Postnatal Depression and Anxiety: Signs, Symptoms and Getting Help

What is postnatal depression and anxiety?

Postnatal depression is depression that develops after having a baby. It can begin gradually or become noticeable over a shorter period of time. For some women, depression begins during pregnancy and continues after birth.

Postnatal anxiety involves persistent worry, fear or tension that becomes difficult to manage or begins affecting daily life. Depression and anxiety can occur separately, but many women experience symptoms of both.

Both conditions are common during the first year of parenthood, and effective treatments and support are available.

Baby blues or postnatal depression?

Feeling emotional in the first few days after having a baby is very common. This is often described as the baby blues. You may feel tearful, overwhelmed, irritable or anxious, and your mood may change quickly.

Baby blues usually begin within the first few days after birth and settle within a relatively short time.

Postnatal depression is different. Symptoms are more persistent, may be more severe and can interfere with your ability to function, care for yourself or enjoy everyday life.

If low mood or loss of interest has lasted for two weeks or more, or symptoms are worsening or becoming difficult to manage, it is worth talking with a health professional.

Symptoms of postnatal depression

Postnatal depression affects women differently. You do not need to experience every symptom, and symptoms can range from mild to severe.

Common symptoms may include:

• Persistent sadness, low mood or feeling emotionally flat
• Loss of interest or pleasure in activities you would normally enjoy
• Feeling hopeless, worthless or excessively guilty
• Ongoing tiredness or very low energy
• Difficulty concentrating, thinking clearly or making decisions
• Changes in appetite
• Difficulty sleeping even when you have the opportunity to sleep, or sleeping much more than usual
• Feeling unusually restless or slowed down
• Withdrawing from family, friends or activities
• Feeling unable to cope with everyday demands
• Difficulty feeling connected with or enjoying time with your baby
• Recurrent thoughts about death, self-harm or suicide

Some symptoms, such as tiredness and disrupted sleep, are also common when caring for a baby. What matters is the overall pattern, how persistent the symptoms are and how much they are affecting your wellbeing and daily life.

Symptoms of postnatal anxiety

Some worry is normal when caring for a new baby. You may worry about feeding, sleep, your baby’s health, whether you are doing things correctly or how your family will adjust.

Postnatal anxiety becomes more concerning when worry or fear feels persistent, difficult to control, causes significant distress or begins to interfere with everyday life.

Symptoms may include:

• Persistent or excessive worry
• Feeling that something bad is going to happen
• Repeated worries about your baby’s health or safety
• Feeling constantly on edge, tense or unable to relax
• Racing or repetitive thoughts
• Irritability
• Restlessness
• Difficulty concentrating
• Difficulty sleeping because of worry, even when you have the opportunity to rest
• Physical symptoms such as a racing heart, trembling, sweating, dizziness or shortness of breath
• Panic attacks
• Avoiding situations or activities because of fear that something may go wrong

If anxiety is beginning to take over your thinking or affecting your ability to cope day to day, consider speaking with your GP or another health professional.

When to consider extra support

You do not need to wait until symptoms become severe before asking for help.

Consider seeking professional support if:

• Low mood or loss of interest has continued for two weeks or more
• Worry or anxiety feels persistent or difficult to control
• Your symptoms are worsening
• You are struggling to manage everyday activities
• Your relationships, sleep or ability to care for yourself are being significantly affected
• You are withdrawing from people or activities that would normally support you
• You feel overwhelmed or unable to cope on your own

Recognising symptoms early and talking about how you are feeling can help you access appropriate support sooner.

When to seek urgent help

Seek urgent professional help if you are thinking about suicide or self-harm, feel unable to keep yourself or your baby safe, or are experiencing severe confusion, hallucinations, unusual beliefs or rapidly changing behaviour.

If there is an immediate risk to you, your baby or someone else, call 000 or attend your nearest hospital emergency department.

For additional crisis and urgent mental health support options, visit MumSpace Urgent Help.

What contributes to postnatal depression and anxiety?

There is no single cause of postnatal depression or anxiety. These conditions usually develop through a combination of biological, psychological, social and life factors.

Factors that can increase vulnerability include:

• Depression or anxiety during pregnancy
• A personal or family history of depression, anxiety or other mental health conditions
• Past or current trauma or abuse
• A difficult or traumatic birth
• Major life changes or stressful events
• Relationship difficulties
• Limited emotional or practical support
• Financial, housing or employment pressures
• Having a baby with health problems or additional care needs
• Ongoing difficulties with feeding or settling
• Alcohol or other drug problems

Having one or more risk factors does not mean you will develop depression or anxiety. Some women develop these conditions without any obvious risk factors.

Screening and assessment after having a baby

Mental health screening is an important part of postnatal care. Australian perinatal mental health guidelines recommend that women are offered screening for depression and anxiety and assessment of relevant psychosocial factors during the postnatal period.

The Edinburgh Postnatal Depression Scale (EPDS) is commonly used to help identify possible symptoms of depression. Questions from screening tools can also help identify symptoms of anxiety.

A screening result does not provide a diagnosis. It helps identify whether a more detailed assessment may be helpful.

If your screening result suggests you may be experiencing depression or anxiety, your GP, maternal and child health nurse, child and family health nurse, psychologist or another health professional can talk with you about what you are experiencing and the support that may be appropriate.

You can also learn more about further assessment following screening for perinatal depression.

Treatment and support for postnatal depression and anxiety

Postnatal depression and anxiety are treatable. The type of treatment or support that is most appropriate depends on your symptoms, their severity, your circumstances, your preferences and your mental health history.

A useful first step is often talking with your GP, maternal and child health nurse, child and family health nurse or another health professional. They can help assess what you are experiencing and discuss suitable treatment and support options.

Psychological therapies

Psychological therapies can be effective treatments for postnatal depression and anxiety. Cognitive behavioural therapy (CBT) and interpersonal psychotherapy (IPT) are structured approaches that may be recommended depending on your needs.

Psychological treatment can help you understand patterns in your thoughts, emotions and behaviour, develop practical coping strategies, strengthen relationships and gradually rebuild activities and connections that support your wellbeing.

Social and practical support can also be important. Connecting with trusted family, friends or other parents, accepting practical help and reducing unnecessary pressures may support recovery alongside professional treatment.

Medication

For some women, medication may be recommended, particularly when depression or anxiety is moderate to severe or when psychological treatment alone has not been sufficient.

If you are breastfeeding, have recently given birth or are already taking medication for a mental health condition, discuss your treatment with your GP, psychiatrist or prescribing health professional. They can help you consider the potential benefits and risks for your individual circumstances.

Do not stop or change prescribed mental health medication without discussing it with the health professional responsible for your care.

Online treatment with MumMoodBooster

MumMoodBooster is a free, evidence-based online cognitive behavioural therapy program developed specifically for mothers experiencing depression, anxiety or feeling overwhelmed after having a baby.

The program can be completed online from home and does not require a formal diagnosis to participate. It may be used independently or alongside support from a GP or other health professional.

You can also visit MumSpace for evidence-based information, self-assessment tools and mental health programs for pregnancy and early parenthood.

Mother and Baby Units

When a mother is experiencing a severe mental health condition, more intensive specialist treatment may sometimes be needed.

Mother and Baby Units provide specialist inpatient mental health care while allowing mothers and their babies to remain together where appropriate. These services may provide psychiatric, psychological, nursing and parenting support while helping develop a plan for ongoing care after discharge.

Access and referral arrangements vary between services and locations. Your GP, psychiatrist or other health professional can advise whether this type of care may be appropriate.

Your relationship with your baby

Depression and anxiety can sometimes make it harder to feel connected with your baby or enjoy parenting in the way you expected. Some mothers feel guilty when bonding does not happen immediately.

Bonding is not something that has to occur at a particular moment. Relationships develop through repeated everyday interactions over time.

Simple activities such as holding, talking to, soothing, playing with and responding to your baby help build your relationship. If depression or anxiety is making these interactions difficult, this does not mean you have failed or that the relationship cannot develop.

Support for the mother-baby relationship can form part of treatment where needed. As your mental health improves and you receive appropriate support, your confidence and connection with your baby can also grow.

Hearing from women who have experienced postnatal depression

Many women find it reassuring to hear from someone who has been through postnatal depression. Australian journalist Jessica Rowe has spoken openly about her own experience after becoming a mother.

Other mental health conditions after birth

Depression and anxiety are not the only mental health difficulties that can occur after having a baby. Other conditions can include:

• Post-traumatic stress disorder (PTSD), which can develop following a traumatic birth or other traumatic experience
• Obsessive-compulsive disorder (OCD), which may involve distressing intrusive thoughts and repetitive behaviours
• Eating disorders
• Bipolar disorder
• Postpartum psychosis, a rare but serious mental health condition that requires urgent medical assessment

Postpartum psychosis can cause major and rapid changes in mood, thinking and behaviour. Symptoms may include severe confusion, very little need for sleep, unusually high energy or agitation, hallucinations, or strongly held beliefs that are not based in reality.

If you or someone close to you develops symptoms that could indicate postpartum psychosis, seek urgent medical help immediately.

Learn more about other mental health difficulties that can occur during pregnancy and after birth.

Young mothers may face additional pressures

Postnatal depression and anxiety can affect mothers of any age, but becoming a parent while young can bring additional social and practical challenges.

Some young mothers may be dealing with changes to friendships, education or employment, an unplanned pregnancy, financial or housing difficulties, relationship changes, limited support or feeling judged by other people.

These pressures can contribute to feeling isolated or overwhelmed. The symptoms of depression and anxiety are not something you should simply have to put up with because parenting is difficult.

If you are struggling, consider talking with your GP, maternal and child health or child and family health nurse, or another health professional you trust. Support is available, and seeking help early can make a difference.

What about fathers and partners?

Fathers and partners can also experience depression, anxiety and significant emotional distress during the transition to parenthood. Supporting a partner who is struggling while adjusting to caring for a baby can place considerable pressure on both people.

Some dads may notice persistent low mood, irritability, withdrawal, exhaustion, loss of interest in things they normally enjoy, anxiety, difficulty concentrating or feeling disconnected from their partner or baby.

Looking after a father’s or partner’s mental health is important for them and for the family as a whole.

PIRI provides dedicated information and support for fathers through DadSpace.

DadBooster is an evidence-based online program developed for fathers experiencing depression, anxiety, stress or low mood during early parenthood.

You do not have to manage this alone

Postnatal depression and anxiety can make the early months of parenthood feel very different from what you expected. Many women find it difficult to admit they are struggling, particularly when they feel they should be happy after having a baby.

Experiencing depression or anxiety does not mean you are failing as a parent. These are treatable mental health conditions, and asking for help is an important step towards recovery.

Whether your symptoms are beginning to affect your wellbeing or have become difficult to manage, support is available. With appropriate treatment, practical support and time, recovery is possible.