Postnatal depression — more than tiredness

Postnatal depression (PND) is depressive episode in perinatal period — onset within first year — peak first 3 months.

~10–15% mothers — under-recognised — shame delays help

Baby blues vs PND vs psychosis

Baby bluesPNDPostpartum psychosis
TimingDays 3–10>2 weeksDays to weeks
SeverityMildModerate–severeSevere
TreatmentSupportTherapy ± medsEmergency psychiatry
PsychosisNoNo (unless severe)Yes

Why it happens

Multifactorial:

  • Hormonal crash — oestrogen, progesterone
  • Sleep deprivation
  • Birth trauma
  • Previous mental health
  • Isolation, financial stress
  • Difficult feeding, colic
  • NOT weakness or not loving baby

Symptoms to act on

Emotional:

  • Anhedonia — nothing enjoyable
  • Guilt — “bad mother”
  • Intrusive thoughts — harm to baby — common, treatable, not acted on

Physical:

  • Insomnia despite exhaustion
  • Appetite loss

Bonding:

  • Detached, going through motions

Partner PND — ~10% fathers/partners — also needs GP

Screening

EPDS at 6–8 week check

Score ≥13 — referral

Question 10 self-harm — any score >0 — urgent

Treatment

Mild-moderate:

  • Listening visits, IAPT CBT
  • Peer support — PANDAS, Netmums

Moderate-severe:

Mother and baby units — keep dyad together

Safety planning

If intrusive harm thoughts:

  • Tell GP — not child protection automatic if no intent/risk
  • Support person, sleep blocks

Postpartum psychosis — 999 — do not leave alone with baby unsupervised if acutely unwell

Common questions about postnatal depression

What is the difference between baby blues and postnatal depression?
Baby blues — starts days 2–5 after birth, tearfulness, mood swings, anxiety — peaks day 5, resolves within 2 weeks — no treatment needed. Postnatal depression — persists beyond 2 weeks, more severe, affects daily function, bonding, and enjoyment — needs GP assessment and treatment.
What are the symptoms of postnatal depression?
Persistent sadness, hopelessness, exhaustion beyond normal new-parent tiredness, loss of interest, guilt about parenting, anxiety and panic, irritability, difficulty bonding with baby, concentration problems, appetite change, insomnia when opportunity exists, intrusive thoughts (common — distressing), social withdrawal. Can include suicidal ideation — medical emergency.
How is postnatal depression treated?
Guided self-help, CBT, interpersonal therapy via NHS talking therapies — IAPT perinatal priority. Antidepressants — sertraline often first choice if breastfeeding. Severe cases — specialist perinatal mental health team, day units, mother and baby unit if inpatient needed. Practical support — health visitor, family help with sleep.
Can you take antidepressants while breastfeeding?
Yes — several SSRIs pass minimally into breast milk — sertraline and paroxetine often preferred. Untreated PND harms mother and child — balance risks. Discuss with GP — monitor baby for sedation or feeding change. Breastfeeding not mandatory to receive medication if you choose not to.
What is postpartum psychosis?
Rare severe psychiatric illness — days to weeks postpartum — manic or mixed episodes, hallucinations, delusions, confusion, rapid deterioration. Medical emergency — mother and baby unit admission — antipsychotics, lithium. Higher risk if previous bipolar or postpartum psychosis. Different from PND though can coexist.

Sources

How we reviewed this page

Medically reviewed by Dr Neil Singh, MBChB, nMRCGP

General Practitioner · GMC 7039648

Dr Neil Singh is a General Practitioner based in Yorkshire with over a decade of experience working in UK primary care.

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