Postnatal depression: symptoms, causes and treatment

Key points

• Postnatal depression starts in pregnancy or the first year after birth and does not lift on its own [1][2].
• The baby blues are different: mild, affecting 30 to 80% of women, and gone within two weeks [3].
• Anxiety often occurs with it and is under-recognised: in one UK study only 16.7% of women with perinatal anxiety or depression were in treatment [5].
• Around one in ten fathers and non-birthing partners are also affected [6].
• NICE recommends talking therapy before medication, and specialist perinatal services for moderate to severe illness [2].
• Postpartum psychosis is a separate, rarer condition, and a medical emergency [2][3].

What postnatal depression is

Postnatal depression is depression that begins during pregnancy or in the first year after having a baby. It brings low mood, loss of enjoyment, exhaustion and difficulty coping that last more than two weeks and do not lift on their own [1].

If you need help now. Samaritans: call 116 123, free, 24/7. Shout: text SHOUT to 85258. NHS 111, then choose the mental health option. Call 999 if anyone is in immediate danger.

The baby blues are different. They bring tearfulness, irritability and mood swings in the first days after birth, affect 30 to 80% of women, and pass within about two weeks without treatment [3]. Low mood still there after two weeks, or worsening, is not the baby blues [1].

Estimates vary. Pooling studies that used diagnostic criteria, Gavin and colleagues put the cumulative prevalence of major depression at 21.9% by twelve months after birth, with the rate at any one moment highest at two months, at 5.7%. NICE notes most of these estimates rest on a single study and sit above those from the larger ALSPAC cohort [3].

Symptoms

Mood and thinking

• Low mood or emptiness most of the day [1]
• Loss of interest or pleasure [1]
• Hopelessness, guilt, or feeling like a bad parent [1]
• Trouble concentrating or deciding [1]
• Thoughts of self-harm or suicide [1]

Physical and behavioural

• Exhaustion that rest does not relieve [1]
• Trouble sleeping even when the baby is asleep [1]
• Withdrawing from family and friends [1]
• Difficulty feeling connected to the baby [1]
• Irritability, anger or constant on-edge worry [1]

Anxiety. Anxiety commonly occurs alongside depression here and is often missed [5]. Around 9.9% of women have an anxiety disorder after birth, showing as constant worry about the baby, repeated checking, a racing heart, or unwanted frightening images of harm coming to the baby [4].

Commonly confused with. The baby blues, which pass within two weeks [3]. New-parent tiredness, which improves with rest. Postpartum psychosis, which comes on fast, with confusion or beliefs others do not share [3].

Types

There are no formal subtypes. UK practice recognises presentations and severity bands [2].

• By severity. Mild to moderate is managed in primary care or NHS Talking Therapies; moderate to severe goes to a specialist perinatal mental health service [2].
• Antenatal onset. Starting in pregnancy. Around 12.7% of women are depressed while pregnant [3].
• In fathers and non-birthing partners. Around one in ten fathers, more often showing irritability, anger, withdrawal or heavier drinking than sadness [6].

Postpartum psychosis is not a severe form of postnatal depression. It is a separate condition, at roughly 1 to 2 per 1,000 births, and a medical emergency [3].

Causes and risk factors

There is no single cause, and most people with these risk factors never develop it.

• Previous depression, anxiety or another mental health problem [1]
• Severe sleep loss and the physical demands of a newborn [1]
• Rapid hormonal change after birth, a plausible contributor but not established as a cause on its own [1]
• Little support, relationship difficulties, or domestic abuse [1]
• A difficult birth, or a baby born premature or unwell [1]

Two popular explanations are wrong. It is not caused by failing to love the baby: difficulty feeling connected is a symptom, not a cause [1]. It is not weakness.

How it is diagnosed

There is no blood test or scan. A GP usually diagnoses it, or a psychiatrist registered with the GMC or a clinical psychologist registered with the HCPC [1][2].

Screening is built into the UK maternity pathway. NICE says clinicians should consider asking the two Whooley questions at a woman’s first contact with primary care or her booking visit, and during the early postnatal period: whether in the past month she has often been bothered by feeling down, depressed or hopeless, and by having little interest or pleasure in doing things [2]. The two GAD-2 anxiety questions are asked alongside [2]. Midwives ask at booking, health visitors and GPs through the first year [2].

If answers are positive, NICE recommends the Edinburgh Postnatal Depression Scale (EPDS) or the PHQ-9 as part of a fuller assessment, or referral to a GP [2]. A high EPDS score prompts assessment, not a diagnosis. A GAD-2 score of 3 or more prompts the GAD-7 [2].

NICE says assessment should follow referral within two weeks, and treatment start within a month [2]. In England, if you are 18 or over, or 16 or over in some areas, you can self-refer to NHS Talking Therapies [1]. Partners are not screened, and the EPDS has no agreed cut-off for fathers [6].

A diagnosis names a treatable illness. It is not a judgement of parenting, and does not mean a baby will be taken away.

Treatment

NICE recommends psychological treatment first for most people [2].

• Mild to moderate depression. Facilitated self-help, with regular support from a trained practitioner [2].
• Moderate or severe depression. A high-intensity psychological intervention, for example cognitive behavioural therapy [2].
• Medication. NICE says a tricyclic, SSRI or (S)NRI may be considered if the woman prefers it or declines psychological treatment, once risks and benefits are discussed; both together if either alone has not worked [2].

Specialist perinatal mental health teams treat the illness and work on the parent and baby relationship, and in England support women up to 24 months after birth [7]. Inpatient care within 12 months of childbirth should normally be at a mother and baby unit, so the baby stays with the parent [2].

NICE does not treat breastfeeding as a reason to withhold treatment [2]. NHS Specialist Pharmacy Service guidance says treatment choice should focus primarily on controlling the mother’s symptoms, with suitability in breastfeeding a secondary consideration [8]. Which medicine, and whether to keep feeding, are decisions for a prescriber.

Living with postnatal depression

Recovery usually takes months, and treatment shortens it [1].

• Tell your health visitor or GP what a typical day actually looks like, including the parts you would rather not say out loud.
• Protect sleep in blocks. One unbroken stretch, with someone covering a night feed, beats several broken hours.
• PANDAS runs a UK helpline and local groups for parents affected by perinatal mental illness [1].

You do not have to tell an employer your diagnosis. Occupational health can arrange adjustments such as a phased return without giving your manager clinical detail. Any private therapist should be registered with the HCPC, BPS, BACP, UKCP or GMC.

When to speak to a professional

Speak to your GP, midwife or health visitor, or self-refer to NHS Talking Therapies in England, if:

• Low mood, tearfulness or anxiety has lasted more than two weeks after the birth [1]
• You feel guilty most of the time, or that you are failing as a parent
• You cannot sleep even when the baby is asleep [1]
• You are a partner or father who has felt low, angry or withdrawn since the birth [6]

Get help the same day if you have thoughts of harming yourself or your baby, if you feel confused or muddled, or if you are having beliefs or experiences that others do not share. These can be signs of postpartum psychosis, a medical emergency. Call your GP urgently, call NHS 111 and choose the mental health option, or call 999. NICE says suspected postpartum psychosis should be assessed within four hours of referral [2].

If you are having thoughts of ending your life, call Samaritans on 116 123, text SHOUT to 85258, or call 999 if anyone is in immediate danger. Suicide is the leading cause of maternal death between six weeks and one year after pregnancy ends [9].

Common questions

What is the difference between the baby blues and postnatal depression?

The baby blues start within days of birth, affect 30 to 80% of women, and pass on their own within about two weeks [3]. Postnatal depression lasts longer and does not lift by itself [1].

Can fathers and partners get postnatal depression?

Yes, in around one in ten fathers [6]. It is more likely to show as irritability, anger, withdrawal or heavier drinking than as obvious sadness, and UK maternity services do not routinely screen partners [6].

Can you take antidepressants while breastfeeding?

That is a decision for a prescriber, and breastfeeding is not automatically a reason to avoid treatment. NHS Specialist Pharmacy Service guidance says treatment choice should focus primarily on controlling the mother’s symptoms, with suitability in breastfeeding a secondary consideration [8].

Clinical review pending

References

1. NHS. Postnatal depression. NHS. https://www.nhs.uk/mental-health/conditions/postnatal-depression/
2. National Institute for Health and Care Excellence. Antenatal and postnatal mental health: clinical management and service guidance. Clinical guideline CG192, 2014. https://www.nice.org.uk/guidance/cg192/chapter/1-Recommendations
3. National Collaborating Centre for Mental Health. Antenatal and Postnatal Mental Health: Clinical Management and Service Guidance. NICE Clinical Guideline 192, NCBI Bookshelf, 2014. https://www.ncbi.nlm.nih.gov/books/NBK338568/
4. Dennis CL, Falah-Hassani K, Shiri R. Prevalence of antenatal and postnatal anxiety: systematic review and meta-analysis. The British Journal of Psychiatry, 210(5), 2017. https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/prevalence-of-antenatal-and-postnatal-anxiety-systematic-review-and-metaanalysis/9CF2AC0D36E9FF13A32022460FCBA7EE
5. Prevalence and treatment of perinatal anxiety: diagnostic interview study. BJPsych Open, 2025. https://www.cambridge.org/core/journals/bjpsych-open/article/prevalence-and-treatment-of-perinatal-anxiety-diagnostic-interview-study/3873A082E3BF859E141E300B010C6330
6. Towards effective screening for paternal perinatal mental illness: a meta-review of instruments and research gaps. Frontiers in Public Health, 2024. https://www.frontiersin.org/journals/public-health/articles/10.3389/fpubh.2024.1393729/full
7. NHS England. Perinatal mental health. NHS England. https://www.england.nhs.uk/mental-health/perinatal/
8. NHS Specialist Pharmacy Service. Using SSRI antidepressants during breastfeeding. NHS SPS, 2023. https://sps.nhs.uk/articles/using-ssri-antidepressants-during-breastfeeding/
9. MBRRACE-UK. Maternal mortality 2022-2024. National Perinatal Epidemiology Unit, University of Oxford. https://www.npeu.ox.ac.uk/mbrrace-uk/data-brief/maternal-mortality-2022-2024