April 7, 2025

The X-Podcast: Real Conversations About Mental Health

A Conversation About: Postpartum Depression (PPD)

Episode #50

In this episode, the X-Podcast team has a conversation about Postpartum depression (PPD). PDD is a mood disorder that can occur in women after giving birth. Persistent sadness, hopelessness, and loss of interest in activities characterize it. 

Special guest Licensed Professional Counselor-Associate Noelle Kristan discusses her work with PDD. She also talks about her lived experience with PDD. Noelle provides professional and personal tips on how to manage PDD. 

PPD is a common mental health condition that affects about 1 in 8 women. Many women are not comfortable sharing their experience with PPD and are reluctant to ask for help due to stigma. The team discusses why this is the case. This episode hopes to bring more awareness about PPD and to help reduce stigma around PPD in hopes of supporting more women.  

Your body and mind go through many changes during and after pregnancy. If you feel sad, anxious, overwhelmed, or like you don’t love or care for your baby, and these feelings last longer than 2 weeks during or after pregnancy, you may have postpartum depression. Treatment for depression, such as therapy or medicine, works and can help you and your baby be as healthy as possible in the future.

“Postpartum” means the time after having a baby. Some women get the “baby blues,” or feel sad, worried, or tired within a few days of giving birth. For many women, the baby blues go away in a few days. If these feelings don’t go away or you feel sad, hopeless, or anxious for longer than 2 weeks, you may have postpartum depression. Feeling hopeless after childbirth is not a regular or expected part of being a mother.

Postpartum depression is a serious mental health condition that involves the brain and affects your behavior and physical health. If you have depression, then sad and hopeless feelings don’t go away and can interfere with your day-to-day life. You might not feel connected to your baby, as if you are not the baby’s mother, or you might not love or care for the baby. These feelings can be mild to severe.

Mothers can also experience anxiety disorders during or after pregnancy.

PPD typically emerges over the first two to three postpartum months but may occur at any point after delivery. Some women note the onset of mild depressive symptoms during pregnancy. Postpartum depression is clinically indistinguishable from depression occurring at other times during a woman’s life. 

Symptoms of PPD can vary in severity and may include: 

• Depressed or sad mood
• Tearfulness
• Loss of interest in usual activities
• Feelings of worthlessness or incompetence
• Fatigue
• Sleep disturbance
• Persistent sadness or low mood
• Loss of interest in once enjoyable activities
• Changes in appetite or sleep patterns
• Difficulty concentrating or making decisions
• Feelings of guilt, shame, or inadequacy
• Anxiety or panic attacks
• Thoughts of harming oneself or the baby 

Significant anxiety symptoms may also occur. Generalized anxiety is common, but some women also develop panic attacks. Postpartum obsessive-compulsive disorder has also been reported, where women report disturbing and intrusive thoughts of harming their infant. Especially with milder cases, it may be difficult to detect postpartum depression because many of the symptoms used to diagnose depression (i.e., sleep and appetite disturbance, fatigue) also occur in postpartum women in the absence of depression. 

The Edinburgh Postnatal Depression Scale is a 10-item questionnaire that may be used to identify women who have PPD. On this scale, a score of 12 or greater or an affirmative answer on question 10 (presence of suicidal thoughts) raises concern and indicates a need for a more thorough evaluation.

Postpartum psychosis

Postpartum psychosis is the most severe form of postpartum psychiatric illness. It is a rare event that occurs in approximately 1 to 2 per 1000 women after childbirth. Its presentation is often dramatic, with the onset of symptoms as early as the first 48 to 72 hours after delivery. The majority of women with puerperal psychosis develop symptoms within the first two postpartum weeks.

It appears that in most cases, postpartum psychosis represents an episode of bipolar illness; the symptoms of puerperal psychosis most closely resemble those of a rapidly evolving manic (or mixed) episode. The earliest signs are restlessness, irritability, and insomnia. Women with this disorder exhibit a rapidly shifting depressed or elated mood, disorientation or confusion, and erratic or disorganized behavior. Delusional beliefs are common and often center on the infant. Auditory hallucinations that instruct the mother to harm herself or her infant may also occur. The risk for infanticide, as well as suicide, is significant in this population. 

Diagnosis

PPD is typically diagnosed based on a thorough medical history, physical exam, and psychological evaluation. A healthcare professional will ask about symptoms, medical conditions, and family history. 

The Postpartum Period

For most, the symptoms are mild and short-lived; however, 10 to 15% of women develop more significant symptoms of depression or anxiety. 

Postpartum psychiatric illness is typically divided into three categories: (1) postpartum blues, (2) postpartum depression, and (3) postpartum psychosis.

When is it no longer considered PPD?

The postpartum period generally includes the first 4 to 6 weeks after birth, and many cases of PPD begin during that time. But PPD can also develop during pregnancy and up to 1 year after giving birth, so don't discount your feelings if they're happening outside of the typical postpartum period.

Is it in the DSM-5 as a psychological disorder?

While postpartum depression (PPD) isn't a specific diagnosis in the DSM-5, it's recognized as a major depressive episode with a "peripartum onset" specifier, meaning it occurs during pregnancy or within four weeks after childbirth. 

In DSM-5, the diagnosis of depression during the postpartum period still utilizes the onset specifier format. However, the specifier has changed; it is now titled “with peripartum onset,” which is defined as the most recent episode occurring during pregnancy as well as in the four weeks following delivery.

Although both the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) and the International Classification of Disorders, 11th edition (ICD-11) have specifiers for the peripartum onset of major depressive disorder (MDD), they do not have a specific classification for PPD disorder as a DSM mental health disorder.

• Highlights
• Peripartum depression (PPD) is defined as a major depressive disorder (MDD) episode.
• PPD has some specific symptoms and risk factors in comparison to MDD.
• PPD is a heterogeneous disorder with different subtypes according to its onset and severity.
• Diagnostic criteria should change with a time specifier until the first year postpartum.
• The peripartum onset specifier should change to “pregnancy onset” or “postpartum onset”.

Peripartum depression (PPD) is a major depressive disorder (MDD) episode with onset during pregnancy or within four weeks after childbirth, as defined in DSM-5. However, research suggests that PPD may be a distinct diagnosis. 

When compared to MDD, peripartum depression exhibits several distinct characteristics. PPD manifests with a variety of symptoms, i.e., more anxiety, psychomotor symptoms, obsessive thoughts, impaired concentration, fatigue and loss of energy, but less sad mood and suicidal ideation, compared to MDD. Although PPD and MDD prevalence rates are comparable, there are greater cross-cultural variances for PPD. Additionally, PPD has some distinct risk factors and mechanisms, such as distinct ovarian tissue expression, premenstrual syndrome, unintended pregnancy, and obstetric complications.

There is a need for more in-depth research comparing MDD with depression during pregnancy and the entire postpartum year. The diagnostic criteria should be modified, particularly with (i) the addition of specific symptoms (i.e., anxiety), (ii)the onset specifier extending to the first year following childbirth, (iii) changing the peripartum onset specifier to either “pregnancy onset” or “postpartum onset”. Diagnostic criteria for PPD are further discussed.

What are the differences between PPD and MDD?

Comparing symptoms of PPD and MDD, some studies revealed symptomatic differences. The levels of hopelessness, somatization, interpersonal sensitivity, anxiety, hostility, psychoticism, sleep disturbance, and suicidal ideation were less common in pure postpartum depression than in other types of depression.

A study comparing depressive symptoms in postpartum and non-postpartum women showed that reduced interest, more sad mood, and more suicidal ideation were reported by the non-postpartum group. In the postpartum group, psychomotor symptoms (restlessness/agitation) and impaired concentration/decision-making were the most prominent symptoms. 

A large study focusing on symptom features of depression during pregnancy, the postpartum period, and the non-peripartum period confirmed that anxiety symptoms, psychomotor symptoms, and impaired concentration/decision-making were more prevalent in the peripartum period. Another study confirmed higher anxiety levels in PPD compared to MDD. Other differences in PPD compared to MDD are related to experiencing guilt from not being a good mother or having obsessions and aggressive thoughts about causing harm to the infant.

Peripartum Onset 

Specifier:

The DSM-5 uses the term "peripartum onset" to describe a major depressive episode that begins during pregnancy or within four weeks after delivery. 

Not a Separate Diagnosis:

Postpartum depression isn't a distinct diagnosis in the DSM-5, but rather a specific type of major depressive episode with a particular onset time. 

Major Depressive Disorder (MDD):

To be diagnosed with a major depressive episode with peripartum onset, a person must meet the criteria for MDD, which include persistent sadness, loss of interest, and other symptoms. 

Timeframe:

While the DSM-5 focuses on the first four weeks postpartum, clinical practice and research often consider postpartum depression to occur within the first year after delivery. 

Importance of Screening

Screening for perinatal mood disorders, including PPD, is crucial, as symptoms can be subtle and may interfere with a mother's ability to care for herself and her baby. 

How common is postpartum depression (PPD)?

Depression is a common problem after pregnancy. One in 8 new mothers reports experiencing symptoms of postpartum depression in the year after childbirth.

How do you know you have PPD?

Some normal changes after pregnancy can cause symptoms similar to those of depression. Many mothers feel overwhelmed when a new baby comes home. But if you have any of the following symptoms of depression for more than 2 weeks, call your doctor, nurse, or midwife:

• Feeling angry or moody
• Feeling sad or hopeless
• Feeling guilty, shameful, or worthless
• Eating more or less than usual
• Sleeping more or less than usual
• Unusual crying or sadness
• Loss of interest, joy, or pleasure in the things you used to enjoy
• Withdrawing from friends and family
• Possible thoughts of harming the baby or yourself

Some women don’t tell anyone about their symptoms. New mothers may feel embarrassed, ashamed, or guilty about feeling depressed when they are supposed to be happy. They may also worry they will be seen as bad mothers. Any woman can become depressed during pregnancy or after having a baby. It doesn’t mean you are a bad mom. You don’t have to suffer. There is help. Your doctor can help you figure out whether your symptoms are caused by depression or something else.

What causes PPD?

The exact cause of PPD is not known, and many different factors are likely to contribute to someone developing PPD. Hormonal changes may trigger symptoms of postpartum depression. When you are pregnant, levels of the female hormones estrogen and progesterone are the highest they’ll ever be. In the first 24 hours after childbirth, hormone levels quickly drop back to normal, pre-pregnancy levels. Researchers think this sudden change in hormone levels may lead to depression. This is similar to hormone changes before a woman’s period but involves much more extreme swings in hormone levels.

Levels of thyroid hormones may also drop after giving birth. The thyroid is a small gland in the neck that helps regulate how your body uses and stores energy from food. Low levels of thyroid hormones can cause symptoms of depression. A simple blood test can tell whether this condition is causing your symptoms. If so, your doctor can prescribe thyroid medicine.

The exact causes of PPD are not fully understood, but several factors may contribute to its development, including: 

Hormonal changes after childbirth, Sleep deprivation, Stress and anxiety, History of depression or mental health problems, and Social isolation. 

Who is at risk for PPD?

You may be more at risk of postpartum depression if you:

• Had depression before or during pregnancy
• Have a family history of depression
• Experienced abuse or adversity as a child
• Had a difficult or traumatic birth
• Had problems with a previous pregnancy or birth
• Have little or no support from family, friends, or partners
• If you are now or have experienced domestic violence
• Have relationship struggles, money problems, or experience other stressful life events
• Are under the age of 20
• Have a hard time breastfeeding
• Have a baby who was born prematurely and/or has special health care needs
• Had an unplanned pregnancy

The U.S. Preventive Services Task Force recommends that doctors look for and ask about symptoms of depression during and after pregnancy, regardless of a woman’s risk of depression.

The difference between the “baby blues” and PPD?

Many women have the “baby blues” in the days after childbirth. If you have the baby blues, you may:

• Have mood swings
• Feel sad, anxious, or overwhelmed
• Have crying spells
• Lose your appetite
• Have trouble sleeping

The baby blues usually go away within a few days. The symptoms of postpartum depression last longer, are more severe, and may require treatment by a health care professional. Postpartum depression usually begins within the first month after birth.

What to do if you have PPD symptoms?

Call your doctor, nurse, midwife, or pediatrician if:

• Your baby blues symptoms don’t go away after 2 weeks or are very intense
• Symptoms of depression begin within 1 year of delivery and last more than 2 weeks
• It is difficult to work or get things done at home
• You cannot care for yourself or your baby (e.g., eating, sleeping, bathing)
• Do you have thoughts about hurting yourself or your baby

Ask your partner or a loved one to call for you if necessary. Your doctor, nurse, or midwife can ask you questions to test for depression. They can also refer you to a mental health professional for help and treatment.

What you can do at home to help how you feel

Here are some ways to begin feeling better or getting more rest, in addition to talking to a healthcare professional:

• Rest as much as you can. Sleep when the baby is sleeping.
• Don’t try to do too much or to do everything by yourself. Ask your partner, family, and friends for help.
• Make time to go out, visit friends, or spend time alone with your partner.
• Talk about your feelings with your partner, supportive family members, and friends.
• Talk with other mothers so that you can learn from their experiences.
• Join a support group. Ask your doctor or nurse about groups in your area.
• Don’t make any major life changes right after giving birth. More major life changes, in addition to a new baby, can cause unneeded stress. Sometimes big changes can’t be avoided. When that happens, try to arrange support and help in your new situation ahead of time.

It can also help to have a partner, a friend, or another caregiver who can help take care of the baby while you are depressed. If you are feeling depressed during pregnancy or after having a baby, don’t suffer alone. Tell a loved one and call your doctor right away.  

How is PPD treated?

Working with a healthcare professional is a good way to create a plan that will work for you. Here are some ways to get help—they can be used alone or together:

Treatment for PPD typically involves a combination of therapy and medication: 

• Therapy: Psychotherapy, such as cognitive behavioral therapy (CBT), can help women identify and cope with negative thoughts and behaviors. 
• Medication: Antidepressants may be prescribed to improve mood and reduce symptoms. 
• Therapy: Counseling or therapy sessions with a mental health professional can help you understand and cope with your emotions and challenges.
• Support groups: Joining a support group of others experiencing PPD can provide comfort and understanding.
• Self-care: Taking care of yourself is important. Do your best to get enough rest, eat food with a lot of nutrients like fresh produce and whole grains, be physically active, and ask for help when needed.
• Social support: Reach out to family, friends, or other people you trust who can offer advice or support.
• Medication: In some cases, medicine may be prescribed to help manage symptoms. The most common type is antidepressants. Antidepressants can help relieve symptoms of depression, and some can be taken while you're breastfeeding. Antidepressants may take several weeks to start working.
• The Food and Drug Administration (FDA) has also approved a medicine called brexanolone to treat postpartum depression in adult women.Brexanolone is given by a doctor or nurse through an IV for 2½ days (60 hours). Because of the risk of side effects, this medicine can only be given in a clinic or office while you are under the care of a doctor or nurse. Brexanolone may not be safe to take while pregnant or breastfeeding. Zuranolone, the first oral medication approved to treat postpartum depression, may be another option.
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These treatments can be used alone or together. Talk with your doctor or nurse about the benefits and risks of taking medicine to treat depression when you are pregnant or breastfeeding.

Having depression can affect your baby. Getting treatment is important for you and your baby. Getting help is a sign of strength.

Prevention: 

While PPD cannot always be prevented, certain measures may help reduce the risk: 

• Get adequate sleep before and after childbirth.
• Establish a strong support system of family and friends.
• Seek professional help if you have a history of mental health problems.
• Attend postpartum support groups. 

Complications/Untreated

If left untreated, PPD can have serious consequences for both the mother and the baby, including: 

Increased risk of child neglect or abuse, Difficulty bonding with the baby, delayed developmental milestones in the child, and Chronic health problems for the mother. 

Untreated postpartum depression can affect your ability to parent. You may:

• Not having enough energy
• Have trouble focusing on the baby's needs and your own needs
• Feel moody
• Not being able to care for your baby
• Have a higher risk of attempting suicide

Feeling bad about yourself can make depression worse. It is important to reach out for help if you feel depressed.

Researchers believe postpartum depression in a mother can affect the healthy development of her child, which can cause:

• Delays in language development and problems learning
• Problems with mother-child bonding
• Behavior problems
• More crying or agitation
• Shorter height and higher risk of obesity in preschoolers
• Problems dealing with stress and adjusting to school and other social situations

Postpartum depression is a common and serious condition that can significantly impact women after childbirth. It is important to seek professional help if you experience symptoms of PPD. 

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Resources

https://www.thex-studio.org/resources

Get Help Now. Call 1-833-TLC-MAMA (1-833-852-6262) for 24/7 free, confidential support for pregnant and new moms. 

If you are in mental health distress or have a suicidal crisis, call or text the Suicide and Crisis Lifeline at 988 for free and confidential support.

Suicide and Crisis Lifeline: if you are in crisis, immediately call or text 988 for free access to a trained crisis counselor. TTY users can use a preferred relay service or dial 711 then 988

National Maternal Mental Health Hotline: call or text 1-833-TLC-MAMA (1-833-852-6262). TTY users can use a preferred relay service or dial 711 and then 1-833-852-6262.

Postpartum Support International: visit the Postpartum Support International website for additional resources for women and their support networks.

For more information about the Talking PPD campaign and how you can support women experiencing PPD, contact the Office on Women’s Health at:

Email: womenshealth@hhs.gov

OWH HELPLINE: 1-800-994-9662, available Monday–Friday, 9 a.m. — 6 p.m. ET

OWH and the OWH helpline do not see patients and are unable to: diagnose your medical condition; provide treatment; prescribe medication; or refer you to specialists. The OWH helpline is a resource line. The OWH helpline does not provide medical advice. 

For immediate assistance getting help for finding care, you can access:

Suicide and Crisis Lifeline: call or text 988 for free access to a trained crisis counselor. TTY users can use a preferred relay service or dial 711 then 988

National Maternal Mental Health Hotline: call or text 1-833-TLC-MAMA (1-833-852-6262). TTY users can use a preferred relay service or dial 711 and then 1-833-852-6262.

• Call or text the Suicide and Crisis Lifeline at 988 for free access to a trained crisis counselor who can support you and connect you with additional help and resources. If you’re deaf or hard of hearing, use your preferred relay service or dial 711 then 988.
• Call or text the National Maternal Mental Health Hotline at 1-833-TLC-MAMA (1-833-852-6262) for 24/7 free access to professional counselors. If you’re deaf or hard of hearing, use your preferred relay service or dial 711 then 1-833-852-6262.
• Call or text “Help” to the Postpartum Support International helpline at 1-800-944-4773 for PPD information, resources, and support groups for women, partners, and supporters.
• Local resources can be identified in many ways:

• Ask a healthcare professional or find a local health center.
• Reach out to local organizations like social service agencies, family resource centers, libraries, community centers, or places of worship.
• Look for support groups in your area, such as new moms’ groups, breastfeeding support groups, or a baby café. See if there are mother/baby exercise programs in your community.

https://womenshealth.gov/talkingPPD/toolkit?utm_medium=email&utm_source=govdelivery

https://www.thecounselingco.com/blog?ss_source=sscampaigns&ss_campaign_id=67d1a0131eeb572ead3265aa&ss_email_id=67d1bdaa65db4d3e63f88fde&ss_campaign_name=Postpartum+Anxiety%3A+it+can+be+sneaky&ss_campaign_sent_date=2025-03-12T17%3A00%3A52Z

https://www.sciencedirect.com/science/article/pii/S0010440X24000075#:~:text=Although%20both%20Diagnostic%20and%20Statistical,for%20PPD%20disorder%20as%20a

Sources

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2. Schiller, C.E., Meltzer-Brody, S., Rubinow, D.R. (2014). The Role of Reproductive Hormones in Postpartum Depression. CNS Spectrums; 20(1): 48–59.
3. Sit, D.K., Wisner, K.L. (2009). The Identification of Postpartum Depression. Clinical Obstetrics and Gynecology; 52(3): 456–468.
4. U.S. Preventive Services Task Force. (2016). Depression in Adults: Screening .
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6. U.S. Food and Drug Administration. (2019). FDA approves first treatment for post-partum depression.
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8. Surkan, P.J., Ettinger, A.K., Hock, R.S., Ahmed, S., Strobino, D.M., Minkovitz, C.S. (2014). Early maternal depressive symptoms and child growth trajectories: a longitudinal analysis of a nationally representative US birth cohort . BMC Pediatrics; 14: 185.
9. Benton, P.M., Skouteris, H., Hayden, M. (2015). Does maternal psychopathology increase the risk of pre-schooler obesity? A systematic review . Appetite; 87(1): 259–282.
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