Becoming a parent is supposed to feel joyful, and plenty of people feel something very different: wired, weepy, frightened, numb, or ashamed that they don't feel the way they expected to. If that's you, you're not failing — and there's help. The first step is understanding what you're feeling.
Baby blues
Up to the first days or couple of weeks after birth, many people feel tearful, overwhelmed, and moody as hormones shift and sleep disappears. The baby blues are common, usually mild, and tend to fade on their own. If symptoms are more intense, last longer, or make it hard to function, it may be something more.
Postpartum depression
About 1 in 8 women with a recent live birth report symptoms of postpartum depression, according to the CDC. Most episodes begin within 4 to 8 weeks after birth, though they can begin during pregnancy or later. Symptoms can include:
- Persistent sadness, emptiness, or hopelessness
- Crying more than usual, or feeling angry or irritable
- Loss of interest in activities you used to enjoy
- Feeling distant from your baby, or doubting your ability to care for them
- Changes in sleep or appetite beyond what a newborn explains
- Trouble concentrating or making decisions
- Guilt or feelings of worthlessness
Postpartum anxiety
Anxiety after birth is common, and it can happen with or without depression. It often looks like constant worry that you can't turn off, racing thoughts, a feeling of dread, physical symptoms such as a pounding heart or tight chest, trouble sleeping even when the baby sleeps, and intrusive thoughts about something bad happening to your baby. Because it's easy to dismiss as "normal new-parent worry," postpartum anxiety often goes unrecognized.
How to tell the difference
- Baby blues: mild, short-lived, improves on its own, and doesn't stop you from caring for yourself or your baby.
- Postpartum depression: lasts longer and runs deeper — sadness, emptiness, numbness, or detachment, and a sense that you can't cope.
- Postpartum anxiety: dominated by worry, fear, restlessness, and physical tension, often with trouble sleeping and intrusive thoughts.
They also overlap, and you can have more than one. You don't need to figure out the label before asking for help.
Who is more at risk
Anyone can develop postpartum depression or anxiety. Factors that raise the risk include life stress or past trauma, a personal or family history of depression or bipolar disorder, depression during a previous pregnancy or after a prior birth, and the physical and emotional strain of childbirth and newborn care. Having risk factors doesn't mean it will happen — and having none doesn't make it impossible.
When to get help
- Symptoms last more than about two weeks
- They're getting worse, not better
- They make it hard to care for yourself or your baby, to sleep when you can, or to enjoy anything
- You have frightening or intrusive thoughts that you can't shake
Tell your OB, midwife, pediatrician, or primary care provider as soon as you can, and ask for a referral to a mental health professional. Tell every provider if you are pregnant or breastfeeding, since that affects medication decisions.
Treatment
Treatment usually involves therapy, medication, or both. Evidence-based talk therapies include cognitive behavioral therapy and interpersonal therapy. Antidepressants typically take four to eight weeks to work, and more than one may need to be tried. NIMH notes that the risk of birth defects and other problems for babies of mothers who take antidepressants during pregnancy is very low, and advises working with a provider to weigh benefits and risks. Decisions about medication while breastfeeding are individualized, and we coordinate with your OB, midwife, or pediatrician when helpful.
If you're a partner or loved one
You may notice before she does. Say what you see without judgment ("You seem exhausted and I'm worried about you"), offer concrete help with sleep and feeding, and offer to go with her to an appointment or sit in on the call. Take any talk of self-harm seriously and call 988 or 911.
Where to turn right now
- National Maternal Mental Health Hotline: call or text 1-833-852-6262 (1-833-TLC-MAMA), free and confidential, 24/7, in English and Spanish.
- 988 Suicide & Crisis Lifeline: call or text 988, or chat at 988lifeline.org.
- Postpartum Support International: postpartum.net, support and information for families.
- Emergency: 911.
VeraMind provides psychiatric evaluation and ongoing medication management for postpartum mood and anxiety symptoms by telehealth in Alabama. Visits are scheduled, not emergency, care. Learn about our women's mental health care →