Postpartum depression symptoms: When is it more than the “baby blues?”

Postpartum depression symptoms overlap with symptoms of the “baby blues,” the mood swings that mothers experience in the first few days after childbirth. But when symptoms persist beyond two weeks — or take a more severe turn — it’s time to get screened for depression. Here’s what to look for.

depressed mother with infant in foreground

Baby blues — also called “maternity blues” — are a common experience in the first few days after childbirth. All around the world — from Brazil to Hong Kong to Nigeria to Germany — between 33 to 55% of women report feeling moody, vulnerable and stressed in the first few days after childbirth (Faisal-Cury et al 2008; Hau and Levy 2003; Adewuya 2005; Reck et al 2015).

Is this postpartum depression?

The psychiatric profession tends to view baby blues as something different. Maybe that’s because the baby blues are closely linked with the physical exhaustion and rapid hormonal changes that follow childbirth, and because women often experience improvements by two weeks postpartum. But if you dig deeper, several points are clear.

1. The symptoms of the baby blues and postpartum depression are pretty much the same, and largely overlap with the symptoms of depression that women experience outside the context of childbirth (Hoertel et al 2015).

2. Some women experience severe postpartum depression symptoms during the first two weeks — symptoms that seriously impact their ability to function (Gonidakis et al 2007).

3. Women who experience baby blues during the first two weeks are more likely, at a later time point, to get diagnosed with postpartum depression (Reck et al 2009).

So it seems that the baby blues and postpartum depression are part of a continuum, with the term “baby blues” implying, “We think there’s a good chance your symptoms will improve soon, as your body recovers from the chemical and physical effects of childbirth.”

This happens for some women with the baby blues, but not for others. Their symptoms persist. And for some mothers, postpartum depression doesn’t have baby blues as a prequel. Although they don’t report experiencing the baby blues in the early days postpartum, they end up developing postpartum depression months later (Wisner et al 2013). So what are the key symptoms?

Postpartum depression symptoms

  • sadness
  • fatigue, or a decrease of energy
  • impaired concentration and decision making
  • the inability to feel pleasure
  • a tendency to blame yourself; feelings of guilt or worthlessness
  • sleep disturbances
  • agitation or restlessness
  • appetite disturbances or weight loss
  • recurring thoughts of self-harm

These are the nine symptoms of depression recognized by the American Psychiatric Association (2013). This organization stipulates that you need to experience at least 5 of them, on a nearly daily basis, to rate a diagnosis of depression.

In addition, some researchers note that sufferers might experience a sense of being overwhelmed or unable to cope well. And new moms may report symptoms of other perinatal mood disorders, including postpartum anxiety and postpartum obesssive-compulsive disorder, or OCD (Ali 2018; Field 2018). 

Does sleep deprivation cause postpartum depression?

It certainly seems to be a contributing factor. For example, when researchers reviewed 31 relevant studies, they found evidence that women who perceive poor sleep are more likely to develop symptoms of postpartum depression (Lawson et al 2015). And research using objective measures of sleep are suggestive.

In one study, researchers monitored the sleep of 112 new mothers using wrist actigraphs — “fitbit”-like devices that provide an objective estimate of time spent sleeping. The researchers found that the total number of hours slept didn’t predict who would develop postpartum depression. But two other things did — naps, and whether or not parents got enough sleep between the crucial hours of midnight and 6 a.m.

Women who slept less than 4 hours between 12:00 p.m. and 6 a.m. were at increased risk for depression at 3 months postpartum. In addition, new mothers were at increased risk if napped for less than 60 minutes during the day.

How can you judge the frequency and severity of your symptoms?

A quick and easy way is to use the Edinburgh Postnatal Depression Scale, a 10 item multiple-choice questionnaire that asks you to think back over the past week (Cox et al 1987; Wisner et al 2002). Each item in the questionnaire presents a statement that you quantify with an answer — choosing whichever comes closest to representing your feelings over the last 7 days. For example, if you were presented with a statement like this:

“I have felt worthless or hopeless.”

You would choose whichever of the following answer choices came closest to representing your feelings over the last 7 days:

0 No, not at all

1 Hardly ever

2 Yes, sometimes

3 Yes, very often

As you can see, each answer choice is associated with a certain number of points. After you have answered all the questions, you tally up the points and see if they exceed a given threshold.

If they do, you have screened positive for postpartum depression. This isn’t the same as a diagnosis. A diagnosis is made by a qualified physician or therapist, using information that goes beyond the questionnaire. But it’s an indication that you have many of the signs.

Below, you will find a reproduction of the scale that you can use to test yourself. When calculating your score, please note that some questions are reverse-scored (with the top answer choice scored as a 3 and the bottom answer choice scored as a 0).

The Edinburgh Postnatal Depression Scale

In the past 7 days:

1. I have been able to laugh and see the funny side of things

0              As much as I always could

1              Not quite so much now

2              Definitely not so much now

3              Not at all

2. I have looked forward with enjoyment to things

0              As much as I ever did

1              Rather less then I used to

2              Definitely less than I used to

3              Hardly at all

3. I have blamed myself unnecessarily when things went wrong

3              Yes, most of the time

2              Yes, some of the time

1              Not very often

0              No, never

4. I have been anxious or worried for no good reason

0              No, not at all

1              Hardly ever

2              Yes, sometimes

3              Yes, very often

5. I have felt scared or panicky for no very good reason

3              Yes, quite a lot

2              Yes, sometimes

1              No, not much

0              No, not at all

6. Things have been getting on top of me

3              Yes, most of the time I haven’t been able to cope at all

2              Yes, sometimes I haven’t been coping as well

1              No, most of the time I have coped quite well

0              No, I have been coping as well as ever

7. I have been so unhappy that I have had difficulty sleeping

3              Yes, most of the time

2              Yes, sometimes

1              Not very often

0              No, not at all

8. I have felt sad or miserable

3              Yes, most of the time

2              Yes, quite often

1              Not very often

0              No, not at all

9. I have been so unhappy that I have been crying

3              Yes, most of the time

2              Yes, quite often

1              Only occasionally

0              No, never

10. The thought of harming myself has occurred to me

3              Yes, quite often

2              Sometimes

1              Hardly ever

0              Never

So what score is required to screen positive for postpartum depression?

There isn’t any universally accepted, magic number. Suggested cutoffs have ranged between 9 and 13 points, but a doctor may diagnose you with PPD even if you have a lower score. The Edinburgh Postnatal Depression Scale isn’t intended as a complete inventory of postnatal depression symptoms. Your doctor may decide you have additional symptoms or risk factors, and make his or her diagnosis accordingly.

And one question it does ask merits a closer look no matter what: Thoughts of violence or self-harm warrant a follow-up regardless of your overall score. If you are having a mental health emergency, call your local crisis center. People living in the United States can dial 988.

What about men? Can fathers get postpartum depression?

Fathers are subjected to many of the same stressful life changes that cause postpartum depression in women, so it’s not unusual for them to get depressed too. The latest studies suggest that somewhere between 7 and 10% of men experience at least some symptoms depression during the transition to parenthood (Cameron et al 2016). But their symptom profile may differ somewhat, with men being more likely than women to report increased indecisiveness, irritability, and emotional blunting (Scarff 2019). In addition, men are less likely than women to experience extreme postpartum changes, such as the development of a severe psychiatric disorder (Madsen et al 2022).

When do postpartum depression symptoms go away? 

That varies from person to person, but we know there are certain risk factors for prolonged bouts of depression. In one recent study, Sheehan Fisher and her colleagues tracked more than 500 women with postpartum depression, beginning at 4-8 weeks after childbirth. 

The good news? Approximately half the women experienced gradual improvements over time, reaching full remission by 12 months postpartum. But about 40% of the women were still at least mildly depressed at 12 months. And the remaining 8% showed a pattern of chronic, severe depression: Their symptoms worsened between childbirth and 3 months postpartum, and remained severe at 12 months postpartum (Fisher et al 2019). 

Were there any systematic differences between these women — risk factors that marked them from the beginning? Fisher’s team identified several:

  • Depression combined with anxiety. Women whose early symptoms included anxiety had about twice the odds of remaining depressed throughout the first year.
  • Physical abuse in adulthood. The odds were also doubled for women who had survived physical abuse as an adult. Childhood abuse was not linked with a heightened risk for long-term postpartum depression.
  • Chronic illness. Women struggling with chronic illness were more likely to suffer from postpartum depression at 12 months.
  • Having more than one child. For each additional child that a woman had, her risk of long-term depression was increased.
  • Global functioning (handling daily tasks, work, social relationships). The more difficulty women had with global functioning at the beginning of the study, the more likely they were to experience postpartum depression symptoms at 12 months.
  • Severity of symptoms. Sadly, severe postpartum depression symptoms in the early weeks increased the likelihood that a woman would experience continued, severe symptoms at 12 months.

But take heart. Even if you have all of these risk factors, that doesn’t mean the situation is hopeless. If you take action, and get help, you can improve. And the sooner the better. When Fisher’s team delved deeper into the data, they identified a telling pattern. Women who experience early, severe symptoms take longer to seek help (Fisher et al 2019).

So don’t be slow to discuss your symptoms with your medical provider. As I explain elsewhere, postpartum depression doesn’t just affect parents. It also affects our babies, putting them at risk for problems with emotional regulation, cognitive development, and disordered moods. But when parents get effective treatments — like cognitive behavioral therapy — infants tend to get back on track. You can read the details in my article, “Treating postpartum depression benefits babies.”

Are you or is someone you know in crisis? If you are in the United States, you can call the toll-free National Suicide Prevention Lifeline at 1-800-273-TALK (8255).

More information about coping during the postpartum phase

Looking for a discussion of the causes and treatments for postpartum depression? The National Institute of Mental Health provides this excellent fact sheet online, as well as these tips for talking to health care providers about your symptoms.

For additional, evidence-based information about the difficulties that new parents face, see my articles about postpartum stress and childbirth trauma. In addition, you might be interested in these Parenting Science offerings:

References: Postpartum depression symptoms

The Edinburgh Postnatal Depression Scale was designed by John Cox and Jenni Holden and is discussed in these papers:

Cox JL, Holden JM, and Sagovsky R. 1987. Detection of postnatal depression: Development of the 10-item Edinburgh Postnatal Depression Scale. British Journal of Psychiatry 150: 782-786.

Wisner KL, Parry CM, and Piontek CM. 2002. Postpartum Depression. New England Journal of Medicine 347: 194-199.

Other research cited in this article about postpartum depression symptoms follows.

Adewuya AO. 2005. The maternity blues in Western Nigerian women: prevalence and risk factors. Am J Obstet Gynecol. 193(4):1522-5.

Adeyemo EO, Oluwole EO, Kanma-Okafor OJ, Izuka OM, Odeyemi KA. 2020. Prevalence and predictors of postpartum depression among postnatal women in Lagos, Nigeria. Afr Health Sci. 20(4):1943-1954.

Ali E. 2018. Women’s experiences with postpartum anxiety disorders: a narrative literature review. Int J Womens Health. 10:237-249.

American Psychiatric Association. 2013. Diagnostic and statistical manual of mental disorders, 5th ed., (DSM-5). Washington, DC: American Psychiatric Publishing.

Austin MP, Hadzi-Pavlovic D, Priest SR, Reilly N, Wilhelm K, Saint K, Parker G. 2010. Depressive and anxiety disorders in the postpartum period: how prevalent are they and can we improve their detection? Arch Womens Ment Health. 13(5):395-401.

Bernstein IH, Rush AJ, Yonkers K, Carmody TJ, Woo A, McConnell K, Trivedi MH. 2008. Symptom features of postpartum depression: are they distinct? Depress Anxiety. 25(1):20-6.

Cameron EE, Sedov ID, Tomfohr-Madsen LM. 2016. Prevalence of paternal depression in pregnancy and the postpartum: An updated meta-analysis. J Affect Disord. 206:189-203.

Faisal-Cury A, Menezes PR, Tedesco JJ, Kahalle S, Zugaib M. 2008. Maternity “blues”: prevalence and risk factors. Span J Psychol.  11(2):593-9.

Field T. 2018. Postnatal anxiety prevalence, predictors and effects on development: A narrative review. Infant Behav Dev. 51:24-32.

Fisher SD, Sit DK, Yang A, Ciolino JD, Gollan JK, Wisner KL. 2019. Four maternal characteristics determine the 12-month course of chronic severe postpartum depressive symptoms. Depress Anxiety. 36(4):375-383.

Gonidakis F, Rabavilas AD, Varsou E, Kreatsas G, Christodoulou GN. 2007. Maternity blues in Athens, Greece: a study during the first 3 days after delivery. J Affect Disord. 99(1-3):107-15.

Goyal D, Gay C, Lee K. 2009. Fragmented maternal sleep is more strongly correlated with depressive symptoms than infant temperament at three months postpartum. Arch Womens Ment Health. 12(4):229-37.

Hau FW and Levy VA. 2003.  The maternity blues and Hong Kong Chinese women: an exploratory study. J Affect Disord. 75(2):197-203.

Hoertel N, López S, Peyre H, Wall MM, González-Pinto A, Limosin F, Blanco C. 2015. Are symptom features of depression during pregnancy, the postpartum period and outside the peripartum period distinct? Results from a nationally representative sample using item response theory (IRT). Depress Anxiety. 32(2):129-40.

Lawson A, Murphy KE, Sloan E, Uleryk E, Dalfen A. 2015. The relationship between sleep and postpartum mental disorders: A systematic review. J Affect Disord. 176:65-77.

Madsen KB, Mægbæk ML, Thomsen NS, Liu X, Eberhard-Gran M, Skalkidou A, Bergink V, Munk-Olsen T. 2022. Pregnancy and postpartum psychiatric episodes in fathers: A population-based study on treatment incidence and prevalence. J Affect Disord. 296:130-135.

O’Hara MW and McCabe JE. 2013. Postpartum depression: current status and future directions. Annu Rev Clin Psychol. 9():379-407.

O’Keane V, Lightman S, Patrick K, Marsh M, Papadopoulos AS, Pawlby S, Seneviratne G, Taylor A, Moore R. 2011. Changes in the maternal hypothalamic-pituitary-adrenal axis during the early puerperium may be related to the postpartum ‘blues’. J Neuroendocrinol. 23(11):1149-55.

Myers S, Johns SE. 2018. Postnatal depression is associated with detrimental life-long and multi-generational impacts on relationship quality. PeerJ. 6:e4305.

Nakić Radoš S, Tadinac M, Herman R. 2018. Anxiety During Pregnancy and Postpartum: Course, Predictors and Comorbidity with Postpartum Depression. Acta Clin Croat. 57(1):39-51.

Pearson RM, Bornstein MH, Cordero M, Scerif G, Mahedy L, Evans J, Abioye A, Stein A 2016. Maternal perinatal mental health and offspring academic achievement at age 16: the mediating role of childhood executive function. J Child Psychol Psychiatry. 57(4):491-501.

Reck C, Stehle E, Reinig K, Mundt C. 2009. Maternity blues as a predictor of DSM-IV depression and anxiety disorders in the first three months postpartum. J Affect Disord. 113(1-2):77-87.

Scarff JR. 2019. Postpartum depression in men. Innov Clin Neurosci. 16(5-6):11-14.

Surkan PJ, Kennedy CE, Hurley KM, Black MM. 2011. Maternal depression and early childhood growth in developing countries: systematic review and meta-analysis. Bull World Health Organ. 89(8):608-15.

Taraban L, Shaw DS, Leve LD, Natsuaki MN, Ganiban JM, Reiss D, Neiderhiser JM. 2018. Parental Depression, Overreactive Parenting, and Early Childhood Externalizing Problems: Moderation by Social Support. Child Dev. 2018 Feb 20. doi: 10.1111/cdev.13027. [Epub ahead of print]

Wisner KL, Sit DK, McShea MC, Rizzo DM, Zoretich RA, Hughes CL, Eng HF, Luther JF, Wisniewski SR, Costantino ML, Confer AL, Moses-Kolko EL, Famy CS, Hanusa BH. 2013. Onset timing, thoughts of self-harm, and diagnoses in postpartum women with screen-positive depression findings. JAMA Psychiatry. 70(5):490-8.

Content of “Postpartum depression symptoms” last modified 8/2022. Portions of the text derive from a previous version of the article written by the same author.

image depressed mother with baby in foreground by istock / ilkercekic

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