As a reproductive psychiatrist who specializes in postpartum mental health, I see moms every day who wish they had recognized the signs of postpartum depression sooner. This guide will help you understand what postpartum depression looks like, how it differs from the "baby blues," and when to seek help.
Postpartum depression (PPD) is a medical condition (not a character flaw or a sign of weakness!) that involves persistent feelings of sadness, anxiety, or emptiness after childbirth. It's more than just feeling tired or overwhelmed as a new parent. Postpartum depression is a treatable mental health condition that can develop anywhere from during pregnancy up to a year after giving birth or sometimes later in certain circumstances.
This is one of the most common questions I hear, and it's an important distinction.
The Baby Blues affect up to 80% of new mothers and typically include:
The key difference? The baby blues usually start within the first few days after delivery and resolve on their own within two weeks. They're related to the dramatic hormonal shifts after birth and the adjustment to new parenthood.
Postpartum Depression is more severe and longer-lasting. The symptoms don't go away on their own and they significantly interfere with your ability to function and care for yourself and your baby or enjoy your experience.
If you're still struggling any time after two weeks after delivery, or if your symptoms are getting worse instead of better, this is not "just the baby blues." This is your signal to reach out for help.
It is really important to recognize that postpartum depression can look different for different people, but here are the most common signs to watch for:
Persistent sadness or emptiness. This isn't occasional sadness, it's a heavy, persistent feeling that doesn't lift even during moments that "should" feel happy. Most people thing PPD is "just" this and if they're functioning they can't have PPD. This couldn't be further from the case. While sadness or difficulty enjoying things are core features they're not the only features.
Overwhelming anxiety or panic attacks. This can include constant worry about your baby's health or safety, racing thoughts, physical symptoms like rapid heartbeat or shortness of breath, or a sense of impending doom. It can also show up as constant checking, documenting things really carefully and difficulty sleeping because of worry. I could do a whole blog post on postpartum anxiety and I probably will.
Intense irritability or anger. Many people don't realize that postpartum depression can show up as anger rather than sadness. You might find yourself snapping at your partner over small things, feeling rage that seems disproportionate, or having a very short fuse. I will often ask how relationships with pets are going because they can bear the consequences of your irritability!
Feeling hopeless or worthless. Thoughts like "I'm a terrible mother," or "I can't do anything right."
Loss of interest or pleasure. Things you used to enjoy don't bring you joy anymore. You might feel emotionally numb or disconnected from activities and people you care about.
Difficulty bonding with your baby. You might feel detached from your baby, have trouble feeling love or connection, or feel like you're just going through the motions of care without emotional attachment. Sometimes a relationship with baby can take time to develop so if this is your only symptom please know a relationship can develop over time and, in fact, I hear a lot of moms saying they didn't feel the immediate rush of love and joy they thought they were "supposed" to feel.
Changes in sleep. This isn't just the normal sleep deprivation of new parenthood. I always say "I know your baby isn't on board with the plan for you to get good sleep" (I'm a parent myself, I get it!). With postpartum depression, you might have trouble falling asleep even when your baby is sleeping, wake up frequently with racing thoughts, or conversely, want to sleep all the time and struggle to get out of bed.
Changes in appetite. Significant loss of appetite or eating much more than usual. Some moms with PPD forget to eat entirely, while others find themselves eating more as a way to cope.
Severe fatigue or loss of energy. Exhaustion that goes beyond typical new parent tiredness. You might feel physically heavy, like everything requires enormous effort. This is one that we often struggle with because the exhaustion with parenting is relentless so we tease this one apart pretty well in visits to see how the fatigue is impacting you rather than "if" it is there or not.
Physical aches and pains. Headaches, stomachaches, muscle tension, or other physical symptoms without a clear medical cause. Side note: if you're having persistent headaches postpartum please reach out to your delivery team or medical providers to get checked out in person.
Difficulty concentrating, remembering, or making decisions. You might find yourself unable to focus on conversations, forgetting things constantly, or feeling paralyzed when trying to make even simple decisions.
Racing thoughts or inability to slow your mind down. Your brain might feel like it's constantly spinning with worries, worst-case scenarios, or negative thoughts.
Thoughts of harming yourself or your baby. This includes thoughts of suicide, or thoughts of harming your baby. These thoughts are symptoms of a medical condition and they mean you need help right away.
Feeling like you or your baby would be better off if you weren't here. Any thoughts about death, disappearing, or your family being better without you are serious warning signs. I want to provide you reassurance that letting an appropriately trained clinician know about these thoughts doesn't automatically mean you'll be admitted to a psychiatric hospital or have your baby taken away. We try to prevent these situations at all cost!
Severe anxiety about your baby's safety that interferes with functioning. While some worry is normal, if you're unable to sleep because you're constantly checking if your baby is breathing, having intrusive images of harm coming to your baby, or unable to let anyone else hold your baby due to intense fear, this needs professional evaluation.
If you're experiencing several of the symptoms listed above for more than two weeks, and they're interfering with your ability to care for yourself or your baby, this warrants a conversation with a healthcare provider.
You don't need to have every symptom on this list to have postpartum depression. And you don't need to wait until things get "bad enough." If you're struggling and wondering whether you should reach out, that wondering itself is often a sign that you should. Here is another blog on why waiting often isn't the right choice.
Here are some questions to ask yourself:
Postpartum depression isn't caused by anything you did or didn't do. It's a medical condition with multiple contributing factors:
Hormonal changes. The dramatic drop in estrogen and progesterone after delivery affects brain chemistry and can trigger depression in vulnerable individuals.
Sleep deprivation. Severe and prolonged lack of sleep affects mood regulation, emotional resilience, and brain function.
History of depression or anxiety. If you've experienced depression or anxiety before pregnancy, you're at higher risk for postpartum depression.
Stressful life circumstances. Lack of support, financial stress, relationship difficulties, or a traumatic birth experience can all contribute.
Thyroid problems. Sometimes postpartum thyroid dysfunction can cause or worsen mood symptoms.
The important thing to understand is that postpartum depression is not your fault. You didn't cause it by not being grateful enough, not trying hard enough, or not loving your baby enough.
The short answer? Now. If you're reading this article because you're concerned about yourself, that concern is valid and worth addressing.
Here's what I tell my patients: you don't need to wait until you're in crisis to get help. You don't need to wait until you "can't function at all." You can seek help when you're just starting to struggle.
Seek help immediately if:
Seek help soon if:
At Reproductive Psychiatry and Counseling, we see most new patients within two weeks because we understand that when you're struggling, every day matters.
I know reaching out can feel scary, but here's what actually happens:
When you call a reproductive psychiatrist or therapist who specializes in postpartum depression, you'll typically have an initial evaluation where we talk about what you're experiencing, how long it's been going on, and what kind of support would be most helpful for you.
We'll work together to create a treatment plan that feels right for you. This might include:
Therapy. Cognitive behavioral therapy, interpersonal therapy, and other evidence-based approaches have been shown to effectively treat postpartum depression.
Medication. There are safe and effective antidepressant options for postpartum depression, including medications that are reasonable to take while breastfeeding. As a reproductive psychiatrist, I specialize in knowing which medications are appropriate during pregnancy and while breastfeeding.
Support groups. Connecting with other moms who understand what you're going through can be incredibly validating and helpful.
Lifestyle support. Strategies for getting more sleep, asking for help, and prioritizing your basic needs.
The most important thing to know is that postpartum depression is highly treatable. With the right support, you can feel like yourself again.
This is one of the most common concerns for new moms, and the answer is yes. There are several antidepressant medications that are considered safe during breastfeeding. The risks of untreated postpartum depression to both you and your baby are typically greater than the minimal risks of medication.
As reproductive psychiatrists, we specialize in this exact question. We know which medications have the best safety profiles during breastfeeding, and we can help you weigh the benefits and risks to make the decision that's right for your family.
Yes. While postpartum depression is most commonly discussed in birthing parents, research shows that up to 10% of partners can also experience postpartum depression. Partners can experience many of the same symptoms—mood changes, anxiety, irritability, withdrawal, and difficulty bonding with the baby.
If you're a partner who is struggling, you deserve support too. The same treatments that work for postpartum depression in birthing parents can help partners as well.
At RPC we are also available to treat non-birthing parents!
Without treatment, postpartum depression can last for months or even years. But here's the good news: with treatment, most people start feeling significantly better within a few weeks to a few months.
The earlier you get help, the faster you're likely to recover. This is why I encourage people not to wait. Every day you spend struggling is a day you don't have to lose.
If I could tell every mom struggling with postpartum depression one thing, it would be this: what you're experiencing is not your fault, it's not a reflection of how much you love your baby, and you deserve support.
Postpartum depression is a medical condition. Just like you would seek help for diabetes or a broken bone, you deserve help for postpartum depression. You don't have to earn the right to get help by suffering long enough or being "bad enough."
The narrative around motherhood tells us we should be glowing and grateful and completely in love with every moment. When that's not our reality, it can feel isolating and scary. But you are not alone. So many moms struggle. You are not broken. You are experiencing a treatable medical condition.
And you don't have to wait to start feeling more like yourself again.
If you're in Texas and experiencing signs of postpartum depression, Reproductive Psychiatry and Counseling is here for you. Our board-certified reproductive psychiatrists and licensed therapists specialize in postpartum mental health, and we see most new patients within two weeks.
We provide evidence-based treatment through therapy and medication management (including medications safe for breastfeeding), and we work with you to design a treatment plan that feels right for your life and your family.
You can be seen in-person in Austin or virtually anywhere in Texas.
Ready to schedule an appointment? You can request a visit here or call us at (512) 982-4116.
Because you don't have to do this alone.
About the Author
Dr. Nichelle Haynes is a board-certified reproductive psychiatrist at Reproductive Psychiatry and Counseling in Austin, Texas. She specializes in mental health during pregnancy, postpartum, and throughout the reproductive lifespan. Dr. Haynes is passionate about helping mothers receive the compassionate, evidence-based care they deserve. You can follow RPC and Dr. Haynes on instagram!
Frequently Asked Questions About Postpartum Depression
Can postpartum depression start during pregnancy? Yes. What's sometimes called "perinatal depression" can begin during pregnancy and continue after delivery. If you're experiencing depression symptoms during pregnancy, don't wait until after birth to seek help.
Is postpartum depression the same as postpartum psychosis?No. Postpartum psychosis is a rare but serious condition that includes symptoms like hallucinations, delusions, severe confusion, and paranoia. It's a psychiatric emergency that requires immediate medical attention. Postpartum depression does not include these symptoms.
Will postpartum depression go away on its own? While some cases may eventually resolve without treatment, postpartum depression often persists for months or longer without intervention. Treatment significantly speeds recovery and reduces suffering. There's no reason to wait it out when effective help is available.
Can I prevent postpartum depression? If you have risk factors like a history of depression or anxiety, talking to a reproductive psychiatrist during pregnancy can help. Some people benefit from starting treatment preemptively. However, postpartum depression isn't always preventable, and developing it doesn't mean you did anything wrong.
Learn about Postpartum Anxiety and how to help yourself heal.
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By Sarah Rivers Deal, PhD, LPC With Perinatal Loss month in October, I wanted to introduce myself through this blog as well as cast a light in the often dark places that hold this kind of silent, disenfranchised grief. As a psychotherapist that specializes and has been trained in infertility counseling, I too experienced my own reproductive trauma. Five years of fertility and alternative medicine treatments yielded a roller coaster of emotions, existential crises, and ultimately, two small graves in our back yard. Allow me to share something I wrote after my first miscarriage. We read to know that we are not alone – and – you are not alone. If you’re like me, the struggle to create life took over my life. It was all I thought out, dreamt about, planned for, spoke about, made exceptions for, ate for, stopped drinking my favorite red wine for – you name it. Life became hinged on hypotheticals – What if we get pregnant after I accept this new position? What if I accept this invitation then can’t travel in a few months because I’m pregnant? Should we buy the house in the better school district or wait until little one is here? What if little one never gets here? As much as I tried to balance my life, infertility crept in at every turn. In her insightful memoir, The Art of Waiting, Belle Boggs describes this all-consuming experience, calling it the Take Over – “…the problem with infertility is that it is not a patient, serene kind of waiting, not a simple delay in your plans; it happens for many of us in the context of consuming struggle, staggering expense, devastating loss.” Deciding to pursue fertility treatments put my barrenness on the front burner, making it difficult to escape. After five years in fertility clinics, more people had seen my vagina than the inside of my home. What was supposed to be private and magical between my partner and I was now public and scientific. All around me, women were “blessed” with babies, flaunting them as little “miracles.” These terms are especially painful for those struggling to conceive, as it implies that certain people are chosen while others are not. As much as I tried to participate in the world, being around pregnant women or infants was hazardous to my mental health. I remember attending my first baby shower in several years, believing I was safe now because my partner and I were months away from our daughter (by way of adoption) being born. Hope had begun to blossom again in my heart, as I believed that soon I would be a mom too. While I was emotionally prepared for my friend Serena to be eight months pregnant (after years of trying and two miscarriages), I wasn’t informed that the shower host was visibly pregnant too, and to boot – after only one round of I.V.F. with the same doctor I used. As we munched on our blue painted cookies shaped like pacifiers, I learned that the champagne drinking host had a 9-year-old son already, and became recently engaged after finding out about the pregnancy. I wish I could say I genuinely celebrated her happy news, but on the inside, I was fuming. On the drive home, with no other car in sight, I blasted the radio and screamed bloody murder. Despite various challenging life experiences up to this point, I still somehow believed in the concept of justice – a philosophy of how fairness is administered. To put it simply, it seemed unfair to me that this host woman was pregnant and going to be a mom – for the second time – and all I had to show were memorial stones in my yard commemorating two pregnancy losses. Unfair that I had earned high marks for effort and still wasn’t getting to graduate. Unfair that I wasn’t stroking my own belly, marveling at the miracle of science and creation itself. Infertility or perinatal loss may be experienced as an existential crisis, planting seeds of doubt in life questions you thought you had basically addressed, figured out, or had plenty of time to answer. What legacy will I leave behind? Who will carry on my values? Who will remember me after I’m gone? Am I broken? Dr. Anne Malavé, mental health expert in the field of infertility, wrote – “Infertility is like trying to find your children. The child, the imagined and expected child whose presence is palpable yet missing, feels near. It feels like searching for a lost child–you keep looking and searching around every corner. To stop trying can feel like an abandonment of an actual baby, of “my/our own baby.” Pamela Mahoney Tsigdinos in her raw, genuine book Silent Sorority, poignantly captures this existential crisis – “One instant you are like everyone else. The next, you’re not. Your DNA now ends with you. You are infertile. Your branch of the family tree will forever be just a truncated twig. You’ve been denied a rite of passage, a biological imperative. You had no say in the matter. It wasn’t a conscious choice. The comfortable sense of continuity and legacy others take for granted disappears in an instant.” After experiencing perinatal loss in 1999, Amy Douglas poetically wrote: “A life inside me, a love so strong. She died inside me, but the love lives on. It broke my heart for her to go. I love her, I need her like she’ll never know.” If infertility and/or pregnancy loss have ever been downplayed as a less significant human loss, Tsigdinos, Malavé, and Douglas legitimize the profound aftershocks of devastation experienced by those affected. From my personal and professional experience, I want you to know that the takeover is part of the journey. Well- meaning partners and friends might advise you to find a hobby to try to get your mind off of it, to relax, but that probably won’t help. It IS where you are right now, and that’s okay. Most people will be uncomfortable with your discomfort, and you’ll likely receive your fair share of unsolicited and unhelpful advice. Being the recipient of said advice, I tried to remind myself to listen to their intentions, not words. Week after week, clients that struggled with infertility would say something like – “These next few weeks I want to focus on my work and getting back into exercise” or “I want to start hanging out with my friends again and expanding my social circle.” We would set vague or concrete goals, depending on the client, and vow to focus on balance and self-care. And then, week after week, these same clients would come in ashamed, embarrassingly admitting that even if they did go to the gym or see an old friend, the ghost of infertility haunted them. They wanted to be more present in the here-and-now, they really did. Although I truly believe the takeover must run its course, there may be some coping skills and strategies to help it along. And I’m certain that whatever I tell you won’t always work. Some days the takeover will allow some wiggle room to remember the other aspects of your life; other days – it won’t. If you’ve felt quite low more days than not, and for an extended period of time, please check it out with a doctor. I will share with you the most salient professional (and personal) guidance here, and hope that on a few days, it might help. But please, don’t beat yourself up if it doesn’t. Honor the takeover, but also look for windows where you can see the larger picture. 1. Do something that has direct, observable results. You likely have felt powerless for a while. I want to you to do something, no matter how simple, where you can see results. Start with something easy. Make your bed. If you feel relatively competent cooking, use a recipe to create something, then share it with someone. Plant something that you can watch grow. Start with a plant that’s native and more likely to survive; you do not need a failure right now. Rearrange furniture in your space; a new look often evokes new feelings. 2. Practice Self-Compassion Breaks. I adopted this idea from the lovely Dr. Kristin Neff, a self-compassion researcher and professor from my town in Austin, Texas. Here’s the step-by-step process: a) When you notice that the Take Over has happened, say to yourself: “This is a moment of suffering” or “This hurts.” (It may help to place one hand over your heart = self-soothing gesture) b) Then say, “Suffering is a part of life.” c) Then, “May I give myself the compassion or understanding that I need right now.” Then breathe in and out, consciously and with intention. 3. Mindfulness (paying attention on purpose) is an Eastern practice, but its application has hit Western shores, and I’m a firm believer that it’s a necessary healing tool in your toolbox. You can become a conscious consumer of your mind, observing with a curious and gentle sense what’s going on in there. None of us would believe that a face cream could make us look a certain way after a few applications. However, we often experience our thoughts as facts, then experience powerful emotions as a result. It’s important to get some space from our thoughts, and see them for what they are – potentially unhelpful narratives. Use the letters N-N-R to remember the steps: a) Notice. Your mind is an active, interesting narrator that tries to piece information together but often falls short. Become a neutral, curious observer of your mind. Think of it as a radio, always playing music (some songs on repeat). b) Name (thoughts, feelings, body sensations, urges). For example, you may be ruminating (circular thinking that goes nowhere except down) something like “It’s not fair Tamara is pregnant. She didn’t even want another baby” and so on. As soon as you notice you’re stuck on a loop, say to yourself – “That’s a thought” You may notice tightness in your chest. Ask yourself what your feeling. Then say, “I’m having a feeling of sadness.” Noticing and naming gives you critical space to honor what’s going on with you without letting it suck you in automatically. c) Re-engage: Get back to what you were doing before you got caught in the loop. Re-engage in the moment. 4. Make a playlist or soundtrack for various themes throughout your fertility/infertility journey. For example, weeks before my 2nd I.V.F. transfer, I made a compilation of uplifting songs, burned them on a CD that I titled “Hope,” and played it every chance I got. A week after my first miscarriage, I made another playlist, calling it “Coping.” These songs were instrumental in helping me process the often contradictory emotions I experienced. Your body’s limitations don’t define you. Focus on what your body CAN do for you right now. Can you walk, jog, skip, hop, swim, or hug someone? It’s easy and completely understandable to get caught on a failure-loop narrative. But you’re not a failure. This is your roadblock, your life challenge, your grief and sorrow, your call to action. Answer the call, my friends. Above all, be patient with yourself. You are not alone. (Originally written September 2017; Revised September 2020) Dr. Sarah Rivers Deal is an Austin-based licensed professional counselor that specializes in infertility and reproductive trauma. She’s a member of the American Society for Reproductive Medicine (ASRM) and has participated in numerous trainings on infertility counseling and perinatal loss.
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