Baby blues, depression and anxiety are not the same thing
Pregnancy and a new baby turn life upside down. Some tears, worry and exhaustion are expected. The question is whether what you feel is passing or settling in.
ACOG describes the baby blues as feelings of sadness, anxiety and irritability that often start two to three days after birth and usually get better within a few days to two weeks without treatment. NIMH describes them as mild and short-lasting.
Perinatal depression is different. NIMH uses the term for depression during pregnancy and in the weeks and months after birth. Most episodes begin within four to eight weeks after the baby is born, though ACOG notes that postpartum depression can begin any time in the first year. Mood changes that are severe or last longer than two weeks are a reason to call a provider, and NIMH notes that postpartum depression generally does not improve without treatment.
Anxiety can be the main problem rather than sadness. Cleveland Clinic describes postpartum anxiety as worry that becomes all-consuming and nonstop after having a baby or becoming a parent, including through adoption. It often occurs alongside postpartum depression, and it can begin during pregnancy, right after birth or months later.
What it can look like day to day
Many parents do not recognize themselves in the word "depression". These are some of the signs NIMH and Cleveland Clinic list, put in everyday terms:
- Lying awake while the baby sleeps, or waking early and not getting back to sleep
- Feeling numb, empty or cut off from the baby, or doubting you can care for them
- Constant guilt, or a sense that everyone else is doing this better
- Checking the baby's breathing again and again, or being afraid to leave them with a trusted adult for a few minutes
- Sudden, unwanted, frightening thoughts of the baby being harmed
- Irritability, a racing heart, nausea or tension that will not let up
- Losing interest in things you used to enjoy, including people
Unwanted scary thoughts can be one of the most upsetting parts. Cleveland Clinic lists them among the common symptoms of postpartum anxiety. Many parents feel too ashamed to mention them. Saying them out loud to a doctor or therapist is usually the first step toward relief.
Why it happens, and why it is not your fault
NIMH is direct about this: perinatal depression is not caused by anything a mother has or has not done. There is no single cause. Contributors include:
- The sharp drop in estrogen and progesterone after birth, which ACOG describes
- Broken sleep and the physical demands of birth and infant care
- Life stress, little practical support, or a recent loss or move
- A personal or family history of depression or bipolar disorder, or depression during an earlier pregnancy
- A difficult delivery, feeding problems, or a baby with health concerns
If you have had depression before, NIMH suggests making a plan with your provider for follow-up care during and after pregnancy. If you are not sure whether low mood started before the baby, What Causes Depression? Biology, Stress and Life Events explains how these factors combine.
Partners and adoptive parents can struggle too
Postpartum Support International (PSI) notes that perinatal mental health conditions affect not only the person who gave birth but also dads and partners. Adoptive parents can have postpartum anxiety as well. If you are the partner, your sleep, work and sense of identity have changed too. Struggling does not mean you are failing your family.
Partners are often the first to notice that something is wrong. NIMH suggests encouraging a visit with a provider, helping get to appointments, and taking on concrete tasks such as night feedings, meals or time with the baby so the parent can sleep.
Who to call first, and what to say
ACOG advises calling your ob-gyn or another provider right away if you think you have postpartum depression, rather than waiting for the postpartum checkup. A primary care doctor, midwife or pediatrician's office can also be a first call. It can help to say something specific:
- "I have felt low or anxious most days for more than two weeks."
- "I cannot sleep even when the baby is sleeping."
- "I am having frightening thoughts I cannot get rid of."
- "I had depression before, and I am worried it is back."
Bring a list of any medicines and supplements you take, and say whether you are pregnant or nursing. That affects which treatments a prescriber will discuss.
How it is treated
NIMH notes that treatment usually involves therapy, medication or both, and that with proper treatment most women feel better. NIMH also reports that the FDA has approved medications specifically for postpartum depression. Medication decisions belong with your physician, psychiatrist or psychiatric nurse practitioner, who can weigh pregnancy and breastfeeding. Talk with your prescriber before starting, stopping or changing anything.
Therapy gives you a place to say the things that feel unsayable at home, sort out what is hormones, sleep loss and old patterns, and rebuild some footing as a parent. Dr. Lehmann is a licensed clinical psychologist in Franklin who sees adults in person or by telehealth for clients located in Michigan, which can help when leaving the house with a newborn is hard. Her depression therapy page describes how she works. Some parents also want help with the relationship strain a new baby brings; Intimacy After Having a Baby covers that side.
Between appointments, PSI runs more than 50 free online support groups for parents. The PSI HelpLine (1-800-944-4773) is not a crisis line: you leave a message and a trained volunteer calls or texts back with support and local resources. For round-the-clock support, the National Maternal Mental Health Hotline answers calls and texts at 1-833-852-6262, in English and Spanish.