Postpartum Depression and Anxiety: Signs, Scary Thoughts and Getting Help

Baby blues or something more?

• Baby blues: tearful, moody, overwhelmed, often peaking around days 3-5. Up to about 4 in 5 birthing parents get them. They ease on their own within about 2 weeks.
• Perinatal depression and anxiety: last longer than 2 weeks, get worse, or make it hard to get through the day. They affect about 1 in 7 birthing parents (up to 1 in 5 in some estimates) and about 1 in 10 partners, including dads and adoptive parents.
• They can start in pregnancy or any time in the first year, not only right after birth.
• Higher risk with past depression or anxiety, a hard birth, a NICU stay, feeding struggles, little support, money stress or a history of trauma. But it can happen to anyone.

What it can feel like

• Depression: sadness, numbness or emptiness; losing interest; feeling like a bad parent or a burden; hopelessness; crying a lot; not feeling connected to the baby.
• Anxiety: constant worry, racing thoughts, a tight chest, not being able to sleep even when the baby sleeps, checking the baby again and again.
• Irritability or rage, appetite changes, trouble concentrating, pulling away from people.
• Partners may show it more as anger, working longer hours, drinking or withdrawing.

Scary thoughts and postpartum OCD

• Sudden, unwanted thoughts or images of the baby being hurt (dropping them, an accident, even harming them) are very common, especially with anxiety or OCD.
• When the thoughts horrify you and you avoid things because of them, that is a sign of anxiety, not danger. They don't mean you want to act or that you will.
• Tell your provider. They've heard it before, it is treatable, and saying it does not mean your baby will be taken away.

Postpartum psychosis is different

• Rare (about 1-2 in 1,000 births), usually in the first few weeks. It's a medical emergency.
• Signs: confusion, seeing or hearing things others don't, paranoid or strange beliefs, barely sleeping yet feeling wired, rapid mood swings, the person seeming not themselves.
• The person may not realize they're unwell, so family often needs to act. Call 911; don't leave them alone with the baby.

Screening and treatment

• Your OB or midwife should ask about mood in pregnancy and after birth. Pediatricians often ask the birthing parent too, at checkups in the first 6 months, often with a short questionnaire called the EPDS. Answer honestly; it opens the door to help.
• Treatment works, and the sooner the better: talk therapy (such as CBT or interpersonal therapy), peer support groups, help with sleep and practical support.
• Medicines: several antidepressants are commonly used in pregnancy and while breastfeeding. Newer medicines made specifically for postpartum depression also exist, such as zuranolone, a short course of pills. Ask your provider which fits, including how it works with feeding.
• Protecting one 4-5 hour stretch of sleep can make a real difference.

How partners, family and friends can help

• Notice and name it gently: "You don't seem like yourself. Can we call your doctor together?"
• Take night shifts, handle meals and visitors, and make the appointment for them.
• Listen without fixing or judging. Don't say "but you have a healthy baby".
• Check on yourself too. See the self-care for parents guide.

Where to get support (US)

• National Maternal Mental Health Hotline: call or text 1-833-852-6262 (1-833-TLC-MAMA). Free, confidential, 24/7, in English and Spanish.
• Postpartum Support International helpline: 1-800-944-4773, for support and finding local help, plus free online groups and a provider directory. It isn't a crisis line; in a crisis use 988 or 911.
• 988 Suicide & Crisis Lifeline: call or text 988.

When to check in

Get help now if:

• You have thoughts of harming yourself or your baby, or of not wanting to be alive: call or text 988, or call 911.
• Someone shows signs of psychosis (confusion, hallucinations, paranoia, not sleeping for days): call 911 and stay with them.
• You can't care for yourself or the baby, or can't eat or sleep for days: call your provider today.