Signs of Postpartum Depression, Anxiety and Other Mood Changes After Birth

If you are reading this at 3 a.m.

Start here if you need someone now. The 988 Suicide and Crisis Lifeline is free, confidential and open around the clock: call or text 988, or chat at 988lifeline.org. If you or your baby are in immediate danger, call 911. Postpartum Support International (PSI) runs a HelpLine at 1-800-944-4773 (press 1 for Spanish, 2 for English), or text "Help" to 800-944-4773 in English or 971-203-7773 in Spanish; it is not a crisis line and calls are returned, so use 988 or 911 if you cannot wait.

Now the longer version. Mood changes after birth sit on a wide spectrum, from a few teary days to conditions that need real care. Knowing the rough shape of each one makes it easier to decide whether what you feel is worth a call. This page is education, not diagnosis. Only your doctor, midwife or a mental health professional can tell you what is going on.

It also helps to know that the American College of Obstetricians and Gynecologists (ACOG) says to call your ob-gyn or another health care professional right away if you think you may have postpartum depression, or if your partner or family members are concerned that you do, and not to wait for your postpartum checkup.

Baby blues: common, mild and short

ACOG describes the baby blues this way: about 2 to 3 days after childbirth, some people begin to feel depressed, anxious and upset. They may cry for no clear reason, have trouble sleeping, eating and making choices, and question whether they can handle caring for a baby. These feelings may come and go in the first few days.

The defining feature is that they lift. ACOG says the baby blues usually get better on their own within a few days or 1 to 2 weeks. The Office on Women's Health lists mood swings, crying spells, loss of appetite, trouble sleeping and feeling sad, anxious or overwhelmed, and says to call your provider if the symptoms do not go away after 2 weeks or are very intense.

In between the waves, you still feel like yourself. If you do not, or if the two-week mark passes and nothing has eased, that is the line most sources draw. Our earlier post, when it is more than the baby blues, looks at that line in more detail.

Postpartum depression and postpartum anxiety

ACOG defines postpartum depression as a type of depression that causes intense feelings of sadness, anxiety or despair that keep people from being able to do their daily tasks. It can occur up to 1 year after having a baby, and ACOG says it most commonly starts about 1 to 3 weeks after childbirth. The National Institute of Mental Health (NIMH) adds that mood changes that are severe or last longer than 2 weeks after childbirth may be signs of postpartum depression.

Signs the sources describe include a persistent sad, anxious or empty mood most of the day, nearly every day; feeling guilty, worthless or hopeless; withdrawing from friends and family; trouble bonding with the baby; and thoughts of death or of harming yourself or the baby. The Office on Women's Health notes that these symptoms last longer and are more severe than the baby blues.

Anxiety is its own pattern, and it is often missed because the usual questions are about sadness. The Office on Women's Health says mothers can also experience anxiety disorders during or after pregnancy, and PSI describes perinatal anxiety as something that can occur on its own or alongside depression, sometimes with panic attacks. Constant worry that does not respond to reassurance, racing thoughts, and being unable to sleep even when the baby is asleep and someone else is on duty are the signs people describe most. Our post on postpartum anxiety vs. the baby blues covers how to tell them apart.

Both conditions respond to care. ACOG lists talk therapy, one-on-one or in a group, and medication, including antidepressants and zuranolone, which is taken by mouth for 14 days. NIMH says care usually includes therapy, medication, or a combination. Deciding among them is a conversation with your provider, especially if you are breastfeeding.

OCD, PTSD and postpartum psychosis

Three less familiar conditions deserve plain description, because the fear of naming them keeps people silent. The descriptions below come from PSI and NIMH.

• Perinatal OCD. PSI describes it as repetitive, unwanted, intrusive thoughts (obsessions) and urges to perform compulsive actions. PSI notes the thoughts are anxious in nature, not a break from reality, and that parents often avoid things they fear could harm the baby. These thoughts horrify the person having them. Telling a provider about them is the fastest route to relief.
• Perinatal PTSD. PSI says it is caused by a traumatic or disappointing experience during pregnancy, delivery or postpartum. A frightening birth, an emergency cesarean, or a NICU stay can leave flashbacks, avoidance and a sense of being on guard. Our post on healing from birth trauma talks about support after a hard birth.
• Postpartum psychosis. This one is different, and it is an emergency. NIMH calls it a serious mental illness and a psychiatric emergency that requires hospitalization. PSI lists delusions or strange beliefs, hallucinations, rapid mood swings, difficulty communicating at times, severe agitation, decreased need for sleep and paranoia, and says it usually begins in the first 2 weeks. The person may not see it from the inside. Call 911 or go to the emergency room, and PSI advises staying with the person and the child for safety.
• All of these respond to care. PSI says help is available for every condition on its list, and NIMH says therapy, medication or a combination of the two helps with perinatal depression. Needing care says nothing about you as a parent.

Partners can be affected too

PSI has a page for dads for a reason: it says fathers can experience postpartum depression and anxiety, during the pregnancy or the first year postpartum, and it runs a support group specifically for dads. Non-birthing partners of any gender can struggle after a birth, and the same two-week rule of thumb and the same phone numbers apply to them.

Partners are also often the first to notice. NIMH says spouses, partners, family members and friends may be the first to recognize signs of depression in a new mother. If you are the partner, the useful move is to say plainly what you have noticed, help make the appointment, and take the baby so it can happen. Our guide on how partners work with a doula covers the practical side of sharing the load.

What a postpartum doula can and cannot do, and what to do next

A postpartum doula is not a mental health clinician. She does not screen, diagnose or provide therapy, and she does not decide whether what you feel is normal. What she can do is spend many hours in your home during the weeks when these conditions most often appear, notice changes, name them gently, and encourage you to call your provider. She can also hold the baby so you can go to the appointment, and take enough of the night that sleep becomes possible.

The Doulas of the Valley postpartum doula page says our postpartum doulas are trained to recognize signs of postpartum adjustment issues and have resources to point you toward, and the care includes recognizing and affirming normal postpartum emotional responses. Recognizing is not diagnosing; the call to your provider is still yours to make, and a doula will encourage it.

If you want to compare the kinds of emotional support available after birth, from your provider to a therapist to a peer group to a doula, read postpartum doula vs. support group vs. therapist. If anything on this page described you, the next step is one phone call: your provider, 988, or 911. Make it today.