Understanding the Onset of Postpartum Depression: When Does It Start?

Postpartum depression is depression that occurs after giving birth. It affects approximately 1 in 7 people who give birth. Postpartum depression risk factors include having a current or past mood disorder, having gone through a difficult birth, lacking support, or experiencing stressful life events after birth. Knowing the risk factors and warning signs can help you identify if and when it starts.

This article covers when postpartum depression starts, the early warning signs, and how to get help.

What Factors Influence the Onset of Postpartum Depression?

Postpartum depression occurs for a combination of reasons. Biologically, this includes hormonal changes after giving birth, specifically a fast drop in estrogen and progesterone in the first day after birth and dropping levels of thyroid hormones in the days and months after birth.

Socially and emotionally, childbirth is a significant transition that can be associated with stress, worry, anxiety, and loss of identity—among other challenges.

Contributing factors to postpartum depression include:

• Difficulty breastfeeding
• Difficult or traumatic birth
• Domestic violence, current or in the past
• Lack of social support
• Personal or family history of mental health issues
• Premature birth
  
• Previous birth with associated trauma
  
• Stressful life events during pregnancy or the postpartum period
• Surviving childhood abuse or adversity
• Unplanned pregnancy
• Young age (younger than 20)
  

When Does Postpartum Depression Start?

Most cases of postpartum depression start between four and eight weeks after childbirth. However, postpartum depression symptoms can occur as soon as 24 hours to as late as months after giving birth.

While the American Academy of Pediatrics advises screening for postpartum depression up to six months post-birth, some research suggests that healthcare providers should screen for postpartum depression for up to three years after giving birth. This is in light of evidence that postpartum depression can develop after the traditional six-month mark in some cases.

A subgroup of people with postpartum depression develops symptoms closer to a year after birth. One study by the Centers for Disease Control and Prevention (CDC) found that 7.2% of birthing parents had postpartum depression nine or 10 months after birth.

Of these people, nearly 60% had not had any depressive symptoms at their two- and six-month postpartum screenings.

Depression related to childbirth can also develop before birth; this is called prenatal depression. Both prenatal depression and postpartum depression make up perinatal depression, which is depression that occurs during pregnancy up to one year after childbirth.

Early Warning Signs of Postpartum Depression

Specific symptoms can indicate the onset of postpartum depression. Knowing the following symptoms and warning signs can help you get timely and appropriate treatment.

Emotional Symptoms 

Emotional symptoms of postpartum depression include how you feel, which—in some cases—can manifest as certain observable behaviors.

Emotional symptoms include:

• Anxiety
  
• Hopelessness
• Irritability or anger
• Mood swings
• Sadness
• Shame or guilt
• Worthlessness

Physical Symptoms 

Postpartum depression can also affect you physically. There are many physical changes after giving birth and adjusting to life with an infant. Part of the challenge is determining if the symptoms are atypical and more serious.

Physical symptoms of postpartum depression include:

• Appetite changes, such as eating more or less
• Crying episodes
  
• Fatigue and exhaustion
  
• Sleep disturbances
  

Behavioral Symptoms 

There are also behavioral symptoms associated with postpartum depression, specifically, changes in how you interact with your baby, partner, friends, family, and yourself.

Behavioral symptoms of postpartum depression include:

• Difficulty bonding with the baby
• Loss of interest in hobbies or activities you previously enjoyed
• Thoughts of harming yourself or the baby
• Withdrawal from family and friends

Baby Blues vs. Postpartum Depression

The "baby blues" is a common experience of sadness, overwhelm, and low-level depressive symptoms after childbirth. Considering the massive life transition of caring for an infant, these feelings are normal. However, the baby blues is not the same as postpartum depression.

Between 50% and 85% of birthing parents will develop the baby blues. They typically start around two to four days after birth and last less than two weeks. The baby blues are different from postpartum depression, which typically lasts longer than two months and does not go away without treatment.

Symptoms of the baby blues can be similar to postpartum depression. However, the baby blues are less severe and shorter-lived. These include:

• Anxiety
• Appetite loss
• Crying episodes
• Difficulty sleeping
• Mood swings
• Overwhelm
• Sadness
• Trouble concentrating
  

How to Get Help for Postpartum Depression

Since postpartum depression generally does not go away without treatment, it's important to understand how to get treatment.

It can be challenging for new parents to speak openly about their symptoms. You may think feeling this way is a "normal" part of being a new parent, or you may feel guilt or shame for feeling sad during what is expected to be a joyous phase of life.

The truth is that although new parenthood can be hard, it shouldn't cause depression. Talk to your partner, friends, family, and medical professionals about your symptoms to begin the diagnosis process.

Healthcare providers treat postpartum depression with a combination of talk therapy and antidepressants. A medication called Zulresso (brexanolone), which is delivered via a 60-hour continuous intravenous fluid after birth, is another option.

In 2023, the Food and Drug Administration (FDA) approved Zurzuvae (zuranolone), the first oral medication to treat postpartum depression.

Support groups are also beneficial for coping with postpartum depression and connecting to others in a similar situation.

Summary

Postpartum depression is depression that occurs within one year after childbirth. However, the reality of when postpartum depression starts is more complicated.

The general consensus among researchers is that most of the time, postpartum depression occurs within four to eight weeks after birth. However, emerging research indicates that it can also develop later (nine or 10 months after birth), with symptoms continuing potentially for years.

It can be hard to seek help and support for postpartum depression for a variety of reasons, but mental health should be a priority. Treatments, including talk therapy and medication, can bring relief to postpartum symptoms.