Baby Blues Or Postpartum Depression?

Mood swings after the birth of a baby are not uncommon. You might cry for no reason or feel more sad or anxious than usual. This could be due to postpartum depression or the “baby blues.” Find out how to tell the difference between the two and when you may need additional support.

What Is Postpartum Depression?

Postpartum depression, or PPD, is a mood disorder that can affect women after childbirth. Women with PPD experience feelings of extreme sadness, anxiety and exhaustion, which may interfere with a woman’s ability to care for herself or her family.

Postpartum depression and postpartum anxiety are the most common complications of childbirth. Rates of postpartum depression have more than doubled in little over a decade among American women, and now approaches 1 in 5 new mothers, according to a study in JAMA Network Open.

Every parent – both women and men - are at risk of postpartum depression, regardless of age, race or financial status. Parents who have adopted children can also develop perinatal depression.

How Is Postpartum Depression Different From Baby Blues?

Postpartum depression is more serious than baby blues.

Baby blues refer to a short period after giving birth that’s filled with bouts of sadness, anxiety, stress and mood swings. The baby blues typically strike within a few days of giving birth, but if you had an especially tough delivery, you may notice them even sooner.

The “baby blues” are experienced by approximately 80 percent of mothers. Babies are a lot of work so it’s normal to worry, be tired (from lack of sleep and providing care) or get a little teary at times. These feelings are usually mild and last about a week or two, then go away on their own.

What Are Symptoms Of The Baby Blues?

If you have the baby blues, you may:

• Feel sad and cry a lot
• Feel moody or cranky
• Have trouble sleeping, eating or making decisions
• Feel overwhelmed and that you can’t do a good job of taking care of your baby

What Are Symptoms Of Postpartum Depression?

According to Postpartum Support International, symptoms of postpartum depression can start anytime during pregnancy or the first year postpartum.

“Some characteristic symptoms of depression are feeling hopeless, feeling alone, and wanting to isolate,” said Kellie Nichelson, MSW, LCSW, an Employee Assistance Program therapist at Franciscan Health. “That doesn't always go well with needing that skin to skin contact and that need to bond with a baby. And so you have this dichotomous relationship between your depression and your baby. And then on top of that, kind of feeling this guilt and shame over potentially being a bad mother and ‘not fulfilling that role’ necessarily.

“It's this cyclical manifestation of your mental health going into not necessarily being able to bond or feeling like you can't bond even though you have the capacity to. Your brain is just maybe convincing you that you can't in that moment.”

Symptoms of postpartum depression differ for everyone, and might include the following:

• Feelings of anger or irritability
• Lack of interest in the baby
• Appetite and sleep disturbance
• Crying and sadness
• Feelings of guilt, shame or hopelessness
• Loss of interest, joy or pleasure in things you used to enjoy
• Possible thoughts of harming the baby or yourself
• Usually starts 1–3 weeks after birth
• Interferes with ability to do daily life activities
• Usually requires treatment

These symptoms differ from the “baby blues.”

“Baby blues is going to be something that actually a pretty big majority of women experience,” Nichelson said. “A little bit of ups and downs, maybe more reactivity to things that maybe normally wouldn't have a woman reacting a certain way. Mental and physical exhaustion, things like that.”

With postpartum depression or postpartum anxiety, the symptoms continue for more than two weeks and may get worse over time.

“The severity of this increases,” Nichelson said. “We might even start to look at some changes in like self-esteem. So it's not just, ‘I'm a little bit irritable or a little bit discontent with life. It's that I'm a bad mom. I'm failing as a mother. I'm not connecting with my child. I am, possibly, even starting to lose a grasp on what reality looks like.”

Who Is Most At Risk For Postpartum Depression?

First-time moms and new mothers of twins may be among those at greatest risk of postpartum depression symptoms, a large study suggests. 

Research suggests there is a genetic component to postpartum depression, and the hormonal changes of pregnancy may help trigger a depressive episode in vulnerable women. But additional factors can sway postpartum depression risk. And in a study of more than 1 million new moms worldwide in the Journal of Affective Disorders, researchers identified factors that can increase postpartum depression risk:

1. Younger mothers

Depression was most common among women under 25, and rates dipped thereafter. Among those youngest mothers, 10% reported depression symptoms within three months of giving birth. That compared with 8.5% of 25- to 29-year-olds, and 6% to 7% of older women, the findings showed.

In general, relatively older women had a lower prevalence of depression symptoms — unless they gave birth to twins.

2. Moms of twins

Overall, moms of twin newborns more often reported depression symptoms than those who'd had one baby (about 11%, versus 8%). 

3. First-time mothers

First-time motherhood was, in fact, a risk factor for depression across the whole study group. Within each age category, the researchers found, first-time moms had somewhat higher rates of depression symptoms than other women.

“Statistics have shown that, first time mothers specifically, can struggle with some postpartum depression more frequently than mothers who already have children who are going into having another baby,” Nichelson said. “I think part of that is just that it's a lot of novel experiences and a lot of uncertainty.”

Postpartum depression also can appear in fathers.

What Causes Postpartum Depression?

Postpartum depression doesn’t happen because of something the mother did or didn’t do. It isn’t the mother’s fault.

PPD may owe to a combination of biological, hormonal, psychological and social factors, according to the American College of Obstetricians and Gynecologists (ACOG). These include:

Hormonal changes

After childbirth, estrogen and progesterone levels plunge. These hormonal fluctuations, similar to those experienced before a woman's menstrual period, can trigger depression and mood swings.

History of depression

Women who have previously experienced depression, whether before, during or after pregnancy, are at an increased risk of postpartum depression.

Emotional factors

Doubts and uncertainties about the pregnancy are common and can influence emotional well-being. Unplanned or unwanted pregnancies can affect how a woman feels about her pregnancy and the developing fetus. Even with planned pregnancies, adjusting to the idea of a new baby may take time. Parents of sick infants or those needing longer hospital stays may experience sadness, anger or guilt, which can affect their self-esteem and ability to cope with stress.

Fatigue

The physical demands of childbirth and the subsequent recovery can cause profound fatigue. It can also take weeks, and even longer, for women who have had cesarean sections to regain their strength and energy. The persistent exhaustion can contribute to feelings of emotional vulnerability and increase the risk of PPD.

Lifestyle factors

Lack of support from others and stressful life events, such as the recent loss of a loved one, family illnesses, job losses or relocation to a new city, can significantly up the risk for PPD. These external stressors can amplify the emotional challenges faced during the postpartum period.

“If there's a lot of external stress in your life, if you're going home to inadequate supports, if you are going home to a lot of external stress in your home life, in your work life, in your personal life in general, that increases your risks as well,” Nichelson said.

Who Should Be Screened For Postpartum Depression Or Baby Blues?

Guidelines say screening for postpartum depression can be done by both obstetricians and pediatricians, who typically see new moms more often. The American Academy of Pediatrics recommends screening moms for postpartum depression during babies' routine check-ups over the first six months of life. 

How Long Does Postpartum Depression Last?

Left untreated, PPD can last several years, according to the U.S. National Institutes of Health. For some women, symptoms persist beyond the first year after giving birth and extend into the child's toddler years. It's important to note that with appropriate treatment and support, many women can recover from postpartum depression and regain their emotional well-being much sooner.

When To Seek Help

Talking to your doctor is essential. Based on the severity of the symptoms, or if the “baby blues” are not better in 2 weeks and continue to impair a mother’s ability to function, you should speak with your physician.

“These are some pretty drastic mental changes from the ‘baby blues’ that a lot of people experience,” Nichelson said. “If we get to past that two weeks and these are persisting, that's where recommended to continue to talk to your whether it be your OBGYN or even your family doctor. And if you have a therapist or a psychiatrist, talking to them.”

HealthDay News contributed information to this article.