weeks or months after a baby is born, and StatPearls notes that 50% of these episodes start during pregnancy. NIMH says most begin within 4 to 8 weeks of the birth. It is more than the baby blues, it rarely lifts on its own, and with treatment most women feel better.

What Are the Symptoms of Postpartum Depression?

NIMH describes perinatal depression, which includes postpartum depression, as extreme sadness, anxiety and fatigue that can make daily tasks hard, including caring for yourself or others. The symptoms it lists are the ones your provider will ask about, and the ones a partner may notice first.

They include a sad, anxious or empty mood most of the day, nearly every day, for at least two weeks. Irritability, restlessness, and feelings of guilt, worthlessness or helplessness are on the list too. So are loss of interest in things you used to enjoy, and trouble sleeping even when the baby is asleep, waking early or oversleeping.

Two symptoms belong to the postpartum picture specifically. NIMH also names trouble bonding with the baby and persistent doubts about your ability to care for the baby. Both are common and both are treatable. Neither says anything about what kind of mother you are.

The last item on NIMH’s list is thoughts of death, of harming yourself or the baby, or suicide attempts. If that describes you, skip the rest of this article for now. Call or text 988, or call 911 if you or the baby are in immediate danger.

How Is Postpartum Depression Different From the Baby Blues?

NIMH uses “baby blues” for the mild, short-lasting worry, unhappiness and exhaustion that many women feel in the first two weeks after giving birth. That is expected. A newborn needs care around the clock and feeling overwhelmed is a normal response to that.

The line is drawn at two weeks and at severity. NIMH continues, “Mood changes and feelings of anxiety or unhappiness that are severe or last longer than 2 weeks after childbirth may be signs of postpartum depression. Women with postpartum depression generally will not feel better without treatment.”

Our post on the baby blues versus postpartum depression goes through the distinction in detail. It includes the questions that help you see which side of the line you are on.

What Causes Postpartum Depression?

NIMH is clear on what does not cause it. “A woman is not to blame or at fault for having perinatal depression,” and it is not caused by anything she did or did not do. It can affect any pregnant or postpartum woman, whatever her age, background or income.

What contributes, per NIMH, is a mix of genetic and environmental factors. These include life stress, such as work demands or past trauma, and the physical and emotional demands of a new baby. Changes in hormones during and after pregnancy play a part too. StatPearls describes the rapid drop in estradiol and progesterone after delivery as a possible stressor in people who are susceptible.

History raises the risk. NIMH notes that the risk is higher with a personal or family history of depression or bipolar disorder, or depression in a previous pregnancy. If you have had perinatal depression before, NIMH advises making a follow-up plan with a provider in case it comes back. If any of these apply to you, it helps to raise them before the birth.

How Is Postpartum Depression Diagnosed?

StatPearls reports that the American College of Obstetricians and Gynecologists, the American Academy of Pediatrics and the American Academy of Family Physicians all recommend screening for perinatal depression. The most frequently used tool is the Edinburgh scale, a 10-item questionnaire that takes a few minutes. The highest possible score is 30. A score of 13 or higher is linked to a higher risk of perinatal depression and calls for a fuller clinical assessment. StatPearls adds that the threshold for a referral varies between clinics, and in practice the individual answers matter as much as the total.

The questionnaire is a starting point, not the diagnosis. A psychiatric evaluation covers how you have been sleeping, eating and functioning, and your history before the pregnancy, including any past depression or bipolar disorder. It also covers what you are taking and whether you are breastfeeding, because that shapes the medication conversation.

You will be asked whether you have had any thoughts of harming yourself or the baby. It is asked because the answer changes what happens next, not because anyone assumes it. If those thoughts are with you now, do not wait for the visit. Call or text 988, and call 911 if anyone is in immediate danger.

How Is Postpartum Depression Treated?

NIMH says treatment for perinatal depression usually includes therapy, medication or both. It adds that antidepressants can effectively treat perinatal depression, on their own or together with psychotherapy.

Antidepressants take time. NIMH says “usually 4 to 8 weeks,” and that “problems with sleep, appetite, and concentration often improve before mood lifts.” StatPearls names selective serotonin reuptake inhibitors, or SSRIs, as the first-choice class. It calls sertraline and escitalopram good first-line choices and notes that sertraline has extensive and reassuring safety research. Our antidepressants page covers the class in full.

One medication exists specifically for postpartum depression today. NIMH describes zuranolone as “the first oral medication for postpartum depression in adults.” Its label states that it is taken for 14 days. It carries a boxed warning because it impairs driving. Patients should not drive or do anything else hazardous for at least 12 hours after each dose. Whether it is appropriate is a conversation for the evaluation, and it is not a first choice for everyone.

NIMH’s brochure also describes a second medication, brexanolone, given by IV infusion during a hospital stay. It is no longer available. The FDA withdrew its approval effective April 14, 2025, at the manufacturer’s request after it stopped marketing the drug. The brochure predates that and has not been updated, which is worth knowing if you read it elsewhere.

Ridge Way provides the evaluation and medication management. We do not provide therapy. NIMH describes cognitive behavioral therapy and interpersonal therapy as effective for perinatal depression. When therapy is part of the plan, we refer you to someone who provides it.

Can You Take Antidepressants While Breastfeeding?

NIMH’s guidance is to always tell your provider if you are pregnant or nursing. Together you can keep the baby’s exposure to medication low and weigh the risks and benefits of each option.

StatPearls is more specific about breastfeeding. Recommendations “should include discussing the benefits of breastfeeding, the risks of antidepressant use during lactation, and the risks of untreated illness. The risk of breastfeeding while taking a serotonin reuptake inhibitor is relatively low, and patients can be encouraged to breastfeed while on antidepressants.”

The phrase to hold onto is “the risks of untreated illness.” The decision is not treatment versus nothing. It is treatment, whether medication, therapy or both, versus untreated depression. NIMH notes that untreated perinatal depression “can have serious effects on both” mother and baby.

The reassurance above is about SSRIs specifically. It does not automatically extend to newer medications, so ask about each one by name. Bring the question to your evaluation with whatever you have read. It is a normal part of the conversation.

When to Get Help

Consider an evaluation if low mood, anxiety, guilt or trouble bonding lasts longer than two weeks after the birth or comes back after an easy start. The same goes if it makes caring for yourself or the baby hard. You do not have to wait for a routine checkup.

For support between visits, the Postpartum Support International HelpLine at 1-800-944-4773 offers information, resources and support groups for parents and partners. It is not a crisis line. For thoughts of harming yourself or the baby, call or text 988, and call 911 if anyone is in immediate danger.

Ridge Way provides evaluation and medication management for postpartum depression and other women’s mental health concerns across Georgia, through telehealth and at our Sugar Hill office. When therapy is part of the plan, our medical team can refer you. You do not need a referral unless your insurance plan requires one. Request an appointment and we will usually call you back within one business day.

Wondering whether what you are noticing is worth raising? Our free screening tools take about two minutes each and are a starting point, not a diagnosis.