Mental Health4 min read

Postpartum depression vs postpartum anxiety: key differences

Learn the key differences between postpartum depression and postpartum anxiety, plus how to spot symptoms and get the right support.

OR Olga RJune 28, 20264 min read

Postpartum depression vs postpartum anxiety: key differences

Table of contents

Why the distinction matters Side-by-side comparison How they overlap How each is treated Quick self-check

Postpartum depression (PPD) is a mood disorder marked by persistent sadness, hopelessness and emotional withdrawal after childbirth. Postpartum anxiety (PPA) is characterised by excessive, uncontrollable worry, hypervigilance and physical tension in the same period. They are separate conditions with distinct symptom profiles, though they frequently overlap.

This page explains how to tell them apart, why it matters and what to do about each.

Why the distinction matters

Most postnatal screening focuses on depression. The EPDS, used in clinics worldwide, was designed to detect depressive symptoms. Its three anxiety items (the EPDS-3A subscale) have been shown to be inadequate as a standalone anxiety screen, according to a 2024 validation study published in Midwifery.

This means a mother with severe postpartum anxiety but no depression can score "fine" on the standard screen and leave without support. Knowing the difference between the two conditions helps you advocate for the right assessment.

Our detailed guide to postpartum anxiety screening beyond the EPDS covers the tools that catch what the EPDS misses.

Side-by-side comparison

	Postpartum depression	Postpartum anxiety
Core emotion	Sadness, emptiness, hopelessness	Fear, dread, excessive worry
Thought pattern	"Nothing will get better," "I am a bad mother"	"Something terrible will happen," "I cannot keep the baby safe"
Energy	Low; fatigue, lethargy, difficulty getting out of bed	High; restlessness, inability to sit still, feeling wired
Sleep	Difficulty sleeping even when the baby sleeps, or sleeping too much	Cannot sleep because the mind will not stop; hyperarousal at night
Appetite	Decreased or increased	Often decreased; nausea linked to anxiety
Bonding	May feel disconnected, numb or indifferent toward the baby	May feel overly attached; cannot let anyone else hold the baby
Avoidance	Withdrawing from activities, people, the baby	Avoiding specific situations perceived as dangerous (car journeys, bathing the baby)
Crying	Frequent, sometimes without identifiable cause	Less common; more likely to feel tense than tearful
Physical symptoms	Body aches, headaches, heaviness	Racing heart, chest tightness, shortness of breath, stomach issues
Intrusive thoughts	Present in some cases, often passive ("what if I just disappeared")	Common and intense, often about harm to the baby
Prevalence	Approximately 1 in 7 postpartum women (13-17%)	Up to 1 in 5 postpartum women (17-20%)
Screening tool	EPDS (Edinburgh Postnatal Depression Scale)	GAD-7, PSAS or PASS (not reliably caught by EPDS alone)

How they overlap

The Massachusetts General Hospital Center for Women's Mental Health notes that many women with postpartum depression also experience significant anxiety symptoms. One study found that 57% of women with postpartum-onset major depression reported obsessional thoughts. At two weeks postpartum, 19.9% of women with depression also had anxiety symptoms, compared to 1.3% of those without depression.

This overlap means:

You can have PPD without PPA
You can have PPA without PPD
You can have both at the same time (most common presentation)
Treatment should address whichever condition is present, not just the one that was screened for

"Postpartum anxiety demonstrates a greater prevalence rate than depression and appears to be under-recognised and undertreated comparatively." - ScienceDirect (2020)

How each is treated

	PPD treatment	PPA treatment
First-line therapy	CBT or interpersonal therapy (IPT)	CBT with anxiety-specific focus; exposure-based techniques
Medication	SSRIs (sertraline most studied for PPD)	SSRIs; sometimes SNRIs for severe anxiety
Specialist therapy	Not typically needed for mild-moderate	May require OCD-specific ERP if intrusive thoughts are prominent
Self-help	Behavioural activation, social connection, routine	Relaxation training, breathing techniques, reducing avoidance
Combined approach	Therapy + medication for moderate-severe	Therapy + medication for moderate-severe

For a detailed comparison of therapy and medication for PPD, see our CBT vs meds decision guide. For a full breakdown of CBT specifically, see our CBT for postpartum depression guide.

If intrusive thoughts are the dominant symptom, the condition may be perinatal OCD rather than generalised anxiety. The treatment pathway is different and includes ERP (Exposure and Response Prevention).

Quick self-check

This is not a diagnostic tool. It is a starting point for a conversation with your GP or midwife.

You may be experiencing PPD if:

You feel persistently sad, flat or empty for more than two weeks
You have lost interest in things you used to enjoy
You feel disconnected from your baby
You think about disappearing or that your family would be better off without you

You may be experiencing PPA if:

You cannot stop worrying even when everything is objectively fine
You check on the baby repeatedly and cannot rest even when they are safe
You avoid situations because you fear something bad will happen
You experience physical symptoms like racing heart, nausea or chest tightness without medical cause

You may be experiencing both if:

You feel sad and anxious at the same time
Your mood is low but your mind will not stop racing
You withdraw from people but also cannot stop worrying about them

In all cases, speak to a professional. Our EPDS guide and action plan after your score can help you prepare for that conversation. And our guide to choosing the right mental health provider explains who to see and what to ask.

Sources and further reading

MGH Center for Women's Mental Health. (2025). Is it postpartum depression or postpartum anxiety? womensmentalhealth.org
American Counseling Association. (2026). Postpartum anxiety vs postpartum depression: similarities and differences. Counseling Today. counseling.org
ScienceDirect. (2020). Postpartum anxiety. Journal of the American Association of Nurse Practitioners. sciencedirect.com
Buhagiar, R. et al. (2024). Validation of the EPDS and GAD-7 for screening postpartum depression and anxiety. Midwifery.
Postpartum Support International: postpartum.net

Frequently asked questions

How can I tell postpartum depression and postpartum anxiety apart?

Postpartum depression is usually marked by persistent sadness, hopelessness, numbness, and low energy. Postpartum anxiety is more about constant worry, fear, racing thoughts, and feeling on edge or unable to relax.

Can you have postpartum depression and anxiety at the same time?

Yes. Many mothers experience both conditions together, which can make symptoms feel confusing or more intense. You may feel both very low and very worried at the same time.

What does postpartum anxiety feel like?

Postpartum anxiety often feels like your mind will not switch off, with nonstop worry about your baby’s safety or something going wrong. It can also cause physical symptoms such as restlessness, muscle tension, nausea, and trouble sleeping.

What does postpartum depression look like?

Postpartum depression can cause deep sadness, hopelessness, fatigue, crying, and feeling disconnected from your baby or from daily life. Some mothers also lose interest in things they normally enjoy or feel like they are not coping.

Why might postpartum anxiety be missed in screening?

Many routine postnatal screens are better at spotting depression than anxiety. A mother with significant anxiety but little depression may still score as normal, which is why it is important to ask specifically about worry, fear, and physical tension.

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Olga R

a freelance writer and certified maternal wellness coach with a background in psychology and over two years of experience writing about motherhood, mental health, and relationships.

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