Postpartum depression after miscarriage: What you need to know

Miscarriage is a common experience: up to 1 in 4 pregnancies end in loss. Yet, there can still be a stigma in talking openly around the experience of miscarriage, including the effects on your mind and heart in the days, weeks, and months after a pregnancy loss. For some people, that includes depression.

While you might think of postpartum depression as occurring only following a live birth, postpartum depression is common after miscarriage. Here’s all you need to know about postpartum depression after a miscarriage, including symptoms, ways of coping, and when and how to seek more support. 

Can you have postpartum depression after a miscarriage?

Yes, it is possible to have postpartum depression after a miscarriage. In addition to emotionally grieving the loss of a pregnancy, hormonal processes in the wake of a miscarriage, including declining progesterone and estrogen can trigger mood changes, fatigue, and other depressive symptoms. Sometimes referred to as a “hormone crash,” when these symptoms persist over time, they can resemble postpartum depression.

A 2020 study found that over 10% of women reported moderate or severe depression about a month after having a miscarriage, while other research from 2015 indicates up to 20% of all women will have depressive symptoms following early pregnancy loss. There’s also a higher chance of having depression after a miscarriage if you have experienced more than one loss.

Postpartum depression symptoms after miscarriage

A miscarriage is defined as the spontaneous loss of a pregnancy before the 20th week. Although miscarriage often happens in the first trimester (up to 12 weeks), any loss before the 20th week is considered a miscarriage. 

Symptoms of postpartum depression after miscarriage can include: 

• Mood swings
• Anxiety
• Excessive sleepiness
• Trouble sleeping
• Intrusive thoughts
• Feelings of sadness
• Feeling overwhelmed
• Excessive crying
• Reduced concentration

Treatment for depression after miscarriage

It is totally normal to feel sad after having a miscarriage. If you do, it doesn’t necessarily mean you have depression. Be gentle with yourself and give yourself time to return to normal activities. If, after time, it feels like your symptoms and feelings are interfering with your daily life, it may be time to look into treatment for postpartum depression after miscarriage. 

Coping Strategies

You have a lot of options for managing depression or feelings of sadness after a miscarriage. Practicing gentle self-care that feels good for you (whether that’s long baths, yoga classes, neighborhood walks, or chats with friends) is a good place to start. Other coping strategies include meditation, exercise, yoga, journaling, or other activities or practices that work for your life. 

If you have a partner, be honest with them about how you are feeling. They likely also have their own feelings about the loss. Sharing together can remind you that you are healing and grieving as a team. 

Perinatal mental health therapist Paulette Matuk, LCPC, says: “[Find] ways to honor the loss, by talking about it, by having a physical token, etc. Narrative therapy and grief work help us process the feelings and thoughts during postpartum depression and miscarriage, helping us to find ways to integrate these experiences.” 

Support and mental health treatment

Even if you don’t feel as if you have clinical postpartum depression, it can still be helpful to seek out support, whether it’s from a professional or from others in your community. 

A support group is a wonderful way to feel seen and heard in your pregnancy loss experience. Being with other parents who have experienced loss can remind you that you are not alone. There may be support groups in your area or online. Postpartum Support International offers many free online support groups for loss and miscarriage. 

A therapist or other mental health professional, especially one who specializes in the perinatal period, can provide so much useful support after a miscarriage. Research indicates that Cognitive Behavioral Therapy (CBT) is an effective form of talk therapy for peripartum depression. Other types of therapy, like Eye Movement Desensitization and Reprocessing (EMDR), can be helpful if you are experiencing a post-traumatic stress response.

You may eventually decide that taking medication is what you need to improve your mental health. There is no shame in taking medication for depression after a miscarriage or for postpartum depression. Your healthcare provider will help you choose a medication, like an antidepressant or a Selective Serotonin Reuptake Inhibitor (SSRI) that works for your life and body right now, and for any future pregnancies you may be planning. 

The National Maternal Mental Health outline is a resource for you, too. Call 1-833-TLC-MAMA for free, confidential support in English or Spanish. 

Miscarriage and mental health

Grieving a miscarriage

In the wake of a pregnancy loss, many people enter the grief process. The stages of grief are generally accepted as denial, anger, bargaining, depression, and acceptance. You may move through these at any pace in the days, weeks, months and even years after a miscarriage. 

You may also experience other feelings, too, like guilt, shame, or blame. Feelings of loneliness and isolation are common, too. No feeling is wrong after a miscarriage, even if it feels surprising or out of sync with your expectations. Grief is not one-size-fits-all and there is no set timeline to follow.

All feelings, while normal, can be hard to deal with and move through in your everyday life. Go slowly and ask for help when you need it. 

Mental health conditions after pregnancy loss

For some people, sadness after a miscarriage feels very intense and does not lessen with time. If that is how you’re feeling, you may be experiencing a diagnosable mental health condition, like PTSD (post-traumatic stress disorder), prolonged grief disorder, anxiety, or other condition.

PTSD can be tied to the physical process of the miscarriage or the medical treatment you received for it. PTSD after miscarriage can look like flashbacks or intrusive thoughts, feeling constantly on edge, and more. If you are experiencing these symptoms, reach out to a therapist or other mental health professional.

Prolonged grief disorder is when the stages and symptoms of grief do not lessen after some time. You may feel stuck, in a repeating loop of feelings, or feel that the emotional pain that you're experiencing feels just as intense as when the miscarriage happened. This is a recognized condition and can be treated with therapy and medication.

Anxiety is a very common response to miscarriage and it is often linked to depression. It can show up as racing thoughts, constant worry, or persistent fears. If you feel like worry and fear are taking over your everyday life, it's time to reach out to someone for support for your anxiety after miscarriage. 

Healing after miscarriage

Physical recovery

After a pregnancy releases from someone’s body, like in a miscarriage, the body undergoes a physical healing and recovery process. This is true no matter how long the pregnancy was. The recovery process looks different for everyone, but it should always include time and care. 

Miscarriage involves bleeding, cramping, physical pain, and hormonal changes. Even though you did not give birth to a full-term baby, your body was still pregnant and is undergoing a real physical and emotional healing process. 

Give yourself plenty of time to rest. Stay hydrated. Eat nourishing food. Don’t jump back into vigorous activity. Take it easy—for example, if you can cocoon for a few days with cozy blankets and a bunch of your favorite shows on streaming, that’s a good way to let both your body and mind rest after a miscarriage. It may not be possible to take time for dedicated rest with your work, other children, or life responsibilities, but whatever ways you can find to fit rest into your life will support both your physical and emotional recovery. 

You may have had medical assistance for your miscarriage, like the medications mifepristone and misoprostol or even a surgical dilation and curettage procedure (often called a D&C). Recovery timelines can differ based on which path your miscarriage took. A surgical or medically-managed miscarriage may have a more predictable recovery timeline of about 1-2 weeks of light bleeding, while a miscarriage without medical assistance (where your body does the work itself) may have a more variable timeline. 

Follow the guidelines of your doctor or midwife and do not hesitate to reach out for medical help if you experience heavy bleeding, fever, or severe pain. 

Returning to work after miscarriage

Returning to work after a miscarriage may feel strange or jarring—or, it may be a nice relief and useful distraction for you. However it feels, it is ok to go slow, if it’s possible for you based on the nature of your work. Give yourself permission to ease back in. Some parents will want to share what happened with their employer and colleagues, while others will not. 

If you had any medical complications during or after your miscarriage, you may have to share those with your HR department in order to access short-term disability benefits or qualify for leave under the Family Medical Leave Act (or FMLA). You may be able to take a few sick days but in general, there is no leave for miscarriage as there often is with a full-term pregnancy. Some states or employers may have their own policies, so if you feel comfortable, it is worth checking to see what options you may have available. 

Awareness and remembrance

It may feel meaningful to you to do something to remember or mark the pregnancy you lost. There are almost endless ways to do this, and you can do anything that feels right for you and your family. 

For example, you might want to light a candle with your partner and say a few words. You might want to purchase a piece of jewelry to wear. Or, you may find it meaningful to participate in awareness events like Pregnancy and Infant Loss Day (October 15th) or Pregnancy and Infant Loss Awareness Month (the whole month of October).

You may want to talk about your baby and pregnancy a lot, or it may feel right to keep things private. Whatever you decide, there is no wrong way to remember your pregnancy and process the experience of pregnancy loss. 

Trying to conceive after loss

If you decide you would like another pregnancy, the process of trying to conceive may be difficult physically, mentally, or emotionally. 

Generally, it is medically fine to try again after a miscarriage after your next menstrual period, but many women are not emotionally ready yet at that point. If you had any medical complications, check in with your provider about the best timeline for conception for you. There is no rush to conceive quickly after a miscarriage, so listen to your body and mind. 

You may feel anxious when trying to conceive after a loss or even anxious during a subsequent pregnancy. If you hope for a rainbow baby (a baby born after a loss), it is normal to feel a mix of emotions, like fear, hope, excitement and more, all at once. You may fear having another miscarriage or something else going wrong with the pregnancy. Reach out for support during the conception process and/or during pregnancy; a therapist or even a doula trained in loss can provide real support to ground you through the experience.