Postnatal and Postpartum Depression Causes Symptoms Diagnosis and Treatment

Definition and diagnostic criteria

Postnatal depression (PND), sometimes called postpartum depression, is a mood disorder that can begin during pregnancy or after childbirth. Clinicians view it as a major depressive episode with peripartum onset when symptoms arise during pregnancy or within a specified early postpartum window. In many guidelines, the peripartum specifier is used if symptoms begin during pregnancy or within four weeks after delivery; some practices extend consideration to the broader early postpartum period. A formal diagnosis typically rests on a clinician’s comprehensive assessment rather than a single questionnaire, though screening tools help identify people who may need an evaluation.

In clinical terms, a postpartum-related depressive episode commonly meets the criteria for major depressive disorder, with the addition of peripartum onset. The core features resemble other depressive disorders and include persistent sadness or anhedonia (loss of interest or pleasure) plus several accompanying symptoms that impair daily functioning. A diagnosis is made when symptoms are present for a sustained period and cause distress or interfere with the ability to care for oneself or the baby.

Key diagnostic criteria commonly used in practice include the following (requiring a minimum of five symptoms over a two-week period, with at least one being depressed mood or anhedonia):

• Depressed or markedly low mood most of the day, nearly every day
• Markedly diminished interest or pleasure in most activities
• Significant weight loss or gain or changes in appetite
• Insomnia or hypersomnia
• Psychomotor agitation or retardation
• Fatigue or loss of energy
• Feelings of worthlessness or excessive guilt
• Diminished ability to think, concentrate, or make decisions
• Recurrent thoughts of death or suicide, or suicide attempts

For a postpartum specifier, clinicians assess onset in relation to pregnancy and birth, and evaluate how symptoms affect the parent’s ability to function and care for the infant. It is important to distinguish PND from the short-term “baby blues,” which typically involve milder mood fluctuations and resolve within two weeks. If there are thoughts of harming yourself or the baby, emergency help should be sought immediately.

Symptoms and signs

Postnatal depression can manifest in a range of emotional, cognitive, physical, and behavioral ways. Symptoms often overlap with other mental health concerns, so professional evaluation is important. Common signs include:

• Persistent sadness, emptiness, or tearfulness
• Excessive anxiety or worry about the baby’s health or safety
• Irritability, anger, or mood swings
• Guilt, worthlessness, or inadequate parenting feelings
• Difficulty bonding with the baby or enjoying time with the infant
• Sleep disturbances (not solely due to infant care) or fatigue
• Changes in appetite or weight
• Difficulty concentrating, making decisions, or remembering things
• Social withdrawal or reduced interest in activities
• Energy loss or slowed movements (psychomotor changes)
• In severe cases, thoughts of self-harm or harming the baby

Some individuals experience high levels of anxiety, panic, or obsessive thoughts related to the baby’s safety. It’s important to assess risk and provide safety planning if there is any threat to the parent or infant. Distinguishing PND from other conditions—such as postpartum psychosis, anxiety disorders, or bipolar disorder—requires a thorough clinical interview and, when appropriate, medical testing.

Causes and risk factors

Postnatal depression emerges from a combination of biological, psychological, and social influences. No single cause explains every case, but several factors are commonly involved:

• Rapid hormonal changes after birth (estrogen, progesterone), thyroid function shifts, and genetic predisposition can contribute to mood changes. Sleep disruption from caring for a newborn also plays a major role in mood regulation.
• Psychological factors: A history of depression or anxiety, high levels of stress, low self-efficacy in parenting, and trauma history increase risk.
• Social and environmental factors: Limited social support, relationship strain, financial stress, single parenthood, unexpected infant health issues, or a difficult pregnancy can heighten vulnerability.
• Difficult infant temperament, prolonged feeding issues, or NICU stays can add stress and impact mood.
• Challenges with breastfeeding or concerns about infant nutrition may contribute to emotional distress for some parents.

Understanding risk factors helps clinicians plan prevention and early intervention, but even people without obvious risk factors can develop PND. Likewise, the absence of risk factors does not guarantee immunity. Open conversations about mood, stress, and parenting expectations are important for early detection.

How it’s diagnosed by professionals

Diagnosis is typically made through a combination of screening, clinical interview, and medical evaluation. Steps may include:

• Routine screening tools such as the Edinburgh Postnatal Depression Scale (EPDS) or the PHQ-9 can identify symptoms that warrant a fuller assessment. Screening is often done during prenatal visits and postpartum checkups.
• A clinician (primary care physician, obstetrician, midwife, psychologist, or psychiatrist) conducts a structured or semi-structured interview to review mood, sleep, energy, appetite, concentration, safety, and functioning over the preceding weeks.
• A physical exam and targeted laboratory tests (for example, thyroid function tests, iron studies) help rule out medical conditions that may mimic or worsen depressive symptoms.
• Clinicians consider other mental health conditions (anxiety disorders, bipolar disorder, postpartum psychosis), sleep disorders, and medical issues, ensuring an accurate diagnosis and appropriate treatment plan.
• If there is any risk of self-harm or harm to the baby, urgent action—such as safety planning, escalation to urgent care, or hospitalization—may be needed.

Diagnosis is nuanced and personalized. A single score does not determine the outcome; context, duration, impairment, and safety considerations all shape the treatment approach.

Treatment approaches and options

Treatment for postnatal depression often combines evidence-based psychotherapy, pharmacotherapy when indicated, practical support, and lifestyle adjustments. The goal is to reduce symptoms, restore functioning, support maternal-infant bonding, and improve overall well-being for the parent and family.

Psychotherapy

Psychotherapy is a first-line option for many people, with several effective approaches:

• Helps identify and change negative thought patterns and unhelpful behaviors, with practical strategies to manage mood, energy, and daily routines.
• Focuses on improving relationships, role transitions (becoming a parent), and social supports, which can ease depressive symptoms.
• Provides validation, psychoeducation, and coping skills; peer support can reduce isolation.

Pharmacotherapy

Antidepressants can be effective during the postpartum period. Medication decisions depend on symptom severity, breastfeeding status, medical history, and personal preferences. Common options include:

• Selective serotonin reuptake inhibitors (SSRIs): Sertraline and fluoxetine are frequently used due to robust evidence and compatibility with breastfeeding. Other SSRIs may be considered based on history and tolerability.
• Serotonin-norepinephrine reuptake inhibitors (SNRIs): Venlafaxine or duloxetine may be used in certain cases.
• Other antidepressants: Mirtazapine or bupropion may be considered when appropriate.

Most antidepressants pass into breast milk at low levels, but many breastfeeding parents safely take these medications. A clinician will weigh maternal benefits against potential infant exposure and monitor both parent and baby. In some cases, non-pharmacological strategies or rapid-acting interventions (for severe symptoms) may be preferred. Any medication use during breastfeeding should be discussed with a healthcare provider.

Supportive and practical care

• Sleep and fatigue management: Sleep strategies, daytime napping when possible, and support from partners or family.
• Social support: Reconnecting with partners, family, friends, and parent groups reduces isolation and stress.
• Family involvement: Education for partners and caregivers helps create a supportive home environment.
• Breastfeeding support: Consult lactation consultants or pediatric providers to address feeding concerns and preserve bonding.
• Safety planning: Develop a plan for crises, emergency contacts, and steps to take if thoughts of self-harm or harming the baby arise.
• Lifestyle factors: Regular gentle exercise, balanced nutrition, and exposure to natural light can support mood and energy.

In severe or resistant cases, or when there is postpartum psychosis or a failure to respond to standard treatments, higher levels of care may be needed. Electroconvulsive therapy (ECT) can be effective in severe, treatment-resistant postpartum depression or in life-threatening situations, under specialist supervision. Hospitalization may be necessary for safety and intensive treatment during the most acute phases.

Prognosis and living with the condition

With timely diagnosis and a comprehensive treatment plan, many people recover from postnatal depression within a few months, and most regain their prior level of functioning. Recovery can be gradual, and mood may fluctuate during the healing process. A history of PND does, however, increase the risk of recurrence in future pregnancies, so ongoing monitoring and early support in subsequent pregnancies are often recommended.

The impact on mother-infant bonding and early child development is a concern when depression is untreated. Early treatment and supportive caregiving environments help promote healthier bonding and reduce potential developmental risks for the child. Ongoing engagement with mental health professionals, peer support, and practical help from partners or family contribute to better long-term outcomes.

Living with PND involves acknowledging the condition, accepting help, and building a plan that fits the family’s needs. Many parents describe gains in empathy, parenting confidence, and resilience as they navigate treatment and recovery. If mood symptoms persist beyond a few months despite treatment, or if new symptoms arise, it is important to revisit the care plan with a clinician to adjust therapies or explore alternative options.

Support resources

Finding reliable information and connecting with others who understand can make a meaningful difference. The following resources offer education, guidance, and access to professional support. If you or someone you know is in immediate danger, call your local emergency number or go to the nearest emergency department.

• NIMH: Postpartum Depression
• Mayo Clinic: Postpartum Depression
• NHS: Post-natal Depression
• Postpartum Support International
• APA: Postpartum Depression
• Mind (UK): Post-natal Depression

Additionally, many communities offer local maternal mental health programs, counseling services, and hospital-based postpartum clinics.

If you are supporting someone who may be experiencing PND, listen without judgment, encourage professional help, and offer practical assistance with baby care, chores, and sleep routines.

Early, compassionate support makes a difference for both parent and child.