Many women have the baby blues after childbirth. If you have the baby blues, you may have mood swings, feel sad, anxious or overwhelmed, have crying spells, lose your appetite, or have trouble sleeping. The baby blues most often go away within a few days or a week. The symptoms are not severe and do not need treatment.

The symptoms of postpartum depression last longer and are more severe. You may also feel hopeless and worthless, and lose interest in the baby. You may have thoughts of hurting yourself or the baby. Very rarely, new mothers develop something even more serious. They may have hallucinations or try to hurt themselves or the baby. They need to get treatment right away, often in the hospital.

Postpartum depression can begin anytime within the first year after childbirth. The cause is not known. Hormonal and physical changes after birth and the stress of caring for a new baby may play a role. Women who have had depression are at higher risk.

If you think you have postpartum depression, tell your health care provider. Medicines, including antidepressants and talk therapy can help you get well.

“Postpartum” means the time after childbirth. Most women get the “baby blues,” or feel sad or empty, within a few days of giving birth. For many women, the baby blues go away in 3 to 5 days. If your baby blues don’t go away or you feel sad, hopeless, or empty for longer than 2 weeks, you may have postpartum depression. Feeling hopeless or empty after childbirth is not a regular or expected part of being a mother.

Postpartum depression is a serious mental illness that involves the brain and affects your behavior and physical health. If you have depression, then sad, flat, or empty feelings don’t go away and can interfere with your day-to-day life. You might feel unconnected to your baby, as if you are not the baby’s mother, or you might not love or care for the baby. These feelings can be mild to severe.

Mothers can also experience anxiety disorders during or after pregnancy.

Many women have the baby blues in the days after childbirth. If you have the baby blues, you may:

• Have mood swings
• Feel sad, anxious, or overwhelmed
• Have crying spells
• Lose your appetite
• Have trouble sleeping

The baby blues usually go away in 3 to 5 days after they start. The symptoms of postpartum depression last longer and are more severe. Postpartum depression usually begins within the first month after childbirth, but it can begin during pregnancy or for up to a year after birth.

Postpartum depression needs to be treated by a doctor or nurse.

Depression is a common problem after pregnancy. One in 9 new mothers has postpartum depression.

Yes. You may be more at risk of postpartum depression if you:

• Have a personal history of depression or bipolar disorder
• Have a family history of depression or bipolar disorder
• Do not have support from family and friends
• Were depressed during pregnancy
• Had problems with a previous pregnancy or birth
• Have relationship or money problems
• Are younger than 20
• Have alcoholism, use illegal drugs, or have some other problem with drugs
• Have a baby with special needs
• Have difficulty breastfeeding
• Had an unplanned or unwanted pregnancy

The U.S. Preventive Services Task Force recommends that doctors look for and ask about symptoms of depression during and after pregnancy, regardless of a woman’s risk of depression.

Hormonal changes may trigger symptoms of postpartum depression. When you are pregnant, levels of the female hormones estrogen and progesterone are the highest they’ll ever be. In the first 24 hours after childbirth, hormone levels quickly drop back to normal, pre-pregnancy levels. Researchers think this sudden change in hormone levels may lead to depression. This is similar to hormone changes before a woman’s period but involves much more extreme swings in hormone levels.

Levels of thyroid hormones may also drop after giving birth. The thyroid is a small gland in the neck that helps regulate how your body uses and stores energy from food. Low levels of thyroid hormones can cause symptoms of depression. A simple blood test can tell whether this condition is causing your symptoms. If so, your doctor can prescribe thyroid medicine.

Other feelings may contribute to postpartum depression. Many new mothers say they feel:

• Tired after labor and delivery
• Tired from a lack of sleep or broken sleep
• Overwhelmed with a new baby
• Doubts about their ability to be a good mother
• Stress from changes in work and home routines
• An unrealistic need to be a perfect mom
• Grief about loss of who they were before having the baby
• Less attractive
• A lack of free time

These feelings are common among new mothers. But postpartum depression is a serious health condition and can be treated. Postpartum depression is not a regular or expected part of being a new mother.

Some normal changes after pregnancy can cause symptoms similar to those of depression. Many mothers feel overwhelmed when a new baby comes home. But if you have any of the following symptoms of depression for more than 2 weeks, call your doctor, nurse, or midwife:

• Feeling restless or moody
• Feeling sad, hopeless, or overwhelmed
• Crying a lot
• Having thoughts of hurting the baby
• Having thoughts of hurting yourself
• Not having any interest in the baby, not feeling connected to the baby, or feeling as if your baby is someone else’s baby
• Having no energy or motivation
• Eating too little or too much
• Sleeping too little or too much
• Having trouble focusing or making decisions
• Having memory problems
• Feeling worthless, guilty, or like a bad mother
• Losing interest or pleasure in activities you used to enjoy
• Withdrawing from friends and family
• Having headaches, aches and pains, or stomach problems that don’t go away

Some women don’t tell anyone about their symptoms. New mothers may feel embarrassed, ashamed, or guilty about feeling depressed when they are supposed to be happy. They may also worry they will be seen as bad mothers. Any woman can become depressed during pregnancy or after having a baby. It doesn’t mean you are a bad mom. You and your baby don’t have to suffer. There is help. Your doctor can help you figure out whether your symptoms are caused by depression or something else.

Call your doctor, nurse, midwife, or pediatrician if:

• Your baby blues don’t go away after 2 weeks
• Symptoms of depression get more and more intense
• Symptoms of depression begin within 1 year of delivery and last more than 2 weeks
• It is difficult to work or get things done at home
• You cannot care for yourself or your baby (e.g., eating, sleeping, bathing)
• You have thoughts about hurting yourself or your baby

Ask your partner or a loved one to call for you if necessary. Your doctor, nurse, or midwife can ask you questions to test for depression. They can also refer you to a mental health professional for help and treatment.

The common types of treatment for postpartum depression are:

• Therapy. During therapy, you talk to a therapist, psychologist, or social worker to learn strategies to change how depression makes you think, feel, and act.

• Medicine. There are different types of medicines for postpartum depression. All of them must be prescribed by your doctor or nurse. The most common type is antidepressants. Antidepressants can help relieve symptoms of depression and some can be taken while you're breastfeeding. Antidepressants may take several weeks to start working.

  The Food and Drug Administration (FDA) has also approved a medicine called brexanolone to treat postpartum depression in adult women. Brexanolone is given by a doctor or nurse through an IV for 2½ days (60 hours). Because of the risk of side effects, this medicine can only be given in a clinic or office while you are under the care of a doctor or nurse. Brexanolone may not be safe to take while pregnant or breastfeeding.

  Another type of medicine called esketamine can treat depression and is given as a nasal (nose) spray in a doctor's office or clinic. Esketamine can hurt an unborn baby. You should not take esketamine if you are pregnant or breastfeeding.

• Electroconvulsive therapy (ECT). This can be used in extreme cases to treat postpartum depression.

These treatments can be used alone or together. Talk with your doctor or nurse about the benefits and risks of taking medicine to treat depression when you are pregnant or breastfeeding.

Having depression can affect your baby. Getting treatment is important for you and your baby. Taking medicines for depression or going to therapy does not make you a bad mother or a failure. Getting help is a sign of strength.

Here are some ways to begin feeling better or getting more rest, in addition to talking to a health care professional:

• Rest as much as you can. Sleep when the baby is sleeping.
• Don’t try to do too much or to do everything by yourself. Ask your partner, family, and friends for help.
• Make time to go out, visit friends, or spend time alone with your partner.
• Talk about your feelings with your partner, supportive family members, and friends.
• Talk with other mothers so that you can learn from their experiences.
• Join a support group. Ask your doctor or nurse about groups in your area.
• Don’t make any major life changes right after giving birth. More major life changes in addition to a new baby can cause unneeded stress. Sometimes big changes can’t be avoided. When that happens, try to arrange support and help in your new situation ahead of time.

It can also help to have a partner, a friend, or another caregiver who can help take care of the baby while you are depressed. If you are feeling depressed during pregnancy or after having a baby, don’t suffer alone. Tell a loved one and call your doctor right away.

Approximately 1 in 9 women in the United States experiences symptoms of postpartum depression, according to the Centers for Disease Control and Prevention. Now, the U. S. Food and Drug Administration (FDA) has approved brexanolone, an analog of the endogenous human hormone allopregnanolone and the first drug specifically designed to treat postpartum depression.

Some psychiatric drugs owe their discovery to chance – serendipitous observations of clinical benefit – or a process of incremental improvement based on drugs previously discovered by chance. Not so with brexanolone, which has a truly novel mechanism of action and was developed by design, thanks to a series of basic and translational neuroscience studies. FDA approval represents the final phase of a bench-to-bedside journey for this drug — a journey that began in the NIMH Intramural Research Program (IRP).

In the 1980s, NIMH IRP researchers discovered that metabolites (products formed when the body breaks down or “metabolizes” other substances) of the steroid hormones progesterone and deoxycorticosterone bound to and acted upon receptors for gamma-aminobutyric acid (GABA)—a major inhibitory neurotransmitter in the brain. These steroids were found to amplify GABA-activated chloride ion currents, thereby impacting the excitability of neurons.

This finding led to a series of studies, completed by researchers in the NIMH IRP and by researchers at institutions funded by NIMH, that clarified how these metabolites fluctuate during times of stress and during the estrous cycle in rats and the menstrual cycle in humans. Research indicated that the concentration of one of these metabolites (allopregnanolone) increases during pregnancy, but then drops after birth. In some women, this drop triggers the development of depression and anxiety.

A biopharmaceutical company utilized these basic research findings to develop brexanolone, a drug that can be used to treat postpartum depression by restoring levels of this metabolite. Successful clinical trials have led to FDA approval of an injectable version of this drug.

Untreated postpartum depression can affect your ability to parent. You may:

• Not have enough energy
• Have trouble focusing on the baby's needs and your own needs
• Feel moody
• Not be able to care for your baby
• Have a higher risk of attempting suicide

Feeling like a bad mother can make depression worse. It is important to reach out for help if you feel depressed.

Researchers believe postpartum depression in a mother can affect her child throughout childhood, causing:

• Delays in language development and problems learning
• Problems with mother-child bonding
• Behavior problems
• More crying or agitation
• Shorter height and higher risk of obesity in pre-schoolers
• Problems dealing with stress and adjusting to school and other social situations

Mothers with postpartum depression can usually continue to breastfeed. Healthcare providers should work with mothers to ensure they receive appropriate treatment, support, and medications that are safe to use while breastfeeding.

Is there an association between breastfeeding and postpartum depression?

There is insufficient evidence on whether breastfeeding is associated with postpartum depression. In particular, the direction of the relationship between breastfeeding and higher or lower rates of depression is unclear. According to a 2018 systematic review by the Agency for Healthcare Research and Quality (AHRQ), “Elucidating the relationship between breastfeeding and postpartum depression is challenging, because women with depression may have difficulty initiating and sustaining breastfeeding, and women who experience breastfeeding difficulties may develop depression” (p. 107).

Are antidepressant medications safe to take while breastfeeding?

Maybe. Although many medications do pass into breast milk, most have little or no effect on milk supply or on infant well-being. When discussing medications it is important for the healthcare provider to ask a mother about whether she is breastfeeding. Together they can decide which medications are right for her and safe to use while breastfeeding.

Can a mother experiencing postpartum depression continue to breastfeed?

Usually. While some mothers experience positive feelings from breastfeeding, others may not. Healthcare providers can work with mothers to address depression in a timely manner and to help them reach their breastfeeding goals. Healthcare providers can talk to mothers about treatment options for depression including medications and non-pharmacological options (e.g., individual or group therapy) and assist mothers in accessing professional breastfeeding support as needed.

Postpartum psychosis is rare. It happens in up to 4 new mothers out of every 1,000 births. It usually begins in the first 2 weeks after childbirth. It is a medical emergency. Women who have bipolar disorder or another mental health condition called schizoaffective disorder have a higher risk of postpartum psychosis. Symptoms may include:

• Seeing or hearing things that aren’t there
• Feeling confused most of the time
• Having rapid mood swings within several minutes (for example, crying hysterically, then laughing a lot, followed by extreme sadness)
• Trying to hurt yourself or your baby
• Paranoia (thinking that others are focused on harming you)
• Restlessness or agitation
• Behaving recklessly or in a way that is not normal for you