If you are in danger now: in Ireland call 112 or 999, or go to an emergency department. In the UK call 999 or go to A&E. In the US call 911.
Free support, any time: Samaritans 116 123 (Ireland and UK). Pieta 1800 247 247, or text HELP to 51444 (Ireland). Text 50808 (Ireland). Call, text or chat 988 (US). National Maternal Mental Health Hotline 1-833-852-6262, call or text (US).
Thoughts of harming yourself or your baby need help today, not next week.
Postpartum depression, usually called postnatal depression in Ireland and the UK, is depression after having a baby. It affects more than 1 in 10 women within a year of giving birth, and it is treatable. The clearest way to tell it from the baby blues is time. The blues start a few days after birth and usually pass within two weeks. Depression lasts longer, gets worse, or stops you coping. Postpartum psychosis is different again: rare, sudden, usually in the first two weeks, and a medical emergency. Treatment rests on talking therapy, antidepressants, or both. Many antidepressants can be used while breastfeeding. If any of this sounds familiar, tell your GP, midwife, public health nurse, health visitor or obstetrician.
The HSE notes that postnatal depression can start as the baby blues and then get worse. So the question is not only "how bad is it?" but "is it lifting?"
The NHS lists these symptoms:
Some parents have frightening, repeated thoughts about their baby coming to harm. The HSE says very few mothers ever act on these thoughts. Please do not let them stop you asking for help. You may fear your baby will be taken away if you ask for help. The NHS says this is very rare.
Our piece on postpartum brain fog covers the overlap with sleep loss, thyroid problems and iron deficiency. If worry is the main feature, see anxiety as a feeling versus a disorder.
Signs include hallucinations, delusions (beliefs very unlikely to be true), feeling very "high" with racing thoughts, severe low mood or rapid swings, and confusion.
The person may not realise they are ill. Partners and family often have to act for them. In Ireland, contact the GP, midwife, public health nurse or mental health service urgently, or go to an emergency department. In the UK, ask a GP for same-day assessment, call 111, or call 999 if anyone is in danger.
The risk is higher if you have bipolar disorder, have had postpartum psychosis before, or have a close relative who has. NICE says a woman with sudden symptoms should be assessed by a specialist mental health service within 4 hours of referral. Most people make a full recovery with treatment.
The NHS lists past or current mental health problems, recent hard life events, and a premature or unwell baby or twins. Little support, relationship problems and domestic abuse also count. It can happen with none of these.
NICE suggests asking two questions early in pregnancy and after birth. In the past month, have you often felt down, depressed or hopeless? Have you often had little interest or pleasure in doing things? A "yes" to either can lead to a fuller assessment.
That assessment often uses the Edinburgh Postnatal Depression Scale (EPDS). It is a 10-item questionnaire that takes about five minutes. In Ireland, public health nurses screen for postnatal depression, usually at the first visit after birth. In the US, the US Preventive Services Task Force recommends depression screening for adults, including pregnant and postpartum women.
A score is not a diagnosis. A 2020 analysis pooled data from 15,557 women in 58 studies. Against semi-structured clinical interviews, a cut-off of 11 or more picked up 81% of women with major depression. A cut-off of 13 or more picked up only 66%. So a low score with ongoing symptoms still deserves a proper conversation.
NICE guideline CG192 covers mental health in pregnancy and the first year after birth in England. It sets out a stepped approach:
NICE also says women should be assessed within 2 weeks of referral. Psychological therapy should start within 1 month of that assessment. Women needing hospital care within a year of birth should normally go to a mother and baby unit.
The HSE describes a similar approach in Ireland. Counselling alone can help in less severe postnatal depression. In more severe illness it works well alongside medicine. For how these treatments compare in depression generally, see depression: what actually works.
Both the NHS and HSE say your doctor can choose an antidepressant suitable for breastfeeding. Tell them you are breastfeeding before anything is prescribed.
NICE asks prescribers to weigh three things together. The benefits of breastfeeding. The uncertainty about these drugs for the breastfed baby. And the risks of stopping or switching a medicine that has been working. Specialist advice is recommended where there is doubt.
Prescribers use lactation references such as LactMed, a US National Library of Medicine database. For sertraline, it reports low levels in breast milk. It notes most authoritative reviewers consider it a preferred antidepressant during breastfeeding. Babies born prematurely or unwell need extra care, so specialists advise on those cases individually. In the UK, the NHS Specialist Pharmacy Service advises health professionals on medicines in breastfeeding.
What to expect, according to the NHS:
What SSRIs actually do explains how these medicines work and what stopping involves.
Brexanolone (Zulresso) was the first drug approved specifically for postpartum depression, by the US FDA in March 2019. It was a 60-hour intravenous infusion, given only in certified settings because of risks of excessive sedation and sudden loss of consciousness. Its maker stopped marketing it. The FDA withdrew its approval from 14 April 2025, and gave no safety or effectiveness reason. It does not appear in the European Medicines Agency's medicines list.
Zuranolone (Zurzuvae) is a capsule taken once a day for 14 days. The FDA approved it in August 2023 as the first oral treatment for postpartum depression. One trial included 196 women with severe postpartum depression. By day 15, depression scores fell 15.6 points on zuranolone and 11.6 on placebo. That 4-point difference was statistically significant. Women on placebo also improved a lot, which matters when reading the headline.
The US label carries a boxed warning: zuranolone can impair driving. People should not drive or use heavy machinery for at least 12 hours after a dose. It can cause suicidal thoughts and behaviour. It may harm an unborn baby, so effective contraception is needed during treatment and for a week after.
Availability differs by country:
The NHS says fathers and partners can also develop depression after a baby arrives. The HSE puts it at up to 1 in 10 partners. A 2010 review of 43 studies and 28,004 people estimated 10.4% of fathers had depression in pregnancy or the first year. Studies varied widely, and fathers' depression was moderately linked with mothers'. If one parent is struggling, check on the other.
You may see supplements promoted for postpartum mood. The US Preventive Services Task Force found limited or mixed evidence that dietary supplements prevent perinatal depression. Our review of omega-3 and postpartum depression found mixed results, with the best-controlled trials showing no effect. No supplement replaces assessment, therapy or medication.
Yes. The HSE says postnatal depression can start as the baby blues and get worse. If low mood has not lifted after two weeks, speak to your GP, midwife or public health nurse.
Often, yes. The NHS and HSE both say doctors can prescribe antidepressants suitable for breastfeeding. Tell your prescriber you are breastfeeding, and mention if your baby was premature or is unwell.
The NHS says this is very rare. The vast majority of women with postnatal depression are treated at home with their baby, according to the HSE.
It is licensed in both. In the UK, NICE has not yet issued final guidance, with a decision expected in late November 2026. In Ireland, we could not confirm HSE availability. Ask your perinatal mental health team.
This article is general information, not medical advice. It does not replace assessment or treatment by a qualified health professional. If you are worried about yourself or someone else, contact your GP or the crisis services listed above.
Reviewed by: Proco Team
Last updated: November 2026