Depression (including postpartum)
During a depression check‑up, your doctor or nurse will ask detailed questions about how you have been feeling. You may be asked to fill in a questionnaire such as the PHQ‑9 to rate your mood or, if you recently gave birth, the Edinburgh Postnatal Depression Scale. They will talk about changes in your mood, sleep, appetite, energy, and concentration, as well as medications, alcohol or drug use and any family history of depression. There is no single test to diagnose depression, but your provider may perform a physical exam and order blood tests to look for medical problems like anemia or thyroid disease that can cause similar symptoms. Your provider will also screen for suicidal thoughts, postpartum psychosis and other mental health conditions.
Antidepressant medicines help rebalance brain chemicals. Classes include selective serotonin reuptake inhibitors (SSRIs) and serotonin‑norepinephrine reuptake inhibitors (SNRIs), which are usually first‑line choices. Atypical antidepressants like bupropion and mirtazapine may be used, as well as tricyclic antidepressants and the less commonly used monoamine‑oxidase inhibitors. For severe or treatment‑resistant depression, fast‑acting medicines like esketamine nasal spray or intravenous brexanolone may be used in the hospital, and a newly approved oral medication, zuranolone, is taken for two weeks and can relieve postpartum depression quickly. Many people also benefit from psychotherapy: cognitive behavioral therapy (CBT) helps you identify and change unhelpful thoughts and behaviors, and interpersonal therapy (IPT) focuses on improving relationships and communication.
Blood tests do not diagnose depression but help rule out medical problems. A complete blood count (CBC) looks at red and white blood cells and can detect anemia or infection. A comprehensive metabolic panel measures electrolytes and organ function. Thyroid tests (TSH and T4) check for an underactive or overactive thyroid. Vitamin B12 or folate levels may be checked because low levels can affect mood. Fasting glucose and hemoglobin A1c identify diabetes, which can contribute to fatigue and mood changes. If you are postpartum, your provider may also order a pregnancy test or tests for thyroid conditions that mimic postpartum depression.
None – depression is not diagnosed with imaging. Brain scans are only used if there are unusual symptoms suggesting another neurological problem.
Call your provider if sadness, hopelessness or anxiety last more than two weeks; if you have trouble sleeping, eating, concentrating or caring for yourself; if you feel worthless, guilty or unable to bond with your baby; or if you have thoughts of hurting yourself or others. Warning signs of postpartum psychosis include confusion, agitation, hallucinations or delusions and require emergency care. Seek help right away if you think about suicide or harming your baby.
After starting medication or therapy, most providers see patients every 1–2 weeks to monitor progress and side effects. Once symptoms improve, visits may be spaced to every 3–6 months. Postpartum depression screening is usually repeated at the postpartum check‑up and again during the baby’s well‑child visits.
Healthy lifestyle habits can lower the risk of depression and support recovery. Aim for at least 30 minutes of moderate activity like walking each day. Keep a regular sleep schedule and eat balanced meals. Stay connected with friends and family and ask for help when you need it. Limit visitors and give yourself permission to rest when your baby sleeps. Take breaks for things you enjoy and practice relaxation techniques. Avoid alcohol, nicotine and non‑prescribed drugs. Being realistic about what you can do and accepting help from others can prevent postpartum depression from getting worse.
Depression care often involves a team. Your primary care provider screens and orders basic tests, then works with mental health specialists. Psychiatrists are doctors who can prescribe antidepressant medications; psychologists, licensed counselors and social workers provide therapy sessions. In postpartum depression, obstetricians and pediatricians can also help coordinate care. Support groups and peer counselors offer encouragement. For severe or persistent symptoms, your provider may refer you to a psychiatrist for specialized treatment or a social worker for help with community resources or postpartum support.