Postpartum depression (PPD), psychosis, and related conditions

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therapist.com team

Last updated: 09/14/2023

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What is postpartum depression?

Postpartum depression (PPD) is a type of depression that can affect you after you’ve given birth. The physical, emotional, and behavioral changes that go along with it can add to the challenges of caring for a newborn.

PPD isn’t easy to manage on your own, and it’s more common than you might realize—about one in seven people experience it after birthing a child.¹ It can also be long-lasting: In one study, around 5% of women were still experiencing symptoms three years after childbirth.²

PPD can look similar to the “baby blues,” an even more common emotional state that often follows childbirth temporarily.³ But PPD symptoms tend to be more intense and last longer, interfering with your daily life. While the baby blues typically resolve on their own within a couple of weeks, PPD is a serious clinical disorder that requires treatment.⁴

What does “postpartum” mean?

“Postpartum” specifically deals with the experiences a person has after giving birth. Other important terms in pregnancy and childbirth are “prenatal” (referring to the prebirth period), “postnatal” (referring to the postbirth period), and “perinatal” (meaning the time surrounding pregnancy, both before and after childbirth). Depression during a pregnancy is called perinatal depression (PND).

Signs and symptoms of PPD

After the birth of your child, you may notice changes in your feelings and behavior. These changes are common, but if they’re mostly negative and seem to linger, they could signify PPD.

Some common signs include:⁵

• Intense mood swings or a persistent low mood
• Loss of interest in things you used to enjoy
• Difficulty bonding with your baby or feeling little to no joy in parenting
• Changes in your sleep, eating patterns, and/or weight
• Feelings of irritability, guilt, shame, worthlessness, hopelessness, or helplessness
• Problems concentrating or making decisions
• Thoughts of death, suicide, or harming yourself or your child

If you’ve had one or more of these symptoms for at least two weeks, contact your health care provider or a mental health professional immediately to get help.

If you’re in crisis or having thoughts about hurting yourself or your baby, please call or text the 988 Crisis Lifeline at 988 for free, confidential, 24/7 support.

PPD risk factors

It’s important to recognize that PPD is not your fault. Experts believe a combination of factors may increase your risk for this disorder.⁶ These can include:

• Hormonal changes: Giving birth can sharply decrease hormones such as estrogen and progesterone, which can contribute to depression.⁷
• Emotional adjustments: New parents have to adapt to major changes in their relationships, work lives, and identities.
• Lack of support: Having an unsupportive or absent partner, or no loved ones nearby for assistance, can make you feel isolated and helpless.⁸
• Sleep difficulties: If your newborn wakes up frequently during the night, it can seriously deprive you of sleep. This can raise your PPD risk or make existing symptoms worse.⁹
• Family or personal history: If your family has a history of mental health disorders, or if you have history of depression or other mental health conditions, it may increase your risk.^{10, 11}
• Violence or abuse: If you’ve experienced intimate partner violence or sexual abuse in the past, you may be more vulnerable.¹²
• Stress or trauma: Complications during pregnancy, a difficult delivery, or other traumas and stressors may increase your risk for PPD.¹³

Related postpartum conditions

In addition to PPD, mental health conditions that can happen during or after pregnancy include:

The baby blues

The “baby blues,” or postpartum blues, usually come on within the first few days or weeks following delivery, and they can last up to a few weeks.¹⁴ They affect some 70 to 80% of new mothers after childbirth.¹⁵ As with PPD, symptoms can include mood swings, anxiety, sadness, irritability, and crying spells. The baby blues typically don’t require treatment, but self-care and social support (from friends, family, or support groups) may help reduce symptoms.¹⁶

Postpartum anxiety (PPA)

Anxiety after giving birth is quite common, but sometimes those feelings are severe and long-lasting. Postpartum anxiety (PPA) involves panic, fear, worry, agitation, and restlessness. You may have trouble sleeping, tension, or constant thoughts about your baby’s safety.

Postpartum obsessive-compulsive disorder (OCD)

Postpartum obsessive-compulsive disorder (OCD) is an anxiety disorder that causes intrusive thoughts, compulsive behaviors, and intense distress. Symptoms typically involve obsessing over your baby’s health and safety or fearing something bad will happen to them.

Postpartum posttraumatic stress disorder (P-PTSD)

It’s possible to develop postpartum posttraumatic stress disorder (P-PTSD) after having a traumatic birth, pregnancy, or postpartum experience. P-PTSD symptoms can include flashbacks, nightmares, and constant anxiety.

Postpartum bipolar disorder

Postpartum bipolar disorder isn’t common, but a history of bipolar disorder may increase your risk for it.¹⁷ Typical symptoms include severe mood swings, agitation, disorganized thinking, and racing thoughts.

Postpartum psychosis

Postpartum psychosis is a rare but serious mental health condition that’s estimated to affect between one and five in 1,000 birthing parents.¹⁸ It involves a sudden onset of severe mood swings, hallucinations, delusions, and disordered thinking, which can lead to dangerous behavior and an inability to care for yourself or your newborn. Given its severity, postpartum psychosis requires immediate hospitalization.

The condition often goes undiagnosed and unreported because many practitioners don’t screen patients for it during both prenatal and postnatal stages.¹⁹ Preexisting bipolar disorder may put you at a higher risk,²⁰ but it can also occur in otherwise healthy people.

Paternal perinatal depression (PPND)

Dads and other nonbirthing partners can have mental health issues after the birth of a baby, too. Paternal perinatal depression (PPND), a type of depression in new fathers, can involve feelings of sadness, worthlessness, and detachment from the family.

The broad impact of PPD

After birth, your baby is likely to interact with you countless times each day. If you’re depressed, it can decrease your ability to connect and communicate. It can also interfere with your ability to bond with your baby—an essential step for your child’s healthy social and emotional growth. Babies of parents with PPD are at risk for poorer developmental outcomes, including problems with language, communication, cognition, and emotional development.²¹

Beyond the distressing symptoms it causes you in the moment, having PPD can harm your long-term well-being. It’s associated with lower mood states later in life, including anxiety, anger, sadness, and low self-esteem.²² It can also increase your risk for chronic health issues like heart disease.²³

The rest of the family may feel the effects of PPD as well. Partners may experience increased symptoms of depression and anxiety.^{24, 25} Older children who feel neglected or confused as their parents struggle may develop behavioral issues like defiance or acting out.²⁶

Barriers to care

Unfortunately, the stigma associated with PPD can stop suffering people from seeking help. Other barriers to treatment include being misinformed about the condition, not having access to care, or fearing people’s judgment. Some new parents even believe that talking about their struggles with loved ones will drive them away.

Prevention

Regardless of what your risk factors look like, it’s a good idea to take steps during and after pregnancy to reduce your chance of developing PPD. Preventive actions can include attending childbirth and parenting classes, learning PPD signs and symptoms, getting regularly screened for depression, and seeking treatment if needed.

Other preventive steps include receiving support for breastfeeding, learning about positive parenting, asking for social support from loved ones and healthcare providers, taking care of yourself, and getting adequate sleep.

You can be screened regularly both during and after pregnancy for PND and PPD.²⁷ Common screening tools include the Patient Health Questionnaire depression scale (PHQ-9) and the Edinburgh Postnatal Depression Scale (EPDS), both which take only a few minutes to complete.

Treatment options

Psychotherapy and antidepressant medications (such as SSRIs) are two effective ways to treat PPD.²⁸ For mild to moderate cases, therapy is the first choice; and for moderate to severe cases, a combination of therapy and medication is recommended. Treatment typically lasts 6 to 12 months to avoid relapse.

Two neurosteroid medications for PPD, brexanolone and zuranolone, are also newly available, but more research may be needed to understand their long-term safety and effectiveness.²⁹

If you’re nursing and worried about the effects of medication on your baby or yourself, talk to your doctor about the benefits and risks. Repetitive transcranial magnetic stimulation (TMS), a procedure that uses magnetic waves to stimulate nerve cells, may be an effective alternative.

Electroconvulsive therapy (ECT)—when an electric current is sent to the brain under general anesthesia—may help in severe cases where other treatments don’t work.

Coping strategies

Along with treatment, lifestyle changes can help you manage PPD symptoms. The following strategies may help:

• Eat a balanced diet.
• Make daily physical activity a habit.
• Limit your alcohol and caffeine intake.
• Ask for help from your partner, other family members, and friends.
• Take time for yourself, even if it’s just a few minutes here and there.
• Practice stress management techniques like meditation, deep breathing, self-compassion, and mindfulness.
• Speak to others who’ve experienced PPD.
• Seek support from a mental health professional.

Supporting someone you know with PPD

If someone you know is struggling with PPD, your support can go a long way. Here are some ways to help:

• Encourage them to share their feelings. Listen without judgment, and let them express themselves in their own way.
• Remind them that they aren’t alone.
• Offer to help with an everyday task such as chores, errands, or looking after the baby for a short period.
• Encourage them to take time for self-care.
• Let them know that it’s okay not to be okay, and offer to help them connect with a mental health professional or support group.

The partner of a person with PPD may also need support. Don’t hesitate to talk with them, check on their well-being, and offer encouragement or assistance.