Postpartum depression: recognizing the symptoms and finding help

Postpartum depression is a depressive disorder that occurs within the year following childbirth, lasts more than two weeks, and disrupts daily life. It affects between 10% and 20% of women after giving birth. It is neither a sign of weakness nor a lack of love for your baby: it is a common illness, and it is treatable.

You are expected to be happy, radiant, fulfilled. Yet you feel empty, exhausted, and guilty for not feeling the promised joy. If this resonates with you, we explain how to recognize postpartum depression, why it occurs, and how to overcome it.

Need help now? If you are having suicidal thoughts or feel that you can no longer take care of your baby, call 3114 (national suicide prevention hotline, free, 24/7). In an emergency, call 15 or 112.

Postpartum depression in numbers

You are not alone. According to the Île-de-France Regional Health Agency, postpartum depression affects between 10% and 20% of women after childbirth, which is between one in ten and one in five women.

The 2021 national perinatal survey estimates it at 16.7% two months after birth, according to Assurance Maladie.

However, the illness often remains underdiagnosed. Many women do not dare to talk about it, out of guilt or fear of being judged. If you are in the postpartum period and feel unwell, you are not the only one.

Postpartum depression and baby blues: what is the difference?

The two look similar at first, but they have neither the same duration nor the same severity. Baby blues is a very common emotional phase that disappears on its own. Postpartum depression is an illness that requires medical care.

To learn all about the former, read our article on the baby blues after childbirth. If your malaise lasts more than two weeks or worsens, talk to a healthcare professional.

Symptoms of postpartum depression

Symptoms vary greatly from one woman to another, which partly explains why the illness often goes unnoticed. Here are the signs to watch for.

Emotional and psychological signs

• Lasting sadness: you feel empty or sad for no apparent reason, and rest does not help.
• Overwhelming guilt: you think you are a bad mother, not up to the task.
• Loss of pleasure: things you used to enjoy now leave you indifferent, including moments with your baby.
• Intense anxiety, focused on your baby's health or your ability to protect them.
• Intrusive thoughts: fear of harming them or dropping them. These are known as impulse phobias.

These thoughts are very distressing, but they are part of the anxiety: they do not mean you will act on them. Talk to a professional about them anyway. The sooner you speak up, the sooner you will receive help.

Physical and behavioral signs

• Sleep disturbances, even when your baby is sleeping: you are exhausted, but your thoughts keep you awake.
• Profound fatigue, different from typical postpartum fatigue.
• Loss of appetite, or conversely, the urge to eat without feeling hungry.
• The feeling of doing everything in slow motion, with a huge effort required for simple tasks.
• Headaches, muscle pain, or digestive issues with no identified cause.
• Difficulty concentrating or making decisions.

Signs related to the bond with your baby

• The feeling of not knowing how to take care of them, or failing to build a bond.
• Irritability, or even the impression of rejecting your child.
• In more severe forms, indifference towards your baby or those around you. This is not a lack of love: it is a symptom of depression.

One or more of these signs lasting more than two weeks, or preventing you from functioning in daily life, justify a consultation. A diagnosis is never made alone: it is done by a healthcare professional.

When to seek emergency help?

Certain situations require immediate help:

• you have suicidal thoughts or the urge to harm yourself;
• you fear that you can no longer protect your baby or protect yourself;
• you are confused, disoriented, or have delusional ideas, especially centered on your baby;
• your mood shifts very abruptly.

In these cases, call 15 or 112, go to the emergency room, or contact 3114. Do the same if you observe these signs in a new mother.

Postpartum psychosis is rare (1 to 2 births per 1,000, most often within 4 weeks after birth), but it is a psychiatric emergency. According to Assurance Maladie, it is treated in a hospital, if possible in a mother-baby unit.

Causes and risk factors

There is no single cause. Postpartum depression results from a combination of biological, psychological, and social factors. It can also occur after a pregnancy and birth with no issues whatsoever.

Hormones, sleep, and biology

After childbirth, estrogen and progesterone levels drop sharply. According to the MSD Manuals, the exact cause remains unknown, but this hormonal drop, sleep deprivation, and genetic predisposition can contribute to it.

A postpartum thyroid disorder can also cause fatigue and low mood. Your doctor can check for this via a blood test if your symptoms justify it.

Personal history

• Depression before or during pregnancy, or after a previous pregnancy: this is one of the most significant risk factors.
• Marked sadness during periods or while using hormonal contraception.
• Family history of depression or bipolar disorder.
• A very pronounced baby blues that does not go away and worsens.

The experience of pregnancy and childbirth

• Unplanned pregnancy, or ambivalence towards the pregnancy, including if an abortion was considered.
• Difficult obstetric history, such as a miscarriage or a premature birth.
• A birth experienced as traumatic, or a complication (preeclampsia, hemorrhage, infection).
• A premature or hospitalized baby, involving separation from you.

Life context

• Isolation and insufficient support: according to the 2021 national perinatal survey, more than a third of women have fewer than three relatives to turn to in the event of great difficulty.
• Tensions in the couple or an uninvolved partner.
• Financial difficulties or difficult living conditions.

Your body also needs specific care after childbirth. Our article on postpartum care provides an update on physical recovery.

Why it often goes unnoticed

1. Atypical forms are common. Depression can hide behind physical symptoms: you consult for headaches or fatigue, not to talk about your mood.
2. Asking for help is difficult. Guilt ("I have a healthy baby, I shouldn't complain"), fear of judgment, and stigma hold many women back.
3. All eyes are on the baby. During the first few weeks, the mother becomes invisible.
4. Symptoms are trivialized. Fatigue, crying, broken sleep: all of this resembles the daily life of a newborn.

This is why follow-up appointments exist. The mandatory early postnatal visit takes place between the 4th and 8th week after childbirth with a midwife or a doctor. It is intended, among other things, to identify the first signs of depression.

You can also talk about it during the postnatal check-up (6 to 8 weeks), or at any time with your primary care physician.

The EPDS scale: a screening tool

To help with identification, professionals use the EPDS (Edinburgh Postnatal Depression Scale). According to the Île-de-France Regional Health Agency, it is a self-administered 10-question questionnaire that allows for the assessment of postpartum depression risk based on a score.

Each question is scored from 0 to 3, for a total out of 30. A high score does not provide a diagnosis: it indicates that an in-depth evaluation with a psychiatrist or psychologist is useful. The threshold used varies among professionals, often around 10 to 13.

The questionnaire is available online, notably on the "1000 premiers jours" site relayed by Assurance Maladie. Fill it out, then show the result to your doctor or midwife.

What are the consequences if it is not treated?

Without treatment, postpartum depression can last for several months or even years. It affects both the mother and the child.

Suicide risk

This is the most serious complication. According to Assurance Maladie, suicide is the second leading cause of mortality during the postpartum period. The 2021 national perinatal survey indicates that about one in twenty women has suicidal thoughts two months after giving birth.

Talking about it to a professional or calling 3114 can truly protect you.

The bond with your baby

When you are depressed, it becomes harder to respond to your baby's needs and offer constant care. Attachment can then become more fragile.

According to Assurance Maladie, the babies concerned may have more difficulty interacting, sleep disorders, or more colic. The good news: with treatment, postpartum depression usually heals within the first year. Taking care of yourself also means taking care of your child.

How is postpartum depression treated?

According to Assurance Maladie, early outpatient care, without hospitalization, is usually sufficient. It combines several approaches depending on the severity.

Psychological support

Supportive psychotherapy or cognitive-behavioral therapy (CBT) can be offered by a psychologist or psychiatrist, ideally trained in perinatal care. The "Mon soutien psy" scheme allows for sessions covered by Assurance Maladie.

Antidepressants

Depending on the severity, psychotherapy is associated with an antidepressant, most often a selective serotonin reuptake inhibitor (SSRI). The effects are not immediate: it takes several weeks to assess the benefit.

Your doctor will take your wish to breastfeed into account to adapt the treatment. Never stop treatment without medical advice.

Severe forms

In case of very severe depression, suicidal risk, or psychotic symptoms, hospitalization may be necessary, if possible in a mother-baby unit to preserve the bond with your child.

Support from loved ones

Your partner and loved ones play an essential role: listening without judging, taking over at night, handling meals and daily tasks.

You can also contact the Maman Blues association, or call "Allô Parent-Bébé" at 0 800 00 34 56 (free call).

What can help you on a daily basis

These actions do not replace medical follow-up, but they support your recovery.

• Sleep: sleep when your baby sleeps, and ask your partner or a loved one to take over for a night so you can sleep without interruption.
• Diet: eat as much as you need, in a varied way. You will find guidelines without dieting in our article on postpartum nutrition.
• Movement: a daily walk, gentle yoga, or dancing, starting slowly.
• Social connection: join a support group or a mothers' group. Talking to women who have experienced the same thing breaks the isolation.
• Calming: breathing, meditation, or writing can calm anxiety. Choose what makes you feel good.
• Intimacy: a drop in libido postpartum is common, with or without depression. No pressure: desire returns at its own pace.

If you wish to supplement your diet, a postpartum cure can provide nutritional support after childbirth. It is not a treatment for depression, and it does not replace medical or psychological follow-up.

Can it be prevented?

Not always, but we can reduce the risks and identify the illness earlier. If you have multiple risk factors, anticipate:

• talk to your doctor or midwife during pregnancy;
• take advantage of the early prenatal visit, offered from the 4th month of pregnancy and fully covered;
• prepare a support plan before birth: who helps you, with what, and when;
• strengthen your network and address tensions in the relationship before the baby arrives.

What to do if you think you have postpartum depression?

1. Identify the signs: sadness, loss of pleasure, anxiety, guilt, sleep disorders for more than two weeks.
2. Talk to your doctor, your midwife, your gynecologist, the PMI (maternal and child protection center), or a trusted person. If words are difficult, write down your symptoms and give the paper to your doctor.
3. Ask to fill out the EPDS questionnaire, which helps the professional assess the situation.
4. See a specialist if needed: a psychiatrist or psychologist trained in perinatal care can confirm the diagnosis.
5. Define a care plan with them: psychotherapy, medication, social support.
6. Surround yourself: involve your partner, family, and friends. You don't have to carry it all alone.
7. Give the treatment time: the first improvements take several weeks, and that is normal.

Frequently asked questions

How long does postpartum depression last?

Without treatment, it can last for several months, or even years. With care, it most often heals within the first year, according to the French Health Insurance (Assurance Maladie).

Can you have postpartum depression without having had the "baby blues"?

Yes. It can occur in a woman who was doing well until then, including after a pregnancy and birth without any problems, and can appear weeks or months after the birth.

Who should you turn to if you think you have postpartum depression?

Your primary care physician, midwife, local maternal and child protection center (PMI), or gynecologist are the first points of contact. They can refer you to a psychologist or psychiatrist specializing in perinatal care.

How can you help someone with postpartum depression?

Listen without minimizing their feelings or lecturing them, offer concrete help (meals, cleaning, help at night), and encourage the person to seek medical advice, offering to accompany them to the appointment if they wish. If they mention wanting to harm themselves, call 3114 or 15.

Can a father or co-parent also be affected?

Yes. More than 10% of fathers show depressive symptoms within the two months following the birth, according to Inserm, as cited by the French Health Insurance. The risk is higher when the other parent is also depressed.

Can you breastfeed while taking an antidepressant?

Often, yes: your doctor will choose a treatment suitable for breastfeeding. It is a matter of weighing the benefits and risks with a professional. Do not stop breastfeeding or treatment without medical advice.

Can postpartum depression return during a subsequent pregnancy?

It is possible: about 25 to 30% of women who have already had postpartum depression will experience it again, according to the MSD Manuals. Notify your doctor or midwife as soon as you are pregnant to organize appropriate monitoring.

A final word

Postpartum depression is common, real, and treatable. You are neither a bad mother nor a weak woman: you need help, and asking for it is an act of strength. You deserve to be well.