Baby Blues or Postpartum Depression: How to Tell and Where to Get Help

Author: Igel Cudiera

Feeling weepy, wired, or overwhelmed after birth is very common, and it can be hard to know when those feelings are part of normal recovery and when they are a sign of something that needs care. This guide explains how the two differ, what to watch for, what screening means, and where to turn, including what to say when you call and what happens next.

Key Takeaways

• The baby blues usually begin about 2 to 3 days after birth and get better within a few days or 1 to 2 weeks without treatment, according to the American College of Obstetricians and Gynecologists (ACOG).
• Postpartum depression can begin during pregnancy or at any point in the first year after birth. Symptoms that are severe or that last longer than 2 weeks may be a sign of it, according to the National Institute of Mental Health (NIMH).
• About 1 in 8 women with a recent live birth report symptoms of postpartum depression, according to the Centers for Disease Control and Prevention (CDC).
• Postpartum depression is not your fault, and most people feel better with treatment.
• Thoughts of harming yourself or your baby are a reason to get help right away.

Baby Blues vs. Postpartum Depression at a Glance

The table draws on guidance from ACOG, NIMH, and the U.S. Office on Women's Health (OWH). It is a general guide, not a diagnosis.

What Are the Baby Blues?

NIMH describes the baby blues as mild, short-lasting mood changes and feelings of worry, unhappiness, and exhaustion that many women experience in the first 2 weeks after giving birth. Babies need around-the-clock care, so NIMH notes it is normal for new parents to feel tired or overwhelmed sometimes.

Common Signs of the Baby Blues

According to OWH, if you have the baby blues, you may:

• Have mood swings
• Feel sad, anxious, or overwhelmed
• Have crying spells
• Lose your appetite
• Have trouble sleeping

ACOG adds that some people feel angry with the new baby, their partner, or their other children, or cry for no clear reason. These feelings tend to come and go rather than settle in.

When the Baby Blues Start and How Long They Last

ACOG explains that these feelings usually begin about 2 to 3 days after childbirth and get better within a few days or 1 to 2 weeks without any treatment. If they are still there after 2 weeks, or if they are very intense at any point, OWH advises calling your doctor, nurse, midwife, or pediatrician.

What Helps While You Have the Baby Blues

The baby blues do not need medical treatment, but rest and support can make the first weeks easier. OWH suggests:

• Resting as much as you can and sleeping when the baby sleeps
• Not trying to do everything yourself, and asking your partner, family, and friends for help
• Talking about your feelings with people you trust, including other new parents
• Avoiding major life changes right after birth when you can

Our guide to the physical and emotional changes in the early postpartum period covers more of what is normal in those first weeks.

What Is Postpartum Depression?

ACOG describes postpartum depression as a type of depression that causes intense feelings of sadness, anxiety, or despair that keep people from being able to do their daily tasks. OWH notes that feeling hopeless after childbirth is not a regular or expected part of becoming a mother.

You may also see the term perinatal depression. NIMH uses it to include depression during pregnancy (prenatal depression) and in the weeks and months after birth (postpartum depression).

Signs of Postpartum Depression to Watch For

NIMH lists these among the more common symptoms:

• A sad, anxious, or "empty" mood most of the day, nearly every day, for at least 2 weeks
• Feelings of hopelessness, guilt, worthlessness, or helplessness
• Irritability, frustration, or restlessness
• Loss of interest or pleasure in things you used to enjoy
• Fatigue or a noticeable drop in energy
• Trouble concentrating, remembering, or making decisions
• Trouble sleeping even when the baby is asleep, waking very early, or sleeping too much
• Changes in appetite or weight
• Aches, pains, headaches, or digestive problems without a clear physical cause
• Trouble bonding with the baby, or persistent doubts about your ability to care for the baby
• Thoughts of death or of harming yourself or the baby

Not everyone looks visibly distressed. Some parents keep feeding, changing, and caring for the baby while feeling numb or disconnected inside. OWH notes that many new mothers do not tell anyone about their symptoms because they feel embarrassed or worry they will be seen as bad mothers.

When Postpartum Depression Can Start

ACOG states that postpartum depression can occur up to 1 year after having a baby, and that it most commonly starts about 1 to 3 weeks after childbirth. The U.S. Food and Drug Administration (FDA) notes that it can also begin during the later stages of pregnancy. Feeling fine at your two-week mark does not rule it out later.

If you noticed low mood or anxiety while you were pregnant, our article on emotional changes during pregnancy covers what is common and when to ask for help.

Who Is More Likely to Experience It

Postpartum depression can affect anyone, regardless of age, race, income, culture, or education, according to NIMH. OWH lists factors that can raise the risk, including:

• Depression before or during pregnancy, or a family history of depression
• A difficult or traumatic birth, or problems with a previous pregnancy or birth
• Little or no support from family, friends, or a partner
• Relationship struggles, money problems, or other stressful life events
• Domestic violence, now or in the past
• A hard time breastfeeding
• A baby born prematurely or with special health care needs
• An unplanned pregnancy

Having one or more of these does not mean you will develop postpartum depression. It is worth telling your provider early, ideally during pregnancy, so you can plan support together. ACOG notes that for people with a history of depression, this planning may include starting treatment right after birth.

It Is Not Your Fault, and It Is Not a Measure of Your Love

NIMH is clear that a woman is not to blame or at fault for having perinatal depression, and that it is not caused by anything she has or has not done. OWH puts it simply: it does not mean you are a bad mom.

If you do not feel as connected to your baby as you expected, ACOG's advice is not to feel guilty or ashamed. ACOG also notes that with treatment, you can become healthier and more able to bond with your baby.

How to Tell the Difference

The two can overlap at first. OWH notes that some normal changes after pregnancy can cause symptoms similar to those of depression, and many new parents feel overwhelmed when a baby comes home. What usually separates them is how long the feelings last, how heavy they feel, and how much they get in the way of daily life.

What the Difference Can Feel Like

Every experience is different, but here is how the two often compare in everyday life:

• A baby blues day might bring tears over a small thing, a wave of worry, then a good laugh with your partner an hour later. You are exhausted, but you can still rest when someone takes the baby, and the hard moments pass.
• A day that may point to postpartum depression might feel flat, heavy, or empty from morning to night. You cannot sleep even when the baby sleeps, food does not appeal, and nothing seems to lift the feeling, even good news or help from others.

These examples are only a guide. Four questions can help you decide when to reach out.

1. How Long Has It Been?

The baby blues usually fade within 2 weeks. Low mood, anxiety, or emptiness that lasts longer than 2 weeks is a reason to call your provider. So is low mood that starts weeks or months after birth and stays for more than 2 weeks, even if you felt fine at first.

2. Is It Getting Better or Worse?

The baby blues tend to lift little by little. NIMH notes that mood changes that are severe, not just long-lasting, may be signs of postpartum depression. If your feelings are very intense or keep getting heavier, you do not need to wait for the two-week mark to ask for help.

3. Can You Take Care of Yourself and Your Baby?

OWH advises calling your provider if it is hard to get things done at home, or if you cannot care for yourself or your baby, such as eating, sleeping, or bathing.

4. Are You Having Thoughts That Scare You?

Thoughts of harming yourself or your baby always deserve prompt attention. The CDC lists them among its urgent maternal warning signs and advises seeking medical care right away. If you feel you might act on these thoughts, call 911 or 988 now.

These questions cannot diagnose you. NIMH notes that a provider can determine whether your symptoms are due to depression or something else.

Other Postpartum Mood Conditions to Know About

Postpartum Anxiety

Postpartum mood changes are not always sadness. OWH notes that perinatal anxiety often occurs along with perinatal depression, and lists common symptoms such as constant worrying, feeling that something bad is going to happen, racing thoughts, being unable to sit still, and physical symptoms like dizziness, hot flashes, and nausea. ACOG adds that postpartum anxiety most often begins right after delivery and up to 6 weeks postpartum, though it may happen up to a year after delivery.

Unwanted, Scary Thoughts

Many new parents have sudden, unwanted thoughts about something bad happening to their baby, sometimes even about harming the baby. ACOG's screening guidance describes these intrusive thoughts as very common and often related to fears of something happening. ACOG notes that most people who find these thoughts distressing will not act on them, and that they still deserve a conversation with your provider and further evaluation.

So tell your midwife or provider about them. Saying the thought out loud is how you get the right support. OWH advises that if you are having thoughts about harming your baby, you should get help immediately by calling or texting 988.

Postpartum Psychosis: An Emergency

Postpartum psychosis is different from the baby blues and postpartum depression. It is rare: ACOG reports that it occurs in about 1 to 2 of every 1,000 births, with typical onset 3 to 10 days after birth. NIMH describes possible symptoms as delusions (beliefs that are not true), hallucinations (seeing, hearing, or smelling things that are not there), mania (a high, elated mood that seems out of touch with reality), paranoia, and confusion.

NIMH calls postpartum psychosis a psychiatric emergency: anyone with these symptoms should call 911 or go to the nearest emergency room. ACOG names bipolar disorder, a personal or family history of bipolar disorder, and a previous episode of postpartum psychosis as the most significant risk factors, so share that history with your provider during pregnancy. With professional help, recovery is possible.

Partners Can Be Affected Too

Depression after a baby arrives is not limited to the person who gave birth. The American Academy of Pediatrics (AAP) notes that partners of all genders can develop depression, as can adoptive parents and parents of babies born through surrogacy, and reports that between 7% and 9% of new fathers develop postpartum depression. Signs the AAP lists include deep sadness, worry, or anxiety, persistent fears for the baby's health and safety, anger and irritability, and difficulty bonding with the newborn.

How Screening for Postpartum Depression Works

Screening is a routine part of pregnancy and postpartum care, not a sign that someone thinks something is wrong with you. ACOG recommends screening for depression and anxiety at the first prenatal visit, later in pregnancy, and at postpartum visits, using a standardized, validated questionnaire. Tools ACOG lists include the Edinburgh Postnatal Depression Scale (EPDS) and the Patient Health Questionnaire (PHQ-9).

• A short questionnaire. You answer questions about how you have been feeling recently, such as your mood, worry, sleep, and whether you have had thoughts of harming yourself.
• A score is not a diagnosis. ACOG is clear that these are screening tools, not diagnostic tools. A diagnosis comes from an evaluation that includes a conversation with you.
• Screening at your baby's visits. The AAP's schedule of well-baby care includes maternal depression screening at the 1, 2, 4, and 6 month visits, so your baby's provider may ask about your mood too.
• Extra support if you are at higher risk. The U.S. Preventive Services Task Force (USPSTF) recommends that clinicians provide or refer pregnant and postpartum people at increased risk of perinatal depression to counseling.

ACOG recommends contact with your provider within the first 3 weeks after birth and a comprehensive postpartum visit no later than 12 weeks. You do not have to wait for a scheduled visit to bring up your mood.

Where to Get Help

If It Is an Emergency

• Call 911 or go to the nearest emergency room for any life-threatening situation, if you feel you might act on thoughts of harming yourself or your baby, or for signs of postpartum psychosis.
• Call or text 988, or chat at 988lifeline.org, if you are struggling or having thoughts of suicide or of harming your baby. The 988 Suicide and Crisis Lifeline is free, confidential, and available 24/7, and text and chat are also offered in Spanish.

If You Are Worried: Call Your Midwife or Provider

ACOG advises contacting your provider right away if you think you may have postpartum depression, or if your partner or family members are concerned, and not waiting until your postpartum checkup. If making the call feels like too much, OWH suggests asking your partner or a loved one to call for you.

It can help to have words ready. You might say:

• "I had my baby about [number] weeks ago. For the past [number] days, I have been feeling [sad, empty, anxious, irritable, numb]."
• "I am [not sleeping even when the baby sleeps, not eating, struggling to get through the day]."
• "I am worried this is more than the baby blues, and I would like to be screened."
• "I have been having thoughts that scare me, and I want to talk about them."

What Happens After You Reach Out

Reaching out usually starts with a conversation. Based on ACOG, OWH, and NIMH guidance, the next steps may include:

1. Questions about how you are feeling. ACOG notes you may be asked to answer screening questions in writing, followed by a conversation about your answers.
2. Checking for other causes. OWH notes that thyroid hormone levels can drop after birth and cause symptoms of depression, and that a simple blood test can check for this.
3. A referral if needed. Your provider can refer you to a mental health professional, such as a psychologist, psychiatrist, or social worker.
4. A plan that fits you. OWH notes that working with a health care professional is a good way to create a plan that works for you, using one or more of the treatment options below.

Support Lines for Parents and Families

• National Maternal Mental Health Hotline: call or text 1-833-TLC-MAMA (1-833-852-6262) for free, confidential, 24/7 support from professional counselors. NIMH notes that English- and Spanish-speaking counselors are available, and OWH notes that deaf or hard of hearing callers can use a relay service or dial 711 and then 1-833-852-6262.
• Postpartum Support International (PSI) HelpLine: call or text "Help" to 1-800-944-4773 for information, resources, and support groups for mothers, partners, and supporters, as OWH describes. It is a support line, not an emergency service, so use 911 or 988 in a crisis.

Postpartum Support at Birthing Center NYC

Our postpartum care is designed to help mothers recover physically and emotionally after birth. Birthing Center NYC describes postpartum home visits from our midwives within 24 to 48 hours of birth to check on mother and newborn, follow-up care through six weeks postpartum, and a postpartum support group where new parents can connect, with regular meetings facilitated by our midwives.

If you are a client and something feels off, talk to your midwife. Our office hours are Monday through Friday, 9 AM to 5 PM. If you are worried about your safety or your baby's safety at any hour, call 911 or 988 rather than waiting for a callback.

What Treatment Can Look Like

Postpartum depression is treatable. NIMH notes that with proper treatment, most women feel better and their symptoms improve. Treatment usually includes therapy, medication, or both, and the right mix depends on your symptoms, history, and preferences, so it is something to decide with your provider.

• Talk therapy. NIMH names cognitive behavioral therapy (CBT), which helps you notice and change unhelpful thoughts and behaviors, and interpersonal therapy (IPT), which focuses on relationships and support, as evidence-based options. ACOG notes that therapy can be one-on-one, in a group, or with your partner or family.
• Antidepressants. NIMH notes that antidepressants can effectively treat perinatal depression, alone or with therapy. OWH notes that they may take several weeks to start working.
• Zuranolone. In August 2023, the FDA approved zuranolone (Zurzuvae) as the first oral medication for postpartum depression in adults. It has specific side effects and precautions, so ask your provider whether it fits your situation.
• Support groups and social support. OWH lists support groups, social support, and self-care alongside therapy and medication as parts of a treatment plan.

If You Are Breastfeeding

The CDC notes that mothers with postpartum depression can usually continue to breastfeed, and that it may be safe to take antidepressant medications while breastfeeding. Many medications pass into breast milk, but the CDC notes that most have little or no effect on milk supply or the baby. ACOG notes that zuranolone also passes into breast milk and that its effects on breastfed babies are not yet clear. Talk with your provider about the benefits and risks of each option for you and your baby. The CDC also points to LactMed, a National Library of Medicine database of information on medications and breastfeeding.

How Partners and Family Can Help

NIMH notes that spouses, partners, family members, and friends may be the first to recognize signs of depression in a new parent. You can help by:

• Encouraging them to talk with a health care provider, and offering to make the call
• Helping them get to appointments
• Offering emotional and practical support
• Taking on daily tasks, such as caring for the baby or the home, so they can rest
• Calling 911 or 988 if you are worried about their safety or the baby's safety

Many new parents hide how they feel because they think they should be happy. A calm, private "How are you really doing?" can open the door.

Frequently Asked Questions

How long should the baby blues last?

ACOG says the baby blues usually get better within a few days or 1 to 2 weeks. If your symptoms have not gone away after 2 weeks, or they are very intense, OWH advises calling your provider.

Can postpartum depression start during pregnancy or months after birth?

Yes. The FDA notes that it can begin during the later stages of pregnancy, and ACOG states that it can occur up to 1 year after having a baby. OWH advises calling your provider if symptoms of depression begin within a year of delivery and last more than 2 weeks.

Does postpartum depression go away on its own?

Usually not without help. NIMH notes that people with postpartum depression generally will not feel better without treatment, and MedlinePlus notes that untreated, it can last for months or years. The encouraging part is that with treatment, most people feel better.

What if I am taking care of my baby but feel empty inside?

That still matters. NIMH lists a persistent "empty" mood as a symptom of perinatal depression, even when you are getting through the day. Screening questionnaires ask how you feel, not just what you are managing to do, so mention it to your provider.

Can dads and partners get postpartum depression?

Yes. The AAP reports that between 7% and 9% of new fathers develop postpartum depression, and notes that partners of all genders and adoptive parents can be affected too. Partners with symptoms should talk with a health care provider.

Can I take medication for postpartum depression while breastfeeding?

Often, yes. The CDC notes that it may be safe to take antidepressants while breastfeeding and that most medications have little or no effect on the baby. Your provider can help you weigh the options for your situation.

Taking the Next Step

Mood changes after birth are common, and so is needing help with them. If the baby blues are fading, rest and support may be all you need. If your feelings are lasting, getting heavier, or making it hard to care for yourself or your baby, reach out to your midwife or provider. OWH puts it well: getting help is a sign of strength.

Sources and References

• Postpartum Depression, Anxiety and Pregnancy, and Bonding With Your Newborn: What to Know If You Don't Feel Connected Right Away. American College of Obstetricians and Gynecologists.
• Screening and Diagnosis of Mental Health Conditions During Pregnancy and Postpartum, Clinical Practice Guideline No. 4, Perinatal Mental Health: Patient Screening, and Optimizing Postpartum Care, Committee Opinion No. 736. American College of Obstetricians and Gynecologists.
• Perinatal Depression. National Institute of Mental Health.
• Postpartum Depression and Perinatal Mental Health Conditions: Fact Sheet for Women and Their Support Network. U.S. Office on Women's Health.
• Symptoms of Depression Among Women, Urgent Maternal Warning Signs, and Postpartum Depression (Breastfeeding Special Circumstances). Centers for Disease Control and Prevention.
• Postpartum Depression. MedlinePlus, National Library of Medicine.
• FDA Approves First Oral Treatment for Postpartum Depression. U.S. Food and Drug Administration.
• Recommendations for Preventive Pediatric Health Care (Periodicity Schedule) and Perinatal Depression in Partners: Can Both Parents Get the "Baby Blues?". American Academy of Pediatrics.
• Perinatal Depression: Preventive Interventions. U.S. Preventive Services Task Force.
• 988 Suicide and Crisis Lifeline.

About the Author

Igel Cudiera

Igel Cudiera wrote this article for Birthing Center NYC. It draws on guidance from the American College of Obstetricians and Gynecologists, the National Institute of Mental Health, the U.S. Office on Women's Health, the Centers for Disease Control and Prevention, the American Academy of Pediatrics, and the other sources listed above.

This content is intended for educational purposes only and does not replace personalized medical advice, diagnosis, or treatment from a qualified healthcare provider. If you are worried about your mood or your safety, contact your midwife or another health care provider. In an emergency, call 911 or 988.