Postpartum Mood Disorders: Do You Know the Early Signs?

Many parents experience sadness, anxiety, stress, and feelings of overwhelm after the birth of a child. When these emotions persist and significantly interfere with functioning and parent-newborn bonding, it may be indicative of a postpartum mood disorder.

Also known as perinatal mood and anxiety disorders (PMADs), these conditions affect about one in eight women or birthing parents, and as many as one in ten fathers or caregiving partners. ^{1 2} Postpartum mood disorders are also linked to pre-existing conditions like depression, anxiety, trauma, and ADHD. ^{3 4 5 6}

Knowing the signs of postpartum mood disorders is the first step toward early detection and preventing these treatable conditions from worsening.

Postpartum mood disorders are not to be confused with the baby blues, which most birthing parents experience as a result of dramatic hormonal dips after birth. Sadness, sleep disturbances, irritability, anxiety, and tearfulness are common signs of the baby blues.

The symptoms and emotional challenges of postpartum mood disorders are more intense and long-lasting than those of the baby blues, which peak within the first week of birth and last up to three weeks. Postpartum mood disorders, on the other hand, typically begin within three weeks of birth, but onset is possible through the first postpartum year.

The baby blues usually resolves on its own provided that a family has adequate support.

Up to 15% of postpartum parents will develop PPD ^{1 7} though the prevalence may be higher since most studies only look at parents’ symptoms a few weeks postpartum. PPD is characterized by the following symptoms and emotional challenges:

• loss of interest in activities that used to be enjoyable
• weight changes
• sleep troubles
• restlessness or sluggishness/slow movement
• fatigue/fogginess
• irritability, anger, or rage
• resentment (toward the baby, partner, or family)
• feelings of worthlessness or guilt
• feeling unsuccessful with the baby
• feeling disconnected from the baby

[Take This Self-Test: Signs of Postpartum Depression]

All expectant parents worry — about the fetus during pregnancy, about giving birth, about caring for a newborn, and much more. Postpartum anxiety disorder occurs when worries become excessive and uncontrollable, interfering with daily life or the baby’s care. Most parents who experience postpartum depression will also experience clinical levels of anxiety.

Parents with postpartum anxiety may have worrisome thoughts about the health of the baby, their own health, and the health of their partner. They may worry, for example, about dying and leaving their baby without a parent. Some parents may even experience panic attacks.

For parents whose postpartum anxiety involves social anxiety, they may experience extreme fears of social judgment. They worry that they’ll be judged for their parenting or for not feeling happier about being a parent. Their fears may drive them to isolate and avoid others.

Postpartum post-traumatic stress disorder (PTSD) affects up to 9% of women. ⁸ Postpartum PTSD often develops after experiencing a real or perceived traumatic birth or delivery, though previous exposure to trauma is also a risk factor for developing postpartum PTSD. ⁹ Experiences linked to birth trauma include but are not limited to the following: ^{8 10}

• undergoing an emergency or unplanned C-section
• birthing a preterm baby
• a long and painful labor
• pregnancy and/or birth complications
• delivery done with instruments (e.g., forceps, vacuum extractor)
• feeling powerless, unsupported, and ignored by medical staff during delivery

Symptoms of postpartum PTSD include the following:

• recurrent, involuntary, and intrusive distressing memories and/or dreams of the birth experience
• flashbacks to the traumatic event
• distress when exposed to reminders or cues linked to the event
• avoidance of thoughts, people, places, activities, and situations associated with the event
• increased arousal and reactivity (e.g., irritability and anger, hypervigilance, sleep disturbances, concentration difficulties)
• persistent negative mood and thoughts

Recurrent and persistent thoughts, urges, or mental images after childbirth — usually centered on the newborn — that feel intrusive, inappropriate, disturbing, and unwanted mark postpartum OCD. Obsessive thoughts often center on the baby being harmed (by the parent or by others, accidentally or intentionally) or becoming ill. Parents may perform repetitive behaviors or mental acts (i.e., compulsions) — like refusing to hold the baby or constantly checking on them — to reduce these obsessive thoughts or relieve distress. ¹¹ About 9% of postpartum parents experience symptoms of postpartum OCD.¹²

The most severe postpartum mood disorder, postpartum psychosis, with an approximate prevalence of 1 to 2 per 1,000 births ¹³, is characterized by the following signs:

• loss of touch with reality
• paranoia
• confusion and disorientation
• rapid mood swings
• erratic, disorganized behavior
• visual and auditory hallucinations

Symptoms of postpartum psychosis usually show up within the first few days or weeks after birth. Difficulty communicating with the birthing parent is one of the earliest warning signs of postpartum psychosis. As risk for self-harm or harm to the infant are high with this disorder, postpartum psychosis constitutes a medical emergency. Often, it will be a family member or trusted friend who raises concerns about postpartum psychosis, rather than the birthing parents themselves, since psychosis makes it difficult to perceive accurately.

[Read: Postpartum Care for Mothers with ADHD — A Guide for Clinicians]

It’s not just expectant parents who should learn the signs. It’s imperative for all of us to increase our awareness of postpartum mood disorders to help ourselves, our friends and family, and others in our lives who may develop them. Awareness is key to reducing stigma and shame around these conditions so that everyone who needs help gets it. Catching symptoms early can prevent the development of severe versions of postpartum mood disorders and curb the impact of these conditions on parental and child health.

If you are experiencing any of the above signs of a postpartum mood disorder, don’t wait it out. And don’t convince yourself that it’s all just in your head. Tell your doctors — not just your OB-GYN — about your symptoms and insist on formal screenings. For parents of newborns, screenings should occur all throughout the first postpartum year.

Treatment and intervention options for postpartum mood disorders include the following:

• one-on-one psychotherapy
• support groups with peers who are experiencing or have experienced the same symptoms
• medications (e.g., SSRIs, antipsychotics, mood stabilizers, Zurzuvae)
• self-care strategies (e.g., physical activity, sufficient sleep, stress management, proper nutrition and hydration, socialization, respite)

Postpartum Mood Disorders and ADHD: Next Steps

• Watch: The Unspoken Truths of Postpartum Depression
• Read: Treating for Two — ADHD Meds in Pregnancy
• Read: A Self-Care Guide for Moms with ADHD Raising Kids with ADHD
• Read: Bringing Up Baby — Motherhood with ADHD

If you or someone you know is in crisis and needs help, dial or text 988 to connect to a trained counselor from the Suicide & Crisis Lifeline. Call 911 if you or someone you know is in immediate danger.

Additional Resources

• Postpartum Support International
• MGH Center for Women’s Mental Health
• Postpartum Progress
• The Seleni Institute
• La Leche League International

The content for this article was derived from the ADDitude ADHD Experts webinar titled, “The Unspoken Truths of Postpartum Depression: Help for Women With and Without ADHD” [Video Replay & Podcast #470] with Jayne Singer, Ph.D., IECMH-E®, which was broadcast on September 7, 2023.

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Sources

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² Paulson, J. F., & Bazemore, S. D. (2010). Prenatal and postpartum depression in fathers and its association with maternal depression: a meta-analysis. JAMA, 303(19), 1961–1969. https://doi.org/10.1001/jama.2010.605

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⁶ Bartelt K, Piff A, Vitek G, Barkley E. Maternal ADHD Correlated with Increased Risk of Postpartum Depression. Epic Research. https://epicresearch.org/articles/maternal-adhd-correlated-with-increased-risk-of-postpartum-depression.

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¹¹ International OCD Foundation. What are Postpartum and Perinatal OCD? https://iocdf.org/wp-content/uploads/2014/10/Postpartum-OCD-Fact-Sheet.pdf

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