Postnatal Depression Symptoms: Physical, Cognitive & Emotional Red Flags

Postnatal depression (PND), also known as postpartum depression, is a common mood disorder that can affect any woman after giving birth.

In simple terms, PND means a profound shift toward negative emotions following childbirth. Women who develop PND experience depressive episodes that can, without treatment, severely impact their day-to-day capability, their relationships, and care for their child.

In India, the prevalence of postnatal depression ranges widely, but studies suggest that as many as 1 in 5 of all new mothers may experience some form of PND. (New mother refers to any woman giving birth, regardless of how many children she may or may not already have.)

Early treatment can make a significant difference in the duration and intensity of PND. All prenatal women, their partners, and their families should become familiar with the symptoms of postnatal depression during pregnancy, so they and their loved ones can access help at the earliest signs of struggle.

Postnatal depression symptoms: a comprehensive list

PND symptoms typically appear within the four weeks following delivery. However, some women remain at risk for developing PND for several months to a year after giving birth. Women with this kind of longer-term risk for PND typically experience depression, anxiety, and/or stressful life events during pregnancy; have low levels of social support, a personal or family history of depression, and/or a history of postnatal depression following a previous delivery.

The symptoms of postnatal depression can be classified into three categories: physical, cognitive, and emotional. Here’s a comprehensive breakdown.

Physical symptoms of postnatal depression

• Fatigue or constant exhaustion: Despite getting enough sleep or having opportunities to rest, feeling tired all the time.
• Changes in appetite: Significant increase or decrease in appetite, which might lead to weight loss or gain.
• Sleep disturbances: Difficulty falling asleep or staying asleep, or sleeping more than usual.
• Decreased libido: A notable lack of interest in sexual activity, which is not related to physical recovery from childbirth and related procedures.
• Physical aches and pains: Frequent headaches, stomach issues, or muscle and joint pain that do not have a specific cause.
• Neglect of personal care: Lack of interest or energy to carry out personal care routines.

Cognitive symptoms of postnatal depression

• Difficulty concentrating: Trouble focusing on tasks or making decisions, which may or may not complicate care for a newborn.
• Memory problems: Forgetting appointments or important tasks, which may or may not include aspects of newborn care.
• Indecisiveness: Inability to make decisions about simple or everyday tasks.
• Persistent doubt about abilities as a mother: Questioning one’s ability to care for the newborn, despite evidence of proper care.
• Thoughts of self-harm or suicide: Recurrent thoughts about harming oneself or thoughts that life isn’t worth living.
• Thoughts of harm to the newborn: Intrusive, unwanted thoughts or mental images of the newborn being harmed or injured. (NOTE: These thoughts do not indicate danger to the child; these thoughts are a sign of struggle for the mother only, not a sign that she is planning to ever act on them.)

Emotional symptoms of postnatal depression

• Persistent sadness or low mood: Feeling sad, empty, hopeless, or tearful most of the day, nearly every day.
• Loss of interest or pleasure in activities: Not enjoying activities that used to be pleasurable, including interacting with the newborn.
• Feelings of worthlessness or guilt: Excessive or inappropriate feelings of guilt, particularly regarding one’s abilities as a mother or regarding intrusive thoughts.
• Changes in mood and energy levels: Swinging from mental or physical agitation to lethargy.
• Anxiety: Intense feelings of worry or panic, which may include overconcern for the baby’s health or may be a response to self-doubt and sadness.
• Withdrawal from social interactions: Avoiding friends, family, and social activities.

Postnatal depression vs. the ‘baby blues’

Postnatal depression is often confused with a common, postnatal stage called the ‘baby blues’ or ‘postpartum blues.’

The ‘baby blues’ describes a roughly 2-week period during which a woman’s hormone levels naturally fluctuate wildly in order to shrink the uterus back to un-pregnant size, prepare the body for lactation, and facilitate other postnatal changes.

The baby blues typically start within 2 to 3 days of delivery and in the following 10-14 days cause a new mother to:

• feel weepy or crying easily
• have mood swings between happy and sad, or irritability
• miss parts of her old life
• feel restless or anxious, or have insomnia, despite exhaustion
• experience brain fog and be indecisive
• think overwhelming, but not necessarily negative, thoughts

The baby blues is a very common postnatal experience, affecting roughly 4 in every 5 new mothers in India and elsewhere. It also resolves naturally, with no treatment required, within a couple of weeks of childbirth.

Postnatal depression, by contrast, affects roughly 1 in every 5 new mothers in India, develops later in the postnatal period, and typically requires mental healthcare for recovery.

When to seek help for postnatal depression

Women experiencing either persistent sadness or low mood, or a loss of interest or pleasure, should seek help from a mental healthcare professional – especially if other symptoms are present as well.

Effective treatments typically include some combination of online self-therapy, in-person therapy sessions, support groups, and medication. And accessing effective treatment early can significantly improve the likelihood of recovery.

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SOURCES

• Balaram K, Marwaha R. Postpartum Blues. StatPearls. Treasure Island (FL): StatPearls Publishing; 2024 Jan.
• Lanjewar S, Nimkar S, Jungari S. Depressed Motherhood: Prevalence and Covariates of Maternal Postpartum Depression among Urban Mothers in India. Asian J Psychiatr. 2021 Mar;57:102567.
• Sharma, Verinder, Sharma, Priya. Postpartum Depression: Diagnostic and Treatment Issues. J Obstet Gynaecol Can. 2012 May;34(5):436–442.
• Sit DK, Wisner KL. Identification of postpartum depression. Clin Obstet Gynecol. 2009 Sep;52(3):456-68.

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Liesl Goecker is Mitsu’s Head of Content. She has 16 years of experience researching and writing on topics related to health and mental health. She has also been diagnosed with postnatal depression.

Vidula V Sawant (M.A., M.Phil., CRR No. A80980), Mitsu’s Senior Clinical Psychologist, vetted this article for accuracy.