How can you tell the baby blues from postpartum depression?
The clearest differences are timing and weight. The American College of Obstetricians and Gynecologists (ACOG) describes the baby blues as sadness, fear, anger or anxiety that start about three days after childbirth and usually get better within one to two weeks without any treatment. The National Institute of Mental Health (NIMH) calls them mild and short-lasting, and notes that feeling tired or overwhelmed by around-the-clock care is normal.
Postpartum depression is heavier and it stays. NIMH says mood changes and feelings of anxiety or unhappiness that are severe, or that last longer than two weeks after childbirth, may be signs of postpartum depression, and that women with it generally will not feel better without treatment. It can make it hard to look after yourself or the baby, which the blues usually do not.
What the baby blues usually look like
The blues tend to arrive in the first week, often as milk comes in, sleep falls apart and the adrenaline of the birth wears off. Crying at an advertisement, snapping at a partner, feeling flat one hour and tender the next: all of this is typical. ACOG notes that some people feel angry with the new baby, their partner or their other children, which can be frightening to admit but is part of the picture.
Two features are reassuring. The feelings come and go rather than settling in, and there are still stretches of ordinary relief or enjoyment in between. Rest, food, a shower and someone else holding the baby for a few hours tend to help noticeably.
Signs that it may be postpartum depression
Postpartum depression can start during pregnancy (clinicians then call it perinatal depression) or at any point in the year after birth. ACOG says it most commonly starts one to three weeks after childbirth, while NIMH says most episodes begin within four to eight weeks. The sources differ on the peak, which is one reason not to rule it out because a certain week has passed.
The CDC reports that about 1 in 8 women with a recent live birth report symptoms of postpartum depression. Signs worth taking seriously include:
- Sad, anxious or empty mood most of the day, nearly every day, for two weeks or more.
- Losing interest or pleasure in things, including time with the baby.
- Feeling distant from the baby, or doubting you can care for them.
- Crying more often than usual, or feeling angry much of the time.
- Sleeping poorly even when the baby sleeps, or wanting to sleep all the time.
- Feeling worthless, guilty or hopeless, or that your family would be better off without you.
- Thoughts of harming yourself or the baby.
It does not always look like sadness
For many parents the main symptom is anxiety: racing thoughts, constant checking, being unable to sit down. Unwanted, frightening thoughts about something happening to the baby are also common. Postpartum anxiety and intrusive thoughts explains those in detail, including why they are very different from psychosis.
Who is more at risk?
Anyone can develop postpartum depression, and it is not a sign of weak character or of not loving your baby. ACOG lists factors that raise the risk: a history of depression at any time, the sharp drop in estrogen and progesterone after birth, exhaustion (recovery can take longer after a cesarean), mixed feelings about the pregnancy, a baby who is sick or in the hospital, and a lack of support or other stressful events such as a death in the family, illness or moving to a new city.
If you have had depression before, ACOG suggests telling your ob-gyn, ideally before or during pregnancy, so a plan can be in place. Partners can be affected too; see postpartum depression in fathers and partners.
What to do if you are not sure
You do not need to be certain it is depression before asking for help. ACOG's advice is to call your ob-gyn or another health professional right away if you think you may have postpartum depression, or if your partner or family are worried, and not to wait for the postpartum checkup. Your provider can screen you with a short questionnaire and talk through options.
NIMH describes treatment as therapy, medication, or both. The talk therapies with the strongest evidence for perinatal depression are cognitive behavioral therapy and interpersonal therapy. Medication options include antidepressants and, according to ACOG, zuranolone, a pill approved specifically for postpartum depression. Decisions about medication and breastfeeding belong with a physician or psychiatric prescriber.
Two services can help you think it through, day or night:
- National Maternal Mental Health Hotline: call or text 1-833-TLC-MAMA (1-833-852-6262), 24 hours a day, for pregnant and postpartum parents and their families. It costs nothing and is confidential.
- Postpartum Support International HelpLine: call 1-800-944-4773, or text "Help" to 800-944-4773 (English) or 971-203-7773 (Spanish). PSI connects parents with local support and trained providers; it is not a crisis line.
When it is an emergency
Postpartum psychosis is rare but serious. NIMH describes symptoms such as delusions, hallucinations, mania, paranoia and confusion, and calls it a psychiatric emergency that requires hospitalization. If you or someone you love shows these signs, call 911 or go to the nearest emergency room, and do not leave the parent alone with the baby. If you are having thoughts of suicide or of harming yourself, call or text 988, the Suicide and Crisis Lifeline.
Where counseling fits
Counseling is one part of care for postpartum depression, alongside medical follow-up. It can also help with the parts no prescription touches: grief for the life before the baby, strain with a partner, and the shock of who you are after becoming a mother.
Laura Bass is a psychotherapist in Charlotte who works with adults, including parents with postpartum concerns, in individual counseling. She does not diagnose or prescribe. For the wider picture of the first year, see becoming a parent, or go back to the parenting and postpartum guide.
Common questions
How long do the baby blues last?
ACOG says the baby blues usually get better within a few days or one to two weeks without treatment. NIMH uses the same two-week line. If you still feel low, anxious or hopeless after two weeks, or the feelings are getting stronger rather than easing, that is the point to call your obstetric provider, midwife or doctor and ask to be screened for postpartum depression.
Can postpartum depression start months after the birth?
Yes. ACOG says postpartum depression can occur up to a year after having a baby, and it can also begin during pregnancy. A later start often coincides with returning to work, weaning, or the end of the early help from family. If symptoms appear at six or nine months, they still count, and they are still worth raising with a doctor.
Does postpartum depression go away on its own?
NIMH says women with postpartum depression generally will not feel better without treatment, which is the main practical difference from the baby blues. Treatment usually means therapy, medication or both, and NIMH notes that with proper treatment most women feel better. Getting help early also protects sleep, feeding and the relationship with your partner while you recover.
Is it postpartum depression if I love my baby but feel nothing else?
Feeling numb, flat or cut off from pleasure, even while you care for and love your baby, can be a sign of depression. It does not mean you are a bad parent, and many parents describe exactly this. Mention it to your provider in those words, or call the National Maternal Mental Health Hotline at 1-833-852-6262 to talk it through.