Postnatal depression is depression that develops after having a baby, and the thing that makes it hard to spot is that its symptoms overlap almost completely with the ordinary condition of caring for a newborn. Exhaustion, disrupted sleep, appetite change and tearfulness describe both.
What separates them is duration, pervasiveness and whether you can still enjoy anything. Those are the tests worth applying, and they are more useful than any checklist of symptoms.
Baby blues, and where the line sits
The baby blues affect most new mothers, start within the first few days, peak around day three to five, and resolve on their own inside a fortnight. They involve tearfulness and mood swings against a background in which you can still take pleasure in the baby.
Postnatal depression lasts longer and reaches further. The low mood is persistent rather than fluctuating, enjoyment goes out of things that used to provide it, and many people describe a flatness or detachment, from the baby, from their partner, or from themselves, that frightens them more than the sadness does.
Two weeks is the rough marker clinicians use. Beyond that, the tearful stretch that everybody warned you about has stopped behaving like the tearful stretch that everybody warned you about.
Why a special questionnaire exists
The screening instrument used in practice is the Edinburgh Postnatal Depression Scale, a ten-item self-report questionnaire developed for exactly this population. [cox-1987-epds]
It exists because general depression questionnaires perform badly here. Ask a new parent whether they have had trouble sleeping, low energy, or a change in appetite, and the answer is yes for reasons that have nothing to do with depression. A standard screener therefore flags almost everybody, which makes it useless. The EPDS drops those items and concentrates on mood, enjoyment, self-blame and anxiety instead.
Worth being clear about what a score does. It indicates whether to look further, not what is wrong. The conversation that follows is the assessment; the questionnaire only decides that the conversation should happen.
Has this gone beyond the first fortnight?
Tick anything that has been true most days for more than two weeks. This is a reflection prompt, not the EPDS, and it produces no diagnosis.
0 of 6 ticked
Most of this describes you. Please contact your GP, midwife or health visitor now. Postnatal depression is common and it responds well to treatment.
Some of this describes you and has lasted beyond two weeks. That is worth raising with your GP, midwife or health visitor rather than waiting to see.
Little of this describes you. New parenthood is exhausting without being depression, and exhaustion on its own is not what this is asking about.
See our depression self-assessment
Our screener is the PHQ-9, a general depression measure. It is not the EPDS and is not designed for the postnatal period, where several of its items are answered yes by almost everybody. Treat it as background, and let a clinician use the right instrument.
If you ticked the last item, treat that as the one that decides the timing. Thoughts that your family would be better off without you are a reason to speak to somebody today rather than at the next appointment.
Intrusive thoughts about the baby
Distressing thoughts about harm coming to the baby are common, and they are one of the most frightening things new parents experience precisely because nobody warns them.
These thoughts are experienced as horrifying and unwanted. That reaction is the opposite of intent, and the behaviour that follows is typically over-vigilance rather than risk. Clinicians hear this frequently and will not be alarmed by you saying it.
They are still worth mentioning, for two reasons. Saying them aloud takes a substantial amount of their power away. And they sometimes point towards postnatal anxiety or postnatal OCD rather than depression, which matter because they respond to a different and specific treatment.
What treatment involves
Psychological therapy is usually the first-line option, most commonly cognitive behavioural therapy. Its evidence base in depression generally is about as large as this field gets: a meta-analysis pooling 409 trials and more than 52,000 patients found CBT effective against control conditions and broadly comparable to other active treatments. [cuijpers-2023-cbt]
Antidepressants are used where symptoms are moderate to severe, or where therapy alone has not been enough. Compatibility with breastfeeding is a normal part of that discussion, and it is worth raising rather than assuming it rules the option out.
Alongside both, protect sleep. This sounds like the least serious item on the list and it is not: sustained sleep deprivation produces and maintains exactly the symptoms being treated, and a single protected block of several hours, arranged with whoever is available, changes more than it has any right to.
Not only mothers
Partners develop postnatal depression too, and are asked about it far less often.
The reasoning is not complicated. Partners face the same disrupted sleep, the same reorganisation of identity and relationship, and the same practical pressure, without the physical recovery or the hormonal shift. But services are built around the birthing parent, so nobody asks, and a struggling partner concludes that what they are feeling does not qualify.
If that is you, the route in is your own GP rather than the maternity service.
When to seek help
Contact your GP, midwife or health visitor if low mood has persisted beyond two weeks, if you cannot enjoy anything, or if you feel detached from your baby. None of that requires you to be certain it is depression.
Seek help the same day if you have thoughts of harming yourself or the baby, if you feel unable to care for them, or if you are experiencing anything that feels like losing touch with reality. That last one is rare and it is a medical emergency rather than a version of what this article describes.
Our guide to dealing with depression covers the general picture, and the depression pillar sets out how the condition is defined and treated.
How MyFreud can help
The two-week question is genuinely hard to answer from memory when every day runs together. Daily mood tracking gives you an actual line rather than an impression, which is the single most useful thing to bring to an appointment where the first question will be how long this has been going on.
Download MyFreud and start today: App Store or Google Play.