Postpartum Depression and Anxiety: Signs, Symptoms, and When to Get Help with Dr. Tolu Odebunmi

Pregnancy and new parenthood are often framed as a time of pure joy. For many mothers, the reality can also include anxiety, feelings of sadness, intrusive thoughts, or a quiet sense that something isn't right. Perinatal mood and anxiety disorders are common and treatable. We spoke with reproductive psychiatrist Tolu Odebunmi, MBBS, MPH about what to watch for, when to seek help, and where to turn.

How long does the postpartum period actually last?

Longer than most people think. "In the past people thought the postpartum period only lasted for the first few weeks after birth," Dr. Odebunmi says. "But it spans the entire 12 months after birth." 

Mental health concerns can also start before pregnancy (preconception) or during pregnancy (antepartum), which is why perinatal mental health care often begins before a baby is even on the way.

What are the signs of postpartum depression and anxiety?

The "baby blues" typically affect most new mothers in the first two weeks after delivery and usually resolve on their own. Signs that something more is going on include:

  • Persistent sadness, tearfulness, or hopelessness lasting more than two weeks
  • Excessive worry, racing thoughts, or a constant sense of dread
  • Trouble bonding with the baby
  • Excessive guilt about not feeling "the way you're supposed to feel" 
  • Loss of appetite or loss of interest in things you used to enjoy
  • Irritability or anger that feels out of character
  • Difficulty sleeping
  • Intrusive or frightening thoughts

"When moms experience something that's not ‘pure joy,’ they tend to feel the guilt of, 'It's me, something is wrong with me,'" Dr. Odebunmi explains. "Just hearing that these signs are common can provide a lot of relief.” 

When is postpartum mental health an emergency?

There are a few things that can pose as an emergency during the postpartum period. One of them is postpartum psychosis. Postpartum psychosis is rare but serious. Seek immediate care if, in the first few weeks after birth, a new mother is:

  • Unable to sleep at all, or sleeping only one to two hours despite exhaustion
  • Feeling unusually energized with racing thoughts
  • Becoming disorganized in thought, speech, or behavior
  • Hearing voices, seeing things that aren't there, or holding unusual beliefs

According to Dr. Odebunmi, "Given postpartum psychosis is an emergency, it’s treated in the hospital, because that period is really high risk for suicide and infanticide." 

If you're worried about yourself or someone you love, call or text the Suicide & Crisis Lifeline at 988 or go to the nearest emergency department.

What contributes to postpartum mental health shifts?

Postpartum mental health shifts are driven by a mix of biology and identity change. Hormones fluctuate dramatically, sleep is fragmented, and relationships reshape as partners become co-parents. There's even a name for the transformation of becoming a mother: matrescence. "A mother is also born, not just a baby, " Dr. Odebunmi notes, and that new mom needs care, too.

This matters at the population level. Minnesota's Maternal Mortality Review Committee report (2017–2021) identified mental health conditions, including substance use disorders, as a leading cause of pregnancy-related deaths.

What stops people from getting help?

Stigma is the biggest barrier. "Fear of how people will be perceived, fear that the baby will be taken away, or being deemed as unfit to care for their baby," Dr. Odebunmi says. Many providers also feel undertrained and underprepared to care for the mental health of individuals during the perinatal period, which can delay care and access. 

Coping strategies that help

  • Name what you're feeling and tell someone you trust: a partner, friend, doula, or clinician
  • Protect sleep where you can; trade night feeds with a partner or support person
  • Build your support team before the baby arrives, especially if you have a prior mental health history
  • Continue or restart therapy; many medications (if needed) are compatible with pregnancy and breastfeeding
  • Move your body gently, get outside, and limit isolation

Resources for postpartum mental health support

If you're planning a pregnancy, pregnant, or postpartum and something doesn't feel right, please reach out. Treatment works and the earlier it starts, the better the outcomes for both parent and baby.