Why PPD Can Make Every Decision Feel Impossible

When Nisha Patel brought her newborn home from the hospital in November 2023, she struggled with how best to feed him. He was having difficulty breastfeeding, and Dr. Patel, a board-certified internal medicine and obesity medicine physician in San Francisco, was constantly questioning whether he was getting enough milk. During one routine checkup shortly after he was born, she learned he’d lost weight since being discharged from the hospital, and burst into tears. “Am I the best mom for him?” she remembers asking herself.

Soon Dr. Patel started triple feeding, a time-intensive and physically grueling process of nursing, bottle-feeding, and pumping. Eventually, she turned to exclusively pumping, a decision she says she agonized over. “I became obsessed with his feeding and his growth,” she admits. She compulsively logged and reviewed his feeds — the time, ounces consumed, ounces pumped. If she pumped fewer ounces one day than the last, she’d fixate on why. She questioned whether she was adequately nourishing her baby, and wrestled with guilt that she hadn’t been able to breastfeed directly.

“I remember sitting in this room,” she recalls somberly. ”I was dealing with a clogged duct, and it was winter, so it was dark. I was sitting in this dimly lit room with my stupid pump, and I just felt so bone-deep exhausted. Not like, ‘I haven’t been sleeping,’ exhausted, but like, ‘I just can't fathom making another decision.’ It was almost an out-of-this-world kind of feeling. I remember my husband bringing my son over to me — he was probably two months old — and I just could not hold my son.”

In that moment, she knew something was wrong. Looking back, she considers it a bright red flag that she was dealing with postpartum depression (PPD).

Beyond “New Parent Syndrome”

In those early days with a new baby, parents are told it’s normal to second-guess every decision and method — when and what to feed your baby, how to soothe them, or when symptoms warrant a call to the doctor. But in some cases, as with Dr. Patel, indecisiveness, rumination, and decision paralysis can actually be signs of postpartum depression (PPD), a mood disorder that affects nearly one in five people after giving birth and one in 10 non-birthing partners.

The constant self-doubt, fixations, or feeling extreme guilt over decisions — once you finally make them — might not immediately register as potential PPD, partially because of the pervasive misconception that these symptoms are normal new parent anxiety, says Jennifer Payne, M.D., a reproductive psychiatry expert and a professor of psychiatry and neurobehavioral sciences at UVA Health in Charlottesville, Virginia. Sure, you’re spending hours tearfully searching whether your baby’s weird poop could be a sign of a dairy allergy. Sure, you’re losing sleep dwelling on whether it’s time to switch to formula. Sure, you’re panic-texting your entire contact list a picture of your baby’s skin to ask if that red dot looks suspicious. But isn’t everyone?

Systemic issues mean PPD — which also causes symptoms such as persistent sadness, anhedonia (loss of pleasure), guilt, feelings of worthlessness or failure, irritability, rage, anxiety, and emotional numbness — often falls through the cracks. “At best we identify about 50% of PPD cases and fewer than that get treated,” says Dr. Payne. A 2024 study in the journal Frontiers in Global Women’s Health calls PPD “the most underdiagnosed pregnancy-related health problem in the U.S.” Fear of seeming weak or being judged by loved ones, lack of access, and lack of support from healthcare providers all contribute to the problem, according to the study authors.

The troubling symptoms of PPD can be incredibly painful, says Olivia Verhulst, LMHC, PMH-C, a New York City-based licensed psychotherapist certified in perinatal mental health. “The cognitive symptoms of postpartum depression, which may include difficulty concentrating and memory lapses in addition to the impacts on decision-making, can be particularly distressing for new parents because you’re tasked with an enormous amount of decisions from day one,” she says.

Why Postpartum Depression Complicates Decision-Making

All types of depression impact cognition, and research indicates that physiological changes likely contribute to the changes. While treatment can reverse these effects, the hippocampus actually shrinks when you’re depressed, explains Dr. Payne. “The hippocampus is involved in memory and cognition, and some of the core symptoms of depression, whether it's postpartum depression or outside of the postpartum time period, include difficulty concentrating, thinking more slowly, having trouble making decisions,” she says.

Postpartum depression has unique effects on the brain, too. Levels of the reproductive hormones progesterone and estrogen crash after giving birth. Some people’s brains may be more sensitive to that crash. For them, the hormone drop leads to several outcomes, including reduced production of allopregnanolone, a steroid in the brain that helps dial back the body’s stress response, according to a 2025 study in the World Journal of Clinical Cases. Without enough allopregnanolone, the brain becomes more reactive to stress.

People with postpartum depression also tend to have changes in a region of the brain known as the cognitive control network, which governs working memory and attention, per 2025 research in the journal Molecular Psychiatry. Other studies have shown that dysfunction in that part of the brain can cause symptoms like anxiety, poor concentration, difficulty paying attention, indecisiveness, and difficulties suppressing negative emotions.

Lack of sleep during this time can also worsen cognitive symptoms. “During [the postpartum] period you're completely sleep-deprived most of the time, even if you do have a great village and a great partner,” says Verhulst. Sleep deprivation can make it harder to make decisions for anyone, but especially those with PPD.

“Then you have to attend to many, many needs of your newborn, says Sharon Dekel, Ph.D., an associate professor at Harvard Medical School and the founding director of the Postpartum Traumatic Stress Disorders Research Program at Massachusetts General Hospital. “And if you're a new mom, there's also a lot of information that you need to learn. All of these contextual factors make it much more difficult, as postpartum demands can compound the cognitive difficulties associated with depression.”

What’s more, if you tended to self-criticize or ruminate before you had a child, you might be more likely to develop PPD, according to the World Journal of Clinical Cases study.

How to Separate “Normal” New Parent Anxiety From PPD

When you’re already doubting every decision you make, it can be even more difficult to distinguish between the typical “baby blues” and signs of PPD, says Alexa Bonacquisti, Ph.D., PMH-C, a licensed psychologist with expertise in reproductive health psychology, certified perinatal mental health specialist, and associate professor of clinical psychology at the Philadelphia College of Osteopathic Medicine.

Looking at a few key factors that commonly coincide with PPD can help guide you.

Severity of symptoms: If your decision paralysis, mental fog, or rumination are so severe that they disrupt your day-to-day functioning, such as your ability to sleep, eat, participate in your relationships, or care for yourself or your child.

How long symptoms last: If your symptoms persist for longer than two weeks. Up to 80% of people experience symptoms like difficulty concentrating, feeling overwhelmed, tearfulness, and irritability in the first few weeks postpartum, but these should get better on their own after that period. If they get worse, go away and then come back and persist, or become debilitating at any point, professional help is warranted, says Bonacquisti.

Concurrent symptoms: It can be helpful to zoom out and look at the bigger picture of your mental health. Postpartum indecisiveness is unlikely to occur in a vacuum. “For postpartum depression, people may also experience low mood, low energy, and a loss of sense of self-worth, which unfortunately could translate into suicidal ideation,” says Dekel. “If you find yourself overall in a good mood and having energy, but you’re having a difficult time being decisive … that’s likely to be very normal and may reflect the effects of sleep deprivation and the demands of early parenthood rather than postpartum depression.”

Feelings of guilt: “If all or most of the decisions you’re making are really characterized by guilt, pressure, or anxiety, that's when we want people to ask for help, because that's not a quality of life that someone can sustain,” says Verhulst.

If you’re still unsure about what your symptoms mean, ask your friends or family for their honest opinions, says Dr. Payne. If someone close to you suggests that you might benefit from extra support, listen; they may be noticing changes that you’re missing.

What To Do If PPD Affects Your Decision-Making

PPD is treatable — and if you suspect you have it, it’s essential to seek help as soon as possible. While PPD is typically defined as occurring during pregnancy or within the first year after childbirth, without treatment, the condition can persist much longer, says Verhulst. “If you're not getting treatment for postpartum depression, the symptoms can be prolonged and can actually last from weeks to months to, if untreated, years,” she cautions.

Unfortunately, not all healthcare providers react with urgency to patients’ PPD concerns. If you feel dismissed, don’t hesitate to get a second opinion, says Dr. Payne. Your primary care doctor, OB-GYN, or even your baby’s pediatrician are first lines of support for postpartum parents. Use your network. Plus, self-care strategies can really help. Finding ways to get bouts of uninterrupted sleep and taking mini-breaks from caregiving can be huge for a new parent’s mental health, adds Verhulst.

Around the same time Dr. Patel realized she couldn’t muster the energy to pick up her newborn, she began seeing a perinatal therapist to learn how to manage her symptoms. Three months ago she had her second child, and she credits her continued therapy with giving her a happier postpartum experience this time around.

Now, she says she’s always watching for obsessive thoughts that want to creep in, avoids baby tracking apps, and uses the tools she’s learned in therapy to help remove a lot of the blameful self-talk.

She looks back at her postpartum experience with her firstborn with equal parts sympathy for her past self and frustration at a system that doesn’t do enough to help support women through what can be one of the most difficult times in their lives, adding, "I wish more people said to moms, ‘It's OK. Your kid's going to be fine. You need to take care of yourself.’”

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