Symptoms and Diagnosis of Postpartum Depression

Postpartum depression is a mental health disorder affecting as many as one in nine new mothers. It’s more common than most of us realize. Yet there is still a strong stigma surrounding postpartum depression (PPD), which often makes mothers feel ashamed about sharing the symptoms they are experiencing and getting the help they need to feel better.

Knowledge is power here. Understanding what postpartum depression is—what it really feels like to experience it—is the first step toward recognizing that you have a problem.It’s also valuable to understand how postpartum depression is diagnosed and what happens when you make that first brave step toward feeling better.

Signs and Symptoms

Postpartum depression is a perinatal mood disorder experienced by mothers in the first 12 months after having a baby and is usually diagnosed after you have experienced symptoms for two weeks or more. Some women may experience a common perinatal mood disorder while pregnant called prenatal depression or antepartum depression.

There are several different perinatal mood and anxiety disorders. These include postpartum anxiety, postpartum obsessive-compulsive disorder (OCD), and PPD. A less common, but more severe perinatal mood disorder is postpartum psychosis, which is considered a medical emergency and usually requires hospitalization.

Postpartum Blues vs. Postpartum Depression

It is estimated that 50% to 80% of new mothers experience “postpartum blues” after having a baby. But postpartum blues are not the same thing as postpartum depression.

Although the symptoms of postpartum blues—moodiness, trouble sleeping, weepiness, feelings of anxiety, and changes in appetite—are similar to the symptoms of postpartum depression, it’s important to understand what distinguishes postpartum blues from postpartum depression:

• Mothers who experience postpartum blues generally have less severe symptoms that don’t interfere with their ability to function or care for themselves or their babies.
• Postpartum blues usually last for a few days and are intermittent.
• Postpartum blues are limited to the first two weeks postpartum.

Physical Symptoms

Postpartum depression isn’t just about feeling anxious or sad. Sometimes the first signs of postpartum depression are physical in nature. Physical symptoms may include:

• Changes in hunger (eating less or more)
• Inability to concentrate
• Inability to fall asleep or stay asleep
• Racing thoughts and rapid heart-rate
• Tightness in the chest, nausea, and digestive issues

Emotional Symptoms

Postpartum depression is more than a “sad” feeling. Many mothers experience anxiety or anger along with depressed feelings. Emotional symptoms may include:

• Agitation
• Excessive, obsessive worry
• Feeling a sense of dread
• Feeling disconnected from everyone around you
• Feelings of worthlessness
• Feeling “trapped” in your life
• Guilt
• Intense mood swings
• Lack of interest in the basics of self-care
• Long crying spells
• Rage
• Suicidal ideation
• Wanting to escape from your life
• Wanting to withdraw from family and friends
• Worrying that you are going to feel this way forever

How You Might Feel About Your Baby

Some of the scariest symptoms of postpartum depression can include unsettling thoughts about your baby or about being a mom. These are common for mothers who are experiencing postpartum depression and may include:

• Convincing yourself that you don’t love your baby and then feeling extremely guilty about this
• Feeling afraid to be alone with your baby
• Feeling like you can’t bond with your baby
• Feeling obsessively worried about something happening to your baby
• Thinking you are completely failing as a mom and don’t know what you’re doing
• Thoughts of harming your baby

Postpartum Psychosis

Postpartum psychosis is a very rare, but extremely serious variant of bipolar disorder. About one or two of every 1000 postpartum mothers experiences postpartum psychosis. Symptoms usually present themselves within four weeks after childbirth, and as early as 48 to 72 hours postpartum. Symptoms of postpartum psychosis may include:

• Displaying erratic behavior
• Distrusting others
• Experiencing visual hallucinations
• Feeling agitated, restless, and irritable
• Feeling confused
• Having alternating feelings of extreme elation and depression
• Having thoughts of harming yourself or your baby
• Hearing voices (auditory hallucinations)
• Refusing to eat
• Sleeping very little or being unable to sleep

The good news is that postpartum psychosis is treatable and doesn’t last forever. However, it is considered a medical emergency and requires immediate treatment.

Obstacles to Diagnosis

The first step in getting help for postpartum depression is recognizing the symptoms and understanding that there is nothing wrong with seeking care. Postpartum depression is not something you did to yourself: It is a medical condition, and it is very treatable. You are not broken, and you will be OK.

Still, many mothers and their loved ones are unfamiliar with the process for getting a diagnosis of postpartum depression. They also wonder who the best professionals are to help you navigate the process and where to go after a diagnosis.

How to Get Help

If you think you have postpartum depression, the best thing you can do is seek help right away. Postpartum depression can be diagnosed and treated anytime during the first year after childbirth, but the earlier you seek treatment, the better—and the sooner you will feel like yourself again.

Your healthcare provider will likely ask you questions about your mood during a postpartum check-up and have you take a postpartum depression survey to ascertain whether you have symptoms of postpartum depression or have a risk of developing it. Sometimes this is how you will begin the process of getting a formal diagnosis of postpartum depression.

But sometimes the symptoms of postpartum depression present themselves before or after these check-ups.

Postpartum Depression Guide

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

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Even if you have been screened for postpartum depression previously, don’t hesitate to reach out if you think you are experiencing symptoms of postpartum depression right now. Not all cases of postpartum depression happen within the first six weeks postpartum when most mothers are screened. Plus, each case of postpartum depression is unique.

Diagnosis

If you think you have postpartum depression, you will want to consult a medical professional to get a proper diagnosis. You can make an appointment with your doctor, usually an internist or your OB-GYN. Mental health professionals like psychiatrists also diagnose postpartum depression.

Here’s what might happen during the diagnosis:

• Many doctors test for anemia and thyroid issues, as well as medical conditions that may contribute to or be mistaken for postpartum depression.
• Usually, your healthcare provider will start by asking you some questions about your symptoms, including what they are like, how severe they are, whether they are interfering with your ability to function or care for your baby, and how long your symptoms have lasted.
• Your doctor also may do a physical exam, take down your medical history, and order blood work.

Screening Tools for Postpartum Depression

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) includes criteria for diagnosing postpartum depression and characterizes it as a depressive episode that is identified during pregnancy or within the first four weeks after giving birth. However, most experts think this is too narrow a definition, and agree that postpartum depression can be diagnosed within one year of giving birth.

Most doctors and clinicians use a more comprehensive diagnostic tool that is more specific to postpartum mothers than the DSM criteria. For example, the American College of Obstetricians and Gynecologists (ACOG) recommend using a tool such as The Edinburgh Postnatal Depression Scale (EPDS) to screen new moms for postpartum depression.

The EPDS consists of 10 diagnostic questions and takes mothers about five minutes to complete. Many OB-GYNs use a questionnaire like this at a mom’s postpartum check-up, which generally occurs at six weeks postpartum.

A Word From Verywell

If you think you might be experiencing postpartum depression, it’s easy to feel like you are completely alone. You might see other mothers seemingly adjusting smoothly to new motherhood, and it may feel like everyone has it together but you. The truth is, every new mother struggles, but for some of us, the challenges associated with new motherhood are complicated by postpartum depression.

Remember, you are not alone. You are stronger than you know. And if you think you may have symptoms of postpartum depression, don’t hesitate to reach out. Help is only a phone call away—and your healthcare providers and loved ones are ready and willing to help you navigate this process. Your mental health is as important as anything else in your life right now, and you deserve to feel better.