- Postpartum Depression and the Baby Blues — HelpGuide.org
- Is it the baby blues or postpartum depression?
- Signs and symptoms of postpartum depression
- Postpartum depression causes and risk factors
- Signs and symptoms of postpartum psychosis
- Coping with postpartum depression tip 1: Create a secure attachment with your baby
- Tip 2: Lean on others for help and support
- Tip 3: Take care of yourself
- Tip 4: Make time for your relationship with your partner
- Treatment for postpartum depression
- Helping a new mother with postpartum depression
- How to help your wife or partner
- Perinatal Depression
- What causes perinatal depression?
- Cognitive Behavioral Therapy (CBT)
- Interpersonal Therapy (IPT)
- How can family and friends help?
- Federal Resources
- Behavioral Health Treatment Services Locator
- Talking to Your Health Care Provider About Your Mental Health
Postpartum Depression and the Baby Blues — HelpGuide.org
Having a baby is stressful—no matter how much you’ve looked forward to it or how much you love your child. Considering the sleep deprivation, new responsibilities, and lack of time for yourself, it’s no surprise that a lot of new moms feel they’re on an emotional rollercoaster.
In fact, mild depression and mood swings are so common in new mothers that it has its own name: the baby blues.
Is it the baby blues or postpartum depression?
The majority of women experience at least some symptoms of the baby blues immediately after childbirth.
It’s caused by the sudden change in hormones after delivery, combined with stress, isolation, sleep deprivation, and fatigue. You might feel more tearful, overwhelmed, and emotionally fragile.
Generally, this will start within the first couple of days after delivery, peak around one week, and taper off by the end of the second week postpartum.
The baby blues are perfectly normal, but if your symptoms don’t go away after a few weeks or get worse, you may be suffering from postpartum depression.
Signs and symptoms of postpartum depression
Un the baby blues, postpartum depression is a more serious problem—one that you shouldn’t ignore.
In the beginning, postpartum depression can look the normal baby blues. In fact, postpartum depression and the baby blues share many symptoms, including mood swings, crying jags, sadness, insomnia, and irritability. The difference is that with postpartum depression, the symptoms are more severe (such as suicidal thoughts or an inability to care for your newborn) and longer lasting.
- You might find yourself withdrawing from your partner or being unable to bond well with your baby.
- You might find your anxiety control, preventing you from sleeping—even when your baby is asleep—or eating appropriately.
- You might find feelings of guilt or worthlessness overwhelming or begin to develop thoughts preoccupied with death or even wish you were not alive.
These are all red flags for postpartum depression.
The Edinburgh Postnatal Depression Scale is a screening tool designed to detect postpartum depression. Follow the instructions carefully. A score greater than 13 suggests the need for a more thorough assessment because you could have postpartum depression.
Postpartum depression causes and risk factors
There’s no single reason why some new mothers develop postpartum depression and others don’t, but a number of interrelated causes and risk factors are believed to contribute to the problem.
- Hormonal changes. After childbirth, women experience a big drop in estrogen and progesterone hormone levels. Thyroid levels can also drop, which leads to fatigue and depression. These rapid hormonal changes—along with the changes in blood pressure, immune system functioning, and metabolism that new mothers experience—may trigger postpartum depression.
- Physical changes. Giving birth brings numerous physical and emotional changes. You may be dealing with physical pain from the delivery or the difficulty of losing the baby weight, leaving you insecure about your physical and sexual attractiveness.
- Stress. The stress of caring for a newborn can also take a toll. New mothers are often sleep deprived. In addition, you may feel overwhelmed and anxious about your ability to properly care for your baby. These adjustments can be particularly difficult if you’re a first-time mother who must get used to an entirely new identity.
Signs and symptoms of postpartum psychosis
Postpartum psychosis is a rare, but extremely serious disorder that can develop after childbirth, characterized by loss of contact with reality. Because of the high risk for suicide or infanticide, hospitalization is usually required to keep the mother and the baby safe.
Postpartum psychosis develops suddenly, usually within the first two weeks after delivery, and sometimes within 48 hours. Symptoms include:
- Hallucinations (seeing things that aren’t real or hearing voices)
- Delusions (paranoid and irrational beliefs)
- Extreme agitation and anxiety
- Suicidal thoughts or actions
- Confusion and disorientation
- Rapid mood swings
- Bizarre behavior
- Inability or refusal to eat or sleep
- Thoughts of harming or killing your baby
Coping with postpartum depression tip 1: Create a secure attachment with your baby
The emotional bonding process between mother and child, known as attachment, is the most important task of infancy. The success of this wordless relationship enables a child to feel secure enough to develop fully, and affects how he or she will interact, communicate, and form relationships throughout life.
A secure attachment is formed when you as the mother respond warmly and consistently to your baby’s physical and emotional needs. When your baby cries, you quickly soothe him or her. If your baby laughs or smiles, you respond in kind. In essence, you and your child are in sync. You recognize and respond to each other’s emotional signals.
Postpartum depression can interrupt this bonding. Depressed mothers can be loving and attentive at times, but at other times may react negatively or not respond at all. Mothers with postpartum depression tend to interact less with their babies, and are less ly to breastfeed, play with, and read to their children. They may also be inconsistent in the way they care for their newborns.
However, learning to bond with your baby not only benefits your child, it also benefits you by releasing endorphins that make you feel happier and more confident as a mom.
If you didn’t experience a secure attachment as an infant, you may not know how to create a secure attachment—but you can learn. Our human brains are primed for this kind of nonverbal emotional connection that creates so much pleasure for you and your baby.
Tip 2: Lean on others for help and support
Human beings are social. Positive social contact relieves stress faster and more efficiently than any other means of stress reduction.
Historically and from an evolutionary perspective, new mothers received help from those around them when caring for themselves and their infants after childbirth.
In today’s world, new mothers often find themselves alone, exhausted and lonely for supportive adult contact. Here are some ideas for connecting to others:
Make your relationships a priority. When you’re feeling depressed and vulnerable, it’s more important than ever to stay connected to family and friends—even if you’d rather be alone. Isolating yourself will only make your situation feel even bleaker, so make your adult relationships a priority. Let your loved ones know what you need and how you’d to be supported.
Don’t keep your feelings to yourself. In addition to the practical help your friends and family can provide, they can also serve as a much-needed emotional outlet.
Share what you’re experiencing—the good, the bad, and the ugly—with at least one other person, preferably face to face.
It doesn’t matter who you talk to, so long as that person is willing to listen without judgment and offer reassurance and support.
Be a joiner. Even if you have supportive friends, you may want to consider seeking out other women who are dealing with the same transition into motherhood.
It’s very reassuring to hear that other mothers share your worries, insecurities, and feelings. Good places to meet new moms include support groups for new parents or organizations such as Mommy and Me.
Ask your pediatrician for other resources in your neighborhood.
Tip 3: Take care of yourself
One of the best things you can do to relieve or avoid postpartum depression is to take care of yourself. The more you care for your mental and physical well-being, the better you’ll feel. Simple lifestyle changes can go a long way towards helping you feel yourself again.
Skip the housework – Make yourself and your baby the priority. Give yourself permission to concentrate on yourself and your baby – there is more work involved in this 24/7 job than in holding down a full-time job.
Ease back into exercise. Studies show that exercise may be just as effective as medication when it comes to treating depression, so the sooner you get back up and moving, the better. No need to overdo it: a 30-minute walk each day will work wonders. Stretching exercises such as those found in yoga have shown to be especially effective.
Practice mindfulness meditation. Research supports the effectiveness of meditation for making you feel calmer and more energized. It can also help you to become more aware of what you need and what you feel.
Don’t skimp on sleep. A full eight hours may seem an unattainable luxury when you’re dealing with a newborn, but poor sleep makes depression worse. Do what you can to get plenty of rest—from enlisting the help of your partner or family members to catching naps when you can.
Set aside quality time for yourself to relax and take a break from your mom duties. Find small ways to pamper yourself, taking a bubble bath, savoring a hot cup of tea, or lighting scented candles. Get a massage.
Make meals a priority. When you’re depressed, nutrition often suffers. What you eat has an impact on mood, as well as the quality of your breast milk, so do your best to establish healthy eating habits.
Get out in the sunshine. Sunlight lifts your mood, so try to get at least 10 to 15 minutes of sun per day.
Tip 4: Make time for your relationship with your partner
More than half of all divorces take place after the birth of a child. For many couples, the relationship with their partner is their primary source of emotional expression and social connection. The demands and needs of a new baby can get in the way and fracture this relationship unless couples put some time, energy, and thought into preserving their bond.
Don’t scapegoat. The stress of sleepless nights and caretaking responsibilities can leave you feeling overwhelmed and exhausted.
And since you can’t take it out on the baby, it’s all too easy to turn your frustrations on your partner. Instead of finger pointing, remember that you’re in this together.
If you tackle parenting challenges as a team, you’ll become an even stronger unit.
Keep the lines of communication open. Many things change following the birth of a baby, including roles and expectations. For many couples, a key source of strain is the post-baby division of household and childcare responsibilities. It’s important to talk about these issues, rather than letting them fester. Don’t assume your partner knows how you feel or what you need.
Carve out some couple’s time. It’s essential to make time for just the two of you when you can reconnect.
But don’t put pressure on yourself to be romantic or adventurous (unless you’re both up for it). You don’t need to go out on a date to enjoy each other’s company.
Even spending 15 or 20 minutes together—undistracted and focused on each other— can make a big difference in your feelings of closeness.
Treatment for postpartum depression
If, despite the self-help and the support of your family, you’re still struggling with postpartum depression, you may want professional treatment.
Individual therapy or marriage counseling. A good therapist can help you successfully deal with the adjustments of motherhood. If you are experiencing marital difficulties or are feeling unsupported at home, marriage counseling can be very beneficial.
Antidepressants. For cases of postpartum depression where your ability to function adequately for yourself or your baby is compromised, antidepressants may be an option. However, medication should be closely monitored by a physician and has shown to be more effective when accompanied by psychotherapy.
Hormone therapy. Estrogen replacement therapy sometimes helps with postpartum depression. Estrogen is often used in combination with an antidepressant. There are risks that go along with hormone therapy, so be sure to talk to your doctor about what is best—and safest—for you.
Helping a new mother with postpartum depression
If your loved one is experiencing postpartum depression, the best thing you can do is to offer support. Give her a break from childcare duties, provide a listening ear, and be patient and understanding.
You also need to take care of yourself. Dealing with the needs of a new baby is hard for the partner as well as the mother. And if your significant other is depressed, you are dealing with two major stressors.
How to help your wife or partner
Encourage her to talk about her feelings. Listen to her without judging or offering solutions. Instead of trying to fix things, simply be there for her to lean on.
Offer help around the house. Chip in with the housework and childcare responsibilities. Don’t wait for her to ask!
Make sure she takes time for herself. Rest and relaxation are important. Encourage her to take breaks, hire a babysitter, or schedule some date nights.
Be patient if she’s not ready for sex. Depression affects sex drive, so it may be a while before she’s in the mood. Offer her physical affection, but don’t push if she’s not up for sex.
Go for a walk with her. Getting exercise can make a big dent in depression, but it’s hard to get motivated when you’re feeling low. Help her by making walks a daily ritual for the two of you.
Authors: Melinda Smith, M.A. and Jeanne Segal, Ph.D. Reviewed by Anna Glezer, M.D.
Anna Glezer, M.D. is a Harvard-trained clinician with joint appointments in the reproductive psychiatry and OB/GYN departments at UCSF Medical Center. She is the founder of Mind Body Pregnancy.
Last updated: October 2021
Perinatal depression is depression that occurs during or after pregnancy. The symptoms can range from mild to severe. In rare cases, the symptoms are severe enough that the health of the mother and baby may be at risk. Perinatal depression can be treated. This brochure describes the signs and symptoms of perinatal depression and how you or a loved one can get help.
Perinatal depression is a mood disorder that can affect women during pregnancy and after childbirth. The word “perinatal” refers to the time before and after the birth of a child.
Perinatal depression includes depression that begins during pregnancy (called prenatal depression) and depression that begins after the baby is born (called postpartum depression).
Mothers with perinatal depression experience feelings of extreme sadness, anxiety, and fatigue that may make it difficult for them to carry out daily tasks, including caring for themselves or others.
How is postpartum depression different from the “baby blues”?
The “baby blues” is a term used to describe mild mood changes and feelings of worry, unhappiness, and exhaustion that many women sometimes experience in the first 2 weeks after having a baby.
Babies require around-the-clock care, so it’s normal for mothers to feel tired or overwhelmed sometimes. If mood changes and feelings of anxiety or unhappiness are severe, or if they last longer than 2 weeks, a woman may have postpartum depression.
Women with postpartum depression generally will not feel better unless they receive treatment.
What causes perinatal depression?
Perinatal depression is a real medical illness and can affect any mother—regardless of age, race, income, culture, or education. Women are not to blame or at fault for having perinatal depression: it is not brought on by anything a mother has or has not done.
Perinatal depression does not have a single cause. Research suggests that perinatal depression is caused by a combination of genetic and environmental factors.
Life stress (for example, demands at work or experiences of past trauma), the physical and emotional demands of childbearing and caring for a new baby, and changes in hormones that occur during and after pregnancy can contribute to the development of perinatal depression.
In addition, women are at greater risk for developing perinatal depression if they have a personal or family history of depression or bipolar disorder or if they have experienced perinatal depression with a previous pregnancy.
Postpartum psychosis (PP) is a severe mental illness that occurs after childbirth. PP is a medical emergency, and it is important to seek help immediately by calling 911 or going to the nearest emergency room.
Women who have PP can have delusions (thoughts or beliefs that are not true), hallucinations (seeing, hearing, or smelling things that are not there), mania (a high, elated mood that often seems touch with reality), paranoia, and confusion.
Women who have PP also may be at risk for harming themselves or their child and should receive help as soon as possible. Recovery is possible with professional help.
Some women may experience a few symptoms of perinatal depression; others may experience several symptoms. Some of the more common symptoms of perinatal depression include:
- Persistent sad, anxious, or “empty” mood
- Feelings of guilt, worthlessness, hopelessness, or helplessness
- Loss of interest or pleasure in hobbies and activities
- Fatigue or abnormal decrease in energy
- Feeling restless or having trouble sitting still
- Difficulty concentrating, remembering, or making decisions
- Difficulty sleeping (even when the baby is sleeping), awakening early in the morning, or oversleeping
- Abnormal appetite, weight changes, or both
- Aches or pains, headaches, cramps, or digestive problems that do not have a clear physical cause or do not ease even with treatment
- Trouble bonding or forming an emotional attachment with the new baby
- Persistent doubts about the ability to care for the new baby
- Thoughts about death, suicide, or harming oneself or the baby
Only a health care provider can help a woman determine whether the symptoms she is feeling are due to perinatal depression or something else. It is important for women who experience any of these symptoms to see a health care provider.
If You Know Someone in Crisis:
- Dial 911 in an emergency.
- Call the toll-free National Suicide Prevention Lifeline (Lifeline) at 1-800-273-TALK (8255), 24 hours a day, 7 days a week. All calls are confidential.
- Contact the Crisis Text Line 24 hours a day, 7 days a week, by texting HELLO to 741741.
Treatment for perinatal depression is important for the health of both the mother and the baby, as perinatal depression can have serious health effects on both. With proper treatment, most women feel better and their symptoms improve.
Treatment for perinatal depression often includes therapy, medications, or a combination of the two.
If these treatments do not reduce symptoms, brain stimulation therapies, such as electroconvulsive therapy, may be an option to explore.
Learn more about these therapies by visiting the National Institute of Mental Health’s (NIMH) Brain Stimulation Therapies webpage. A doctor or health care provider can help women choose the best treatment their symptoms.
Several types of psychotherapy (sometimes called “talk therapy” or “counseling”) can help women with perinatal depression. Two examples of evidence-based approaches that have been used to treat perinatal depression include cognitive behavioral therapy and interpersonal therapy.
Cognitive Behavioral Therapy (CBT)
CBT is a type of psychotherapy that can help people with depression and anxiety. It teaches people different ways of thinking, behaving, and reacting to situations.
People learn to challenge and change unhelpful patterns of thinking and behavior as a way of improving their depressive and anxious feelings and emotions.
CBT can be conducted individually or with a group of people who have similar concerns.
Interpersonal Therapy (IPT)
IPT is an evidence-based therapy that has been used to treat depression, including perinatal depression. It is the idea that interpersonal and life events impact mood and vice versa.
The goal of IPT is to help people to improve their communication skills within relationships, to develop social support networks, and to develop realistic expectations that allow them to deal with crises or other issues that may be contributing to their depression.
For information on how to identify a mental health professional and questions to ask when considering therapy, visit the NIMH Psychotherapies webpage.
Women with perinatal depression are most commonly treated with antidepressants, which are medications used to treat depression. They may help improve the way the brain uses certain chemicals that control mood or stress.
Women who are pregnant or breastfeeding should notify their doctor before starting antidepressants so their doctor can work to minimize the baby’s exposure to the medication during pregnancy or breastfeeding.
The risk of birth defects and other problems for babies of mothers who take antidepressants during pregnancy is very low; however, women should work with their doctor to weigh the risks and benefits of treatment and to find the best solution for their situation.
Women may need to try several different medications before finding the one that improves their symptoms and has manageable side effects.
Antidepressants take time—usually 6 to 8 weeks—to work, and symptoms such as sleep, appetite, and concentration problems often improve before mood lifts. It is important to give medication a chance before deciding whether or not it works.
Do not stop taking antidepressants without the help of a doctor or other health care provider. Sometimes people taking antidepressants feel better and then stop taking the medication on their own, and the depression returns. Stopping medications abruptly can cause withdrawal symptoms.
When a woman and her health care provider have decided it is time to stop the medication, the health care provider will help her to decrease the dose slowly and safely. To find the latest information about antidepressants, talk to a health care provider and visit this U.S.
Food and Drug Administration (FDA) webpage on the use of medications during and after pregnancy.
Please Note: In some cases, children, teenagers, and young adults under the age of 25 may experience an increase in suicidal thoughts or behavior when taking antidepressants, especially in the first few weeks after starting or when the dose is changed. Patients of all ages taking antidepressants should be watched closely, especially during the first few weeks of treatment.
If suicidal behaviors are observed, notify a health care provider right away. If you or a loved one is in crisis, call 911 for emergency services or contact the National Suicide Prevention Lifeline at 1-800-273-TALK (8255).
After the birth of a child, many women experience a drop in certain hormones, which can lead to feelings of depression. FDA has approved one medication, called brexanolone, specifically to treat severe postpartum depression.
Administered in a hospital, this drug works to relieve depression by restoring the levels of these hormones. To learn more, visit the FDA's press announcement on the approval of brexanolone to treat post-partum depression.
Researchers continue to study treatment options for perinatal depression. A health care provider can explain the different treatment options and help women choose the treatment that is right for them.
How can family and friends help?
It is important to understand that depression is a medical condition that impacts the mother, the child, and the family.
Spouses, partners, family members, and friends may be the first to recognize symptoms of perinatal depression in a new mother. Treatment is central to recovery.
Family members can encourage the mother to talk with a health care provider, offer emotional support, and assist with daily tasks such as caring for the baby or the home.
Support or advocacy groups can offer a good source of support and information. One example of this type of group is Postpartum Support International; others can be found through online searches.
Clinical trials are research studies that look at new ways to prevent, detect, or treat diseases and conditions. The goal of clinical trials is to determine if a new test or treatment works and is safe.
Although individuals may benefit from being part of a clinical trial, participants should be aware that the primary purpose of a clinical trial is to gain new scientific knowledge so that others may be better helped in the future.
Researchers at NIMH and around the country conduct many studies with patients and healthy volunteers. We have new and better treatment options today because of what clinical trials uncovered years ago. Be part of tomorrow’s medical breakthroughs. Talk to your doctor or health care provider about clinical trials, their benefits and risks, and whether one is right for you.
For more information about clinical research and how to find clinical trials being conducted around the country, visit NIMH's clinical trials information webpage.
Behavioral Health Treatment Services Locator
The Substance Abuse and Mental Health Services Administration (SAMHSA) provides this online resource for locating mental health treatment facilities and programs in your state. For additional resources, visit our Help for Mental Illnesses webpage.
Talking to Your Health Care Provider About Your Mental Health
Communicating well with your doctor health care provider can improve your care and help you both make good choices about your health. Read our Tips for Talking With Your Health Care Provider to help prepare for and get the most your visit. For additional resources, including questions to ask your doctor, visit the Agency for Healthcare Research and Quality.
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NIH Publication No. 20-MH-8116