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Postpartum depression, anxiety and rage: signs and help

If you need help right now

  • Thoughts of harming yourself or your baby: call or text 988, or the National Maternal Mental Health Hotline, 1-833-TLC-MAMA (1-833-852-6262). Both are free, confidential and open 24/7 [1].
  • Seeing or hearing things others don’t, strange beliefs or paranoia, or barely sleeping at all: that can be postpartum psychosis. It’s an emergency. Call 911 or go to the emergency room [2].
  • Not an emergency, but not OK: call your OB, midwife or primary care doctor today, or tell your baby’s pediatrician. You don’t need to wait for a checkup [3].

The short answer

  • Postpartum depression is common, and it’s treatable with talk therapy, medicine or both [3][4].
  • It isn’t only sadness. It can look like anxiety, anger, numbness or scary thoughts you can’t shake [2][4].
  • It can start any time in the first year, not just the first weeks [3].
  • It can happen to any parent: after a first baby or a fourth, after adoption, and to partners too [2][5][6].
  • Many treatments are safe while breastfeeding or chestfeeding [7].

Baby blues or something more?

Baby blues Postpartum depression or anxiety
Starts 2 to 3 days after birth [3] Most often 1 to 3 weeks after birth, but any time in the first year [3]
Lasts Days, up to 2 weeks [3] Weeks or months without help [4]
Feels like Up and down, tearful, still yourself underneath Heavy, constant, hard to do daily tasks [3]
Needs Rest, food, support A call to your provider [3]

More on the first weeks in baby blues and the hormone crash.

The signs, by type

These often overlap. You don’t need to know which one it is. You only need to tell someone.

Depression

Feeling sad, empty or hopeless most of the day. Losing interest in things. Feeling worthless or guilty, like a bad parent. Trouble bonding with the baby. Sleeping too much or not at all, even when the baby sleeps. Thoughts of death or of hurting yourself [3][4].

Anxiety

Constant worry you can’t switch off. Racing thoughts. Feeling something terrible is about to happen. Checking the baby again and again. A racing heart, tight chest or dizziness. Not being able to sleep even when you finally can [2].

Rage

Sudden anger that feels out of proportion: at your partner, at noise, at the dishwasher. Snapping, shouting, then guilt. It’s a recognized sign of postpartum depression and anxiety [2]. It’s a reason to get help, not a sign you’re a bad parent.

Intrusive thoughts and OCD

Many new parents get sudden, unwanted pictures of something bad happening to the baby: dropping them, hurting them by accident. When those thoughts horrify you and you work to avoid them, that’s the pattern of perinatal OCD [2]. It’s distressing, and it’s treatable. It’s very unlikely you’ll act on the thoughts [8]. Tell your provider exactly what the thoughts are. They have heard it before.

Psychosis

Rare: about 1 to 2 in every 1,000 births [2]. It usually starts in the first 2 weeks, but can start later in the first year [2]. Signs include seeing or hearing things others don’t, strange beliefs, paranoia, severe agitation, and barely sleeping or not sleeping at all [2]. It’s an emergency. Call 911, and stay with the parent and baby until help comes [2].

Screening: the questionnaire you’ll be handed

You’ll probably be asked about your mood:

  • at your own postpartum visits [9];
  • at your baby’s checkups. The AAP recommends screening the birthing parent at the 1-, 2-, 4- and 6-month visits [10].

The most common form is the Edinburgh Postnatal Depression Scale: 10 questions about the last 7 days [7][10]. Answer honestly. A high score doesn’t take your baby away. It opens the door to help.

Treatment

Your provider will talk through options. Common ones:

  • Talk therapy. Cognitive behavioral therapy and interpersonal therapy both have good evidence for perinatal depression [4].
  • Antidepressants. Many can be used while breastfeeding or chestfeeding. Your provider can check each one against the milk-safety data [7].
  • Zuranolone (Zurzuvae). The first pill approved specifically for postpartum depression, by the FDA in 2023. It’s taken for 14 days. You can’t drive or do other risky tasks for at least 12 hours after each dose [11]. It passes into breast milk, and its effect on breastfed babies isn’t yet clear, so talk through feeding with your provider [3].
  • Support groups, in person or online. Postpartum Support International runs free online groups every week [12].

Treatment works best combined with the basics you can’t do alone: sleep, food, and someone else holding the baby.

What to say to your provider

You can read this out:

“Since the baby came, I’ve been feeling [sad / anxious / angry / numb / having scary thoughts] most days, for [how long]. It’s getting in the way of [sleeping / eating / looking after the baby / enjoying anything]. I’d like to be checked for postpartum depression or anxiety.”

For partners

  • Watch for the signs above, and for withdrawal, not eating, or “I’m fine” that doesn’t sound fine. You may notice before they do.
  • Say what you see, kindly. “You don’t seem like yourself. I’m worried. Can I call the doctor with you?”
  • Take a night feed, or a whole night, so they get one long sleep.
  • Make the call or book the appointment if they can’t face it.

Partners get depressed too. A 2010 review of 43 studies found depression in about 1 in 10 fathers during pregnancy and the first year after birth [5]. The research studied fathers, but the advice is the same for any partner. Tell your own doctor. The hotline and 988 are for you too [1].

Help lines

  • National Maternal Mental Health Hotline: call or text 1-833-TLC-MAMA (1-833-852-6262), 24/7, in English and Spanish [1].
  • 988 Suicide & Crisis Lifeline: call or text 988 [1].
  • Postpartum Support International HelpLine: call 1-800-944-4773, or text “Help” to the same number (Spanish text: 971-203-7773). Leave a message and a trained volunteer calls back, 8am to 11pm Eastern. It connects you with local support and providers. It’s not a crisis line [13].

Sources

  1. Health Resources and Services Administration (HRSA), “National Maternal Mental Health Hotline.” mchb.hrsa.gov, and 988 Suicide & Crisis Lifeline. 988lifeline.org
  2. Postpartum Support International, “About Perinatal Mental Health.” postpartum.net
  3. American College of Obstetricians and Gynecologists, “Postpartum Depression.” acog.org
  4. National Institute of Mental Health, “Perinatal Depression.” nimh.nih.gov
  5. Paulson JF, Bazemore SD, “Prenatal and Postpartum Depression in Fathers and Its Association With Maternal Depression: A Meta-analysis,” JAMA 2010;303(19):1961–1969. doi.org
  6. Postpartum Support International, “Adoptive and Birth Mothers.” postpartum.net
  7. HealthyChildren.org (AAP), “Postpartum Depression & Breastfeeding.” healthychildren.org
  8. International OCD Foundation, “Perinatal OCD Overview.” iocdf.org
  9. American College of Obstetricians and Gynecologists, Clinical Practice Guideline No. 4, “Screening and Diagnosis of Mental Health Conditions During Pregnancy and Postpartum” (2023). acog.org
  10. Earls MF, et al., “Incorporating Recognition and Management of Perinatal Depression Into Pediatric Practice,” Pediatrics 2019;143(1):e20183259 (AAP clinical report). doi.org
  11. US Food and Drug Administration, “FDA Approves First Oral Treatment for Postpartum Depression” (4 August 2023). fda.gov
  12. Postpartum Support International, “Weekly Online Support Group.” postpartum.net
  13. Postpartum Support International, “Call or Text the PSI HelpLine.” postpartum.net

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