Perinatal depression and postpartum psychosis !

Depression during pregnancy or in the year after birth, ranging from short-lived postpartum blues to major depression and the emergency of postpartum psychosis.

Updated 2026-11-01

Structures involved

Tap one to see what it is and open it in 3D.

What it is

A spectrum of mood disorders linked to pregnancy and the months after childbirth. Postpartum blues are brief and mild; perinatal depression is a major depressive episode starting in pregnancy or after delivery; postpartum psychosis is a rare psychiatric emergency, usually an episode of bipolar disorder, with risk to the mother and baby.

Who gets it

Depression is the most common mental disorder in pregnancy and the postpartum period worldwide, affecting roughly one in ten pregnant women and more after birth, with higher rates in low- and middle-income countries. In Colombia, maternal mental health is part of the maternal-perinatal care route, and suicide is recognised as a cause of maternal death. Postpartum blues affect most new mothers; postpartum psychosis occurs in about 1 to 2 per 1,000 births.

Causes

Abrupt fall in oestrogen and progesterone after delivery in women with heightened sensitivity to hormonal change
Genetic vulnerability to mood disorders, especially bipolar disorder in postpartum psychosis
Psychosocial stressors: lack of support, partner violence, poverty, unwanted pregnancy
Sleep deprivation and the physical demands of caring for a newborn

Risk factors

Previous depression or perinatal depression
Personal or family history of bipolar disorder or postpartum psychosis
Intimate partner violence, lack of social support or adolescent pregnancy
Pregnancy complications, preterm birth or a baby in neonatal intensive care
Stopping a mood-stabilising or antidepressant medicine during pregnancy
Thyroid dysfunction after delivery

Pathophysiology

The large and rapid drop in placental sex hormones after birth, together with changes in the stress axis (hypothalamic-pituitary-adrenal) and in thyroid function, alters mood-regulating circuits in vulnerable women. Sleep loss and psychosocial stress add to this. In postpartum psychosis, the same triggers unmask an underlying bipolar-spectrum vulnerability.

Classification

Postpartum blues: tearfulness and mood swings starting within days of birth, peaking around day 5 and resolving within about 2 weeks, with normal function
Perinatal depression: a major depressive episode with onset in pregnancy or within the first weeks to months after delivery, lasting at least 2 weeks and impairing function
Postpartum psychosis: abrupt onset, usually in the first 2 weeks after birth, with confusion, mood swings, delusions or hallucinations

Symptoms and signs

Persistent low mood, tearfulness or irritability
Loss of interest or pleasure, including in the baby
Sleep and appetite changes beyond those expected with a newborn
Excessive guilt, feeling a bad mother, hopelessness
Anxiety and intrusive worries about harm coming to the baby
In psychosis: confusion, agitation, delusions (often about the baby) and hallucinations

Diagnosis

Clinical: Clinical interview using major depression criteria with a perinatal onset. Screening with the Edinburgh Postnatal Depression Scale (EPDS) during pregnancy and at postpartum visits, always asking directly about suicidal thoughts and thoughts of harming the baby. Postpartum blues are distinguished by their short duration and preserved function.
Tests: Thyroid function tests, complete blood count for anaemia, and glucose. In postpartum psychosis, basic labs and toxicology to exclude organic causes of delirium (infection, electrolyte disturbance).
Imaging: Not routinely needed. Brain imaging when psychosis or confusion has atypical features or focal neurological signs (for example, suspected cerebral venous thrombosis or eclampsia-related changes).

Differential diagnosis

Postpartum blues
Bipolar disorder with a postpartum episode
Postpartum thyroiditis or hypothyroidism
Anaemia and sleep deprivation
Delirium from infection, eclampsia or other medical causes

Goal of treatment

Keep mother and baby safe, relieve symptoms, support bonding and breastfeeding when possible, and prevent relapse in future pregnancies.

Treatment

Acute: Postpartum psychosis is a psychiatric emergency: hospital admission, ideally in a mother-baby unit, with antipsychotics, mood stabilisers or, in severe cases, electroconvulsive therapy.
Conservative: Mild to moderate perinatal depression: psychotherapy (cognitive behavioural or interpersonal therapy), psychoeducation and practical and family support; stepped care can be delivered by trained non-specialist providers.
Medical: Moderate to severe depression: antidepressants, usually SSRIs such as sertraline, weighing benefits and risks in pregnancy and breastfeeding.
Medical: Brexanolone and zuranolone, neurosteroid GABA-A modulators, are approved in some countries specifically for postpartum depression.
Follow-up: Nursing care: screening at each prenatal and postnatal visit, suicide and infant-safety assessment, sleep protection, observation of mother-infant interaction and referral pathways.

Complications

Maternal suicide
Infanticide in postpartum psychosis
Impaired bonding and poorer infant emotional and cognitive development
Early cessation of breastfeeding
Recurrence in later pregnancies and chronic depression

Prognosis

Postpartum blues resolve on their own. Perinatal depression responds well to treatment, but untreated cases can last months and affect the child. Most women with postpartum psychosis recover fully with treatment, but the risk of recurrence after future deliveries and of later bipolar episodes is high.

Prevention

Routine screening for depression in pregnancy and after birth
Planning care in pregnancy for women with a history of bipolar disorder or postpartum psychosis
Social support, partner involvement and attention to intimate partner violence

Test yourself

Think of the answer, then tap the question to see it.

How are postpartum blues distinguished from postpartum depression?

Blues are mild, start within days, resolve within about 2 weeks and do not impair function; depression lasts at least 2 weeks and impairs function.

Which screening tool is widely used for perinatal depression?

The Edinburgh Postnatal Depression Scale (EPDS).

Postpartum psychosis is most strongly linked to which underlying disorder?

Bipolar disorder.

What is the most urgent nursing priority in a mother with postpartum psychosis?

Safety of mother and baby: assessing suicidal and infanticidal thoughts and arranging urgent psychiatric care.

Which laboratory test should be checked to exclude a medical cause of postpartum depression?

Thyroid function (postpartum thyroiditis).

Add to my cards (5)

Educational information, not medical advice. For any symptom, see a health professional.

Sources: Postpartum depression (MedlinePlus (U.S. National Library of Medicine), 2025); Perinatal Depression (National Institute of Mental Health (NIMH), 2024); Perinatal mental health (World Health Organization (WHO), 2025).

← All conditions

Spotted a mistake?We are always improving for the community. Tell us what is wrong and our team will review it.Report a mistake

Representative model, for educational purposes only.

Hypothalamus highlighted on the Durgical 3D model