Causes and Risk Factors of Postpartum Depression

If you’ve been newly diagnosed with postpartum depression, or if you suspect you are experiencing it, you will naturally be filled with many questions: Why is this happening to me? Where did this come from? You may even start to blame yourself for your postpartum depression, wondering what you did wrong and whether or not you could have prevented it.

Postpartum depression is common—as many as 1 in 9 new moms experience it—and while some people are more vulnerable to getting it, there is no one single thing that causes it. Not only that, but many of the causes and risk factors are not something you could have caused yourself.

All that said, it can be illuminating to understand what causes postpartum depression, what the risk factors are—and maybe most importantly, what steps you may be able to take to prevent it in future pregnancies.

Causes of Postpartum Depression

Experts agree that there is not one thing that causes postpartum depression, but multiple factors taken together that can trigger it. Sometimes, you and your doctor or therapist will be able to understand what these causes are for you; other times, it may remain somewhat of a mystery. Either way, you should know that there is nothing you did specifically to cause your depression.

Hormonal Causes

After you give birth and in the weeks that follow, your body goes through many changes in quick succession. Some of these can contribute to postpartum depression.

Estrogen and Progesterone Hormone Shifts

Your hormone levels change dramatically after giving birth. During pregnancy, your body’s levels of estrogen and progesterone are extremely high. Within the first few days after birth, they quickly drop. It’s similar to the hormone changes that happen during PMS, only more intense. Researchers have surmised that some women are more susceptible to these after-birth hormone shifts than others.

Thyroid Hormone Shifts

In addition to estrogen and progesterone, your levels of thyroid hormones may dip after birth. If the dip is sharp, you may end up experiencing symptoms of fatigue, sluggishness, and depressed mood. Thankfully, issues with your thyroid can be corrected with medication, so if you suspect that thyroid issues are contributing to your depression, speak to your doctor about your options.

Lifestyle Changes

So much changes after you have a baby! While it’s normal to feel overwhelmed and exhausted postpartum, sometimes the experiences of dealing with a newborn can take a toll on your mental health and lead to symptoms of postpartum depression.

This is especially true if you are facing adverse circumstances, such as an absent or unsupportive partner, are experiencing a general lack of a support network, are caring for a medically fragile baby, or are recovering from a traumatic birth.

But the stress of having a new baby can be difficult for anyone, no matter the circumstances. Here are some of the postpartum lifestyle changes that can trigger postpartum depression:

• Fatigue and depletion from childbirth
• Exhaustion and sleep deprivation associated with caring for a new baby
• Changes in identity
• Uncertainty and lack of confidence in your ability to be a mother
• Pressure to be a “perfect mother” or have a “good” baby
• Overwhelming feelings about all your new responsibilities
• Stress from trying to balance baby care with other responsibilities such as housework
• Stress about returning to work, securing childcare, and separating from your baby

Causes of Postpartum Psychosis

Postpartum psychosis is a severe, but very rare perinatal mood disorder, a variant of bipolar. It is characterized by mania (extreme mood swings) and delusions (hallucinations and “hearing voices,” for example). Postpartum psychosis is considered a medical emergency. Although experts aren’t sure what causes it, there are some theories, including:

• A family history of mental illness and mental health issues
• A family history of postpartum psychosis
• A history of postpartum psychosis with a previous baby
• A previous or current diagnosis of bipolar disorder or schizophrenia
• A difficult pregnancy
• A traumatic birth

Risk Factors for Postpartum Depression

Any new mom is at risk for postpartum depression; postpartum depression doesn’t discriminate. You can develop symptoms regardless of your socioeconomic status, your race, how many children you have, and whether you have a history of mental illness.

At the same time, there are certain factors that may increase your risk of developing postpartum depression, including:

• A previous experience of postpartum depression
• A history of depression or other mental illness
• A family member who had clinical depression or postpartum depression
• An experience of depression during pregnancy, or prepartum depression
• Recent life stresses
• Problems in your marriage or partnership
• Lack of a support system or support networks
• A complicated or difficult pregnancy
• A recent job loss, financial strain, or financial stress
• Parenting a baby who is sick, has health issues, or other special needs
• Birthing multiples (twins, triplets, etc.)
• Particularly difficult breastfeeding challenges
• Increased stress about childcare and/or returning to work
• A baby with a difficult temperament, such as a baby with colic
• An unplanned pregnancy

Can You Prevent Postpartum Depression?

If you have had a history of postpartum depression or you are pregnant and you know you have one more more of the risk factors, you may be wondering if there is anything you can do to decrease your chances of developing postpartum depression—or at least mitigate the risk.

Keep in mind that everyone is different, so you should discuss what measures it makes sense for you to take with your doctor, midwife, therapist, or other trusted healthcare provider. It’s recommended that you come up with a plan before you are pregnant, if you know you are prone to postpartum depression.

During Pregnancy

Often, episodes of postpartum depression develop during pregnancy, so it makes sense to work with your doctor to monitor your symptoms. This may include regular check-ins about your mental health. Your doctor may even have you take one or several depression screenings during pregnancy. If you are showing signs of serious depression, your healthcare provider may recommend therapy, depression support groups, and possibly anti-depressants.

After Delivery

If you have a history of depression or postpartum depression, your healthcare provider should screen you early and often for symptoms of postpartum depression. Many providers only do a postpartum depression screening at the six week postpartum visit. But if you have risk factors, you should receive this screening earlier, and possibly more than once.

If you have a history of severe depression, your doctor may suggest you remain on an anti-depressant (SSRI) if you are already taking one, or start one during or after pregnancy if you are experiencing symptoms of depression. If you are concerned about taking anti-depressants while breastfeeding, discuss your options with your doctor.

Be assured that nearly all SSRIs are compatible with breastfeeding. It's important for you to be healthy and happy not only for yourself, but also for your baby. Studies have shown that women who are depressed are less likely to breastfeed, and if they do so, are unlikely to continue for as long as they would have if they were feeling better. Treating depression increases the chances of successful breastfeeding.

Postpartum Depression Guide

Get our printable guide to help you ask the right questions at your next doctor's appointment.

Download PDF

Get daily parenting tips and judgment-free news in your inbox from our friends at Parents.

Sign Up

You're in!

Thank you, {{form.email}}, for signing up.

There was an error. Please try again.

Preventing Postpartum Psychosis

If you have a history of bipolar disorder, schizophrenia, or a history of postpartum psychosis, your healthcare provider may also urge a proactive approach here. A 2018 study published in the International Journal of Bipolar Disorders suggests that lithium therapy for bipolar disorder can be started immediately after delivery to prevent relapse. This strategy is also recommended for moms with a history of postpartum psychosis.

There is some controversy as to whether lithium is safe for breastfeeding mothers. You should discuss your concerns with your psychiatrist. Most psychiatrists do not recommend breastfeeding on lithium for several reasons, including to protect the parent's sleep and thus reduce the risk of relapse of illness. But this should be decided on a case-by-case basis.

You can also consult Lactmed, a government sponsored database that lists different medications along with the available research about their safety during breastfeeding.

A Word From Verywell

Learning more about what causes postpartum depression can be comforting and educational for moms who are battling it. It can help you understand what factors may have contributed to your postpartum depression—and it can help you see that many of these factors were out of your control.

If you are unsure of what may have caused your postpartum depression, you can ask your doctor for some insight, or connect to a therapist who can talk you through your particular triggers. This will not only help you reflect on your experience and begin to understand it better, but it can also help you pinpoint what measures you might consider taking in the future to prevent new episodes of postpartum depression.