Postpartum Depression Questions Answered

By UNC Health Southeastern Internal Medicine Residents Harshita Nadella, DO, and Obi Achuko, MD

Harshita Nadella, DO

Obi Achuko, MD

Postpartum depression (PPD) is a major depressive episode that begins within the first year after childbirth, though it most often starts within the first few weeks or months. It can begin as early as the first week after delivery. There is a range of these symptoms, from postpartum blues to postpartum depression to postpartum psychosis.

Postpartum blues occur in up to 80 percent of childbirths, typically emerging within the first few days after delivery and resolving spontaneously within one to two weeks. Postpartum depression affects approximately 13 percent of mothers and usually begins within one to three weeks postpartum. Symptoms must persist for at least two weeks to meet diagnostic criteria. Unlike the transient nature of postpartum blues, postpartum depression often lasts longer and does not simply fade away without treatment. Postpartum psychosis is a rare condition, affecting about 0.2 percent of childbirths, and is strongly associated with underlying bipolar disorder. This condition typically presents with a sudden onset within two to four weeks after delivery.

What are the signs of postpartum depression?

Symptoms are similar to major depressive disorder and generally last at least two weeks. Key signs include persistent sadness, hopelessness, loss of interest or pleasure in activities, difficulty bonding with your infant, excessive guilt, fatigue or a significant lack of energy, sleep disturbances, changes in appetite, difficulty concentrating, making decisions, or thinking clearly. It is important to note, however, that some of these symptoms may be common to postpartum, such as sleep disturbance, but they are concerning when severe or persistent. One of the most important symptoms is thoughts of harming oneself or the baby. This is a medical emergency, and one needs to seek help immediately.

Who is at risk for postpartum depression?

Several risk factors contribute to the development of this condition. One of the most important is hormonal changes. Levels of estrogen and progesterone decrease sharply after delivery, which can trigger mood shifts. A personal or family history of depression, anxiety, or bipolar disorder also increases risk. Emotional and lifestyle stressors such as fatigue, financial strain, loss, or relationship issues can contribute as well. A few factors that physicians or hospital personnel can help with are lack of social support or isolation, marital or partner conflict, complications during pregnancy or childbirth, or giving birth prematurely and dealing with a baby who has health issues or needs intensive care.

What are the risks of untreated postpartum depression for the child?

When postpartum depression goes untreated, it can affect not only the mother but also the child. In infancy, babies may cry more, sleep less, and be harder to comfort, showing stress early in life. Bonding can suffer, with mothers finding it harder to connect, which may affect the child’s sense of security. During childhood, risks include learning delays, emotional struggles, and trouble with focus or behavior. In adolescence, children may face higher chances of aggression, acting out, or mental health problems. Even before birth, depression during pregnancy can influence the baby’s brain and stress systems, impacting growth and development later. Getting help protects both mother and child.

What is the treatment? Who should I contact if I need help? How can you lower the risk of postpartum depression?

The most important step is to reach out to your OB/GYN or healthcare provider right away if you notice mood changes after delivery. Treatment for postpartum depression is effective and may include therapy, antidepressant medications (some of which are safe while breastfeeding), or both. These are the main treatments and should not be replaced by self-care alone. Lifestyle steps such as resting when you can, eating balanced meals, gentle physical activity like short walks, and leaning on family, friends, or local support groups can support recovery, but they are not substitutes for medical care. Getting help is a sign of strength, and with the right treatment and support, recovery is very possible.

Harshita Nadella, DO, and Obi Achuko, MD, are first-year residents in the Internal Medicine residency program at UNC Health Southeastern. In addition to offering services you’d expect from a community healthcare system, UNC Health Southeastern provides a number of specialized services that are unique to our system and not available anywhere else in the region. To schedule an appointment, call our referral line at 984-974-CARE. To learn more, visit UNCHealthSE.org. To submit questions for consideration for a Frequently Asked Questions article, email unchsoutheasterninfo@unchealth.unc.edu