Cause

Postpartum depression (PPD) seems to be triggered by the sudden hormone changes that happen after childbirth. These hormonal changes most commonly lead to postpartum depression when paired with risk factors such as previous depression (including bipolar disorder), poor support from your partner, friends, and family, or a high level of stress.¹

The hormone changes and grief following miscarriage and stillbirth also trigger PPD in many women.¹

Symptoms

Postpartum blues. A certain amount of insomnia, irritability, tears, overwhelmed feelings, and mood swings are normal during the first days after childbirth. These "baby blues" usually peak around the fourth postpartum day and subside in less than 2 weeks, when hormonal changes have settled down. If you have postpartum blues after childbirth, you're not alone—more than half of women have temporary mild symptoms of depression mixed with feelings of happiness after having a baby.²

Be sure to report any feelings of postpartum blues to your doctor at your first postpartum checkup, so he or she can follow up with you.

Postpartum depression (PPD). Symptoms of postpartum depression can follow postpartum blues. They can feel like more of the same or can feel worse than before. Postpartum depression can also happen months after childbirth or pregnancy loss. In some cases, symptoms peak after slowly building for 3 or 4 months. Possible PPD symptoms require evaluation by a doctor.

If you have postpartum depression, you have had five or more depressive symptoms (including one of the first two listed below) for most of the past 2 weeks, including:^{1, 2}

• Depressed mood—tearfulness, hopelessness, and feeling empty inside, with or without severe anxiety.
• Loss of pleasure in either all or almost all of your daily activities.
• Appetite and weight change—usually a drop in appetite and weight but sometimes the opposite.
• Sleep problems—usually trouble with sleeping, even when your baby is sleeping.
• Noticeable change in how you walk and talk—usually restlessness, but sometimes sluggishness.
• Extreme fatigue or loss of energy.
• Feelings of worthlessness or guilt, with no reasonable cause.
• Difficulty concentrating and making decisions.
• Thoughts about death or suicide. Some women with PPD have fleeting, frightening thoughts of harming their babies. These thoughts tend to be fearful thoughts, rather than urges to harm.

Early treatment of PPD is important for both you and your baby. If you think you may have postpartum depression, take a short quiz to check your symptoms:

Interactive Tool: Are You Depressed?

Postpartum psychosis. This severe condition is most likely to affect women with bipolar disorder or a history of postpartum psychosis. Symptoms, which usually develop during the first 3 postpartum weeks (as soon as 1 to 2 days after childbirth), include:^{1, 3}

• Feeling removed from your baby, other people, and your surroundings (depersonalization).
• Disturbed sleep, even when your baby is sleeping.
• Extremely confused and disorganized thinking, increasing your risk of harming yourself, your baby, or another person.
• Drastically changing moods and bizarre behavior.
• Extreme agitation or restlessness.
• Unusual hallucinations, often involving sight, smell, hearing, or touch.
• Delusional thinking that isn't based in reality.

Postpartum psychosis is considered an emergency requiring immediate medical treatment. If you have any psychotic symptoms, seek emergency help immediately. Until you tell your doctor and get treatment, you are at high risk of suddenly harming yourself or your baby.