Day four, you cried at a diaper commercial. Day five, you cried because the coffee was cold. Everyone smiled and said, the baby blues, it will pass.
And it did, for a lot of mothers.
But it is week six now, or month four. The tears have turned into something heavier. You are not sad so much as empty. You go through the motions of feeding and rocking and you feel nothing at all, and then you feel guilty for feeling nothing.
That is not the baby blues. And you deserve to know the difference.
The short answer: The baby blues are brief mood swings, tearfulness and worry that start a few days after birth and fade within about two weeks without treatment. Postpartum depression lasts longer than two weeks, feels heavier, and gets in the way of daily life. It can begin any time in pregnancy or the first year after birth, and it is very treatable.
Side by side
The baby blues
- Timing: starts in the first few days after birth
- How long: fades within about two weeks
- Mood: tearful and up and down, with good moments mixed in
- Daily life: manageable with rest and support
- Thoughts: worry
- Needs treatment? Usually not
Postpartum depression
- Timing: any time in pregnancy or the first year after birth
- How long: lasts longer than two weeks
- Mood: persistent sadness, emptiness, hopelessness or numbness
- Daily life: hard to eat, rest, or care for yourself
- Thoughts: guilt, worthlessness, or thoughts of self-harm
- Needs treatment? Yes
What postpartum depression can feel like
The National Institute of Mental Health describes persistent sad, anxious or empty mood, irritability, guilt or worthlessness, low energy, trouble concentrating, appetite and sleep changes beyond what a newborn causes, trouble bonding, and thoughts of death or self-harm.
NIMH says something else I want every mother to hear: perinatal depression is a medical condition. You did not cause it. You are not to blame.
Who is more vulnerable?
A personal or family history of depression or bipolar disorder, depression in a previous pregnancy, a hard birth or NICU stay, limited support and major life stress all raise the odds. That is why the American College of Obstetricians and Gynecologists recommends screening for depression and anxiety during pregnancy and after birth (screening guideline).
What helps
Therapy, medication, or both. Cognitive behavioral therapy and interpersonal therapy are well studied for perinatal depression. Many antidepressants can be used while breastfeeding, and ACOG's treatment guideline reviews the safety evidence for pregnancy and lactation. Peer support through Postpartum Support International can be a lifeline.
And here is the part no one says loudly enough: most women get better. Fully.
How I can help
I spent years at the bedside as an antepartum, mother-baby and newborn nursery nurse before I ever wrote a prescription. At Dr. Joanne Psychiatry, I treat postpartum depression by telehealth, including honest, numbers-in-front-of-you conversations about breastfeeding and medication. Through maternal-infant and early childhood mental health care, your baby can be seen right alongside you. Reserve a visit or call 888-210-4050.
Frequently asked questions
Can postpartum depression start months after birth? Yes. It can begin anywhere in the first year, and sometimes during pregnancy.
Can I take an antidepressant and breastfeed? Often, yes. It depends on the specific medication and your history, and we decide together.
What if I am having thoughts of harming myself? That is an emergency. Call or text 988 or go to the nearest emergency department now.
Written by Dr. Joanne Patterson, DNP, MSN, PMHNP-BC, APHN-BC, board-certified Psychiatric Mental Health Nurse Practitioner. About Dr. Joanne
This article is educational and is not medical advice. In a crisis, call or text 988 or call 911. Pregnant and new mothers can call or text the National Maternal Mental Health Hotline at 1-833-TLC-MAMA (1-833-852-6262).
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