Postpartum · Mental Health
Postnatal Depression Test (EPDS)
The Edinburgh Postnatal Depression Scale (EPDS) — 10 questions, 5 minutes. The world-standard perinatal depression screen, validated in 60+ languages. Plus what to do if you score high, treatment options, and what's NOT just baby blues.
Last reviewed 29 May 2026
Edinburgh Postnatal Depression Scale (EPDS)
How have you been feeling in the past 7 days?
Pick the answer that comes closest to how you have felt in the past 7 days, not just how you feel today.
Answer all 10 questions to see your EPDS score and interpretation.
What is the EPDS?
The Edinburgh Postnatal Depression Scale — 10-question self-report screen for depression in pregnancy through 12 months postpartum. Cox, Holden & Sagovsky 1987. Most widely used postnatal depression screen worldwide, validated in 60+ languages. Takes 5 minutes. Screening tool, not diagnosis — positive screen prompts clinical assessment, not automatic diagnosis.
What does my EPDS score mean?
- 0-9: low likelihood of depression. Most women score here.
- 10-12: possible depression. Clinical assessment recommended.
- 13+: major depressive disorder likely. Full diagnostic interview needed.
- Q10 positive (self-harm thoughts): IMMEDIATE clinician contact — regardless of total score.
The 13+ cut-off has sensitivity ~85% and specificity ~85% for major depression in perinatal women (Gibson 2009 meta-analysis).
Baby blues vs postnatal depression vs psychosis
- Baby blues (~80% of mums): tearful, mood swings, anxious in first 1-2 weeks. Resolves by week 3 without treatment.
- Postnatal depression (10-15%): persistent low mood / anhedonia / anxiety > 2 weeks. Can start any time in first year. Treatable.
- Postnatal anxiety / OCD (~10-15%): often without low mood. Intrusive frightening worries, panic, compulsive checking.
- Postpartum psychosis (1-2/1000): rapid onset first 2-4 weeks. Confusion, no sleep, hallucinations, mania. EMERGENCY.
I scored high — what should I do?
Contact your provider promptly. Effective treatments exist:
- Talking therapy — CBT, interpersonal therapy. Strong evidence base. NHS IAPT / Talking Therapies free.
- SSRI medication — sertraline first-line in breastfeeding (very low milk transfer).
- Specialist perinatal mental health teams — available UK-wide; home visits.
- Peer support — PANDAS, MABS, APNI, children’s centres.
- Mother & Baby Units — UK has inpatient units where you stay WITH your baby for severe cases.
The cost of NOT reaching out is much higher than the cost of reaching out.
If you need help RIGHT NOW
- 999 (UK) / 911 (US) if immediate danger to yourself or baby.
- Samaritans (UK / RoI): 116 123 — 24/7 free, anonymous.
- SHOUT (UK): text SHOUT to 85258 (24/7 crisis text).
- NHS 111 (UK): dial 111, select option 2 for mental health.
- 988 Suicide & Crisis Lifeline (US): call or text 988.
- PANDAS (UK perinatal): 0808 1961 776.
- APNI: 0207 386 0868.
- Postpartum Support International (US): 1-800-944-4773.
Are intrusive thoughts about the baby a sign of psychosis?
Almost always NO. Intrusive thoughts of awful things happening to baby (“what if I drop them?”) affect up to 50% of new mums. KEY DISTINCTION: anxious mums find these thoughts horrifying and want to PROTECT baby. In psychosis, beliefs feel real, may be acted on, often grandiose or paranoid. Intrusive thoughts you find disturbing = anxiety/OCD, not psychosis — highly treatable.
Will I lose my baby if I admit I'm depressed?
NO. This is the biggest fear that prevents women seeking help, and it’s misguided. Health visitors and GPs are trained to support, not remove children. Child protection is only considered if direct child-safety concerns arise — and even then, the route is support and intervention, not automatic removal. MBRRACE-UK and AAP both stress that delayed help-seeking is a leading PREVENTABLE contributor to maternal death.
Can I take antidepressants while breastfeeding?
YES for most. Sertraline is first-line in breastfeeding — very low milk transfer, strong safety record. Other options under specialist guidance. The risk of UNTREATED maternal depression to baby OUTWEIGHS the very low risk from antidepressants in nearly all cases. NEVER stop pregnancy/postpartum SSRIs without medical advice. LactMed (NIH) is the reliable database. Don’t accept “you have to stop breastfeeding to take this” without checking — many providers wrongly advise stopping.
Different scenarios — what your score might mean
Scenario 1: EPDS 8, 8 weeks postpartum, generally coping
Below screening threshold. Likely normal adjustment. Repeat at 6 months. Pay attention to any persistent decline.
Scenario 2: EPDS 12, 4 months postpartum, partner says you’re “not yourself”
Borderline / possible depression. GP review this week. Diagnostic interview will clarify. Likely talking therapy and/or SSRI offer.
Scenario 3: EPDS 18, 6 weeks postpartum, struggling to get out of bed
High score with clear functional impact. Likely major postpartum depression. GP / perinatal mental health team referral this week. Treatment combination of therapy + SSRI often most effective.
Scenario 4: EPDS 6 total but Q10 positive (occasional thoughts of self-harm)
Q10 positive overrides total score. Same-day clinician contact essential. Don’t dismiss as “intrusive thoughts” — needs assessment regardless of total.
Scenario 5: EPDS 14 at 12 weeks pregnant (antenatal)
Antenatal depression. Treatable. SSRI risk-benefit conversation (sertraline often used in pregnancy). Talking therapy first-line. Untreated antenatal depression predicts postnatal depression — addressing now reduces postnatal risk.
What treatments actually work?
- CBT — Cognitive Behavioural Therapy. Strong evidence. 8-20 sessions typical.
- IPT — Interpersonal Therapy. Strong evidence for postnatal context (focuses on relationship transitions).
- SSRI — sertraline first-line in breastfeeding. Other options. 4-8 weeks to first effect; 6-8 weeks to full effect.
- Bright light therapy — modest evidence as adjunct.
- Exercise — 30 min walking 5x/week has measurable antidepressant effect.
- Peer support groups — hugely helpful for isolation.
- Sleep protection — even one 4-5 hour stretch per night transforms mood. Negotiate fiercely.
- Mother and Baby Unit (severe) — UK inpatient care without separation from baby.
Care guidance — protecting your mental health postpartum
- Sleep stretch — ANY way you can get one 4-5 hour stretch per night. Partner / family / friends taking baby for one shift.
- Daylight — 20 min outside in morning light helps mood regulation.
- Movement — gentle walking from when you’re physically able.
- Connection — isolated new mums have worse outcomes. Local mums groups, NCT meet-ups, baby massage classes.
- Practical help — accept it. Don’t reject offered meals / babysitting.
- Don’t self-medicate with alcohol.
- Limit social media if comparison is making you feel worse.
- Be honest with health visitor and GP at routine visits.
- If on antidepressants pre-pregnancy, don’t stop without specialist advice.
- Partner mental health matters too — ~10% of fathers / non-birthing partners get perinatal depression.
Sources
- Cox JL, Holden JM, Sagovsky R. Detection of postnatal depression: development of the 10-item Edinburgh Postnatal Depression Scale. Br J Psychiatry 1987.
- NICE CG192. Antenatal and postnatal mental health. 2014, updated 2020.
- Gibson J, et al. A systematic review of studies validating the EPDS in antepartum and postpartum women. Acta Psychiatr Scand 2009.
- MBRRACE-UK. Saving Lives, Improving Mothers’ Care.
- ACOG Committee Opinion 757. Screening for Perinatal Depression.
- LactMed (NIH). Sertraline — lactation.
Frequently asked questions
What is the Edinburgh Postnatal Depression Scale (EPDS)?
10-question self-report screen for depression in the perinatal period (pregnancy through ~12 months postpartum). Developed by Cox, Holden & Sagovsky 1987. Takes 5 minutes. The most widely used postnatal depression screen worldwide, validated in 60+ languages. It's a SCREENING TOOL — not a diagnostic instrument. Positive screen prompts a full clinical assessment, not automatic diagnosis. UK routine: at 6-8 week postnatal check and 6-month health visitor visit. AAP recommends at well-baby visits across first year.
What is a normal EPDS score?
Score 0-9: low likelihood of depression — most women score here. Score 10-12: possible depression, warrants clinical assessment. Score 13+: makes major depressive disorder likely; full diagnostic interview needed. ANY positive answer to question 10 (thoughts of self-harm) warrants IMMEDIATE clinician contact regardless of total score. The 13+ cut-off has sensitivity ~85% and specificity ~85% for major depression in perinatal women (Gibson 2009 meta-analysis).
What's the difference between baby blues and postnatal depression?
BABY BLUES: affects ~80% of mothers in first 1-2 weeks after birth. Tearful, mood swings, anxious, fatigued. Usually resolves by week 3 without treatment. Driven by hormonal shifts. POSTNATAL DEPRESSION: more severe, longer-lasting (weeks-months), interferes with daily functioning. Affects 10-15% of mothers. Can start any time in the first year postpartum (peak ~3 months). Needs treatment. POSTPARTUM PSYCHOSIS: separate, rare (1-2/1000), medical emergency — usually first 2-4 weeks with confusion, hallucinations, mania.
When should I take the EPDS?
ROUTINELY: at the 6-8 week postnatal check; at the 6-month HV review; can be administered at any well-baby visit. PROACTIVELY: any time you feel persistently low for 2+ weeks, or have other concerning symptoms (loss of pleasure, persistent worry, sleep beyond what baby's pattern causes, appetite changes, hopelessness, intrusive thoughts). IN PREGNANCY: antenatal screening also valuable — many cases have antenatal onset. Self-administered or with HV/midwife/GP.
I scored high — what should I do?
CONTACT YOUR PROVIDER promptly. GP, midwife, health visitor, or specialist perinatal mental health team. Effective treatments exist and the earlier the better. EFFECTIVE TREATMENTS: talking therapy (CBT, interpersonal therapy — strong evidence base); antidepressants (sertraline first-line in breastfeeding, very low milk transfer); peer support groups (PANDAS, MABS, APNI); social and practical support. The cost of NOT reaching out is much higher than the cost of reaching out. Postnatal depression is COMMON, TREATABLE, and NOT your fault.
Can I take antidepressants while breastfeeding?
YES for most. SERTRALINE (Zoloft) is first-line in breastfeeding because of very low milk transfer and a strong safety record. Other options under specialist guidance. The risk of UNTREATED maternal depression to baby OUTWEIGHS the very low risk from antidepressants in nearly all cases. Discuss with GP or specialist perinatal mental health team. NEVER stop pregnancy/postpartum SSRIs without medical advice. LactMed (NIH) is the reliable database. Don't accept 'you have to stop breastfeeding to take this' without checking — many providers wrongly advise stopping.
What is question 10 of the EPDS — and why does it matter?
'The thought of harming myself has occurred to me' — answered 'sometimes', 'hardly ever', or 'yes, quite often'. ANY positive answer warrants IMMEDIATE follow-up by a clinician — even if the total EPDS score is below threshold. Don't dismiss as 'just intrusive thoughts'. MBRRACE-UK maternal death enquiries identify suicide as a leading cause of maternal death; many cases had positive Q10 that wasn't acted on. If YOU answered positively: call your GP, NHS 111 option 2, Samaritans 116 123 (UK), or 988 (US) NOW.
Are intrusive thoughts about hurting the baby a sign of postpartum psychosis?
Almost always NO. Intrusive thoughts about awful things happening to baby ('what if I drop them?', 'what if I left them in the car?') are extremely common in postnatal ANXIETY / OCD — and affect up to 50% of new mums. KEY DISTINCTION: anxious mums find these thoughts HORRIFYING and want to PROTECT baby. In psychosis, beliefs feel real, may be acted on, often involve grandiosity or paranoia. Intrusive thoughts you find disturbing = anxiety/OCD, not psychosis, and is highly treatable. Talk to GP / HV — embarrassment is the biggest barrier and there's nothing shameful about it.
Can partners get postnatal depression?
Yes — about 10% of fathers / non-birthing partners experience perinatal depression. Often missed because routine screening isn't done. Symptoms similar but may present more as: irritability, withdrawal, working excessive hours, increased alcohol use, anger. Treatments work equally well. If your partner seems withdrawn / low / irritable / not bonding well with baby — encourage GP review. Maternal mental health is also strongly affected by partner mental health, so it matters for the family system.
What is postpartum psychosis?
RARE (1-2 per 1000 births) but a true psychiatric EMERGENCY. Rapid onset usually in first 2-4 weeks (often within first week). Features: confusion, NOT sleeping at all over multiple nights, hallucinations (hearing/seeing things), delusions, mania, paranoia. HIGHER RISK if history of bipolar disorder or past postpartum psychosis. Same-day emergency assessment essential — call community mental health crisis team, 999/911, or go to A&E. UK has specialist Mother and Baby Units where you stay WITH your baby. Most women recover fully with prompt treatment.
What are risk factors for postpartum depression?
(1) PAST HISTORY of depression / anxiety; (2) PAST POSTPARTUM DEPRESSION (~50% recurrence); (3) ANTENATAL DEPRESSION; (4) STRESSFUL LIFE EVENTS during pregnancy; (5) LACK OF PARTNER OR SOCIAL SUPPORT; (6) RELATIONSHIP problems; (7) UNPLANNED OR UNWANTED PREGNANCY; (8) TRAUMATIC BIRTH or birth disappointment; (9) PRETERM OR SICK BABY / NICU stay; (10) FEEDING DIFFICULTIES; (11) SLEEP DEPRIVATION (huge driver); (12) FAMILY HISTORY of mood disorders; (13) HORMONAL sensitivity (some women have premenstrual depression that predicts PPD). Many are modifiable; many aren't.
Will I lose my baby if I admit I'm depressed?
NO. This is the most common fear that prevents women seeking help, and it's misguided. Health visitors and GPs are trained to SUPPORT, not to remove children. UK and US clinical guidance is explicit: a mother's mental health needs treating; child protection is only ever considered if direct safety concerns about a child arise (and even then, the route is support and intervention, not automatic removal). MBRRACE-UK and AAP both stress that delayed help-seeking is a leading PREVENTABLE contributor to maternal death — the cost of NOT speaking up is far higher than the cost of speaking up.
What about PHQ-9 vs EPDS — which should I use?
Both are validated for perinatal depression. EPDS is more widely used perinatally because it excludes physical symptoms (sleep, appetite, energy) that overlap with normal pregnancy / postpartum — reduces false positives in this population. PHQ-9 is more widely used in general adult mental health and includes those somatic items. Either is fine; EPDS slightly preferred for perinatal context. UK NHS uses both at various points. ACOG / NICE accept both.
How long does postnatal depression last?
Variable. Without treatment: median ~3-6 months but can persist a year or more, with sub-clinical symptoms longer. With treatment: noticeable improvement in 4-8 weeks for talking therapy or SSRI. Full recovery 6-12 months minimum. Some women have recurrent or chronic mood issues post-pregnancy and benefit from longer-term mental health support. Hormonal stabilisation around weaning / menstrual return can sometimes trigger another mood episode worth screening for.
How can I support a friend with postnatal depression?
(1) LISTEN without judgement or advice-giving. (2) NORMALISE without minimising — 'lots of mums feel like this; you're not alone' is helpful; 'cheer up, you have a beautiful baby' is harmful. (3) PRACTICAL HELP — meals, watching baby for an hour, doing laundry, picking up groceries. Don't ask 'is there anything I can do' (overwhelming) — offer specifics. (4) ENCOURAGE PROFESSIONAL HELP — offer to come along to the GP / HV appointment. (5) DON'T disappear — pop-ins for 15 min are valuable when she can't host. (6) CHECK ON DAD too — partners often missed.
How does this relate to other calculators on BumpBites?
Companion: /calculators/postpartum-mood-warning for between-EPDS check-in; /calculators/phq9-perinatal for PHQ-9 alternative; /calculators/gad7-perinatal for anxiety screening; /calculators/postpartum-hair-loss for related postpartum changes; /calculators/postpartum-thyroiditis (similar symptoms can be thyroid).