Signs of Postpartum Depression: Baby Blues or PPD, When It Starts, Help

What are the signs of postpartum depression?

Signs of postpartum depression include a sad, anxious or "empty" mood most of the day, nearly every day, for at least 2 weeks, according to the US National Institute of Mental Health (NIMH). Other common symptoms on the NIMH list include:

• feeling hopeless, guilty, worthless or helpless
• irritability, frustration or restlessness
• losing interest or pleasure in things you used to enjoy
• trouble sleeping even when the baby is asleep, or sleeping too much
• changes in appetite or weight
• trouble concentrating, remembering or making decisions
• trouble bonding with the baby, or constant doubts about caring for them
• thoughts of death, or of harming yourself or the baby

The NHS, which calls it postnatal depression, adds feeling that you are a bad parent and worrying all the time, and says to get help even if you have only some of the signs. The Office on Women's Health (OWH) says 1 in 8 new mothers report symptoms of postpartum depression in the year after giving birth.

Is it the baby blues or postpartum depression?

How long the feelings last and how severe they are tell them apart: the NHS says the baby blues usually go away within 2 weeks of the birth, and NIMH says mood changes that are severe or last longer than 2 weeks may be signs of postpartum depression.

ACOG says the baby blues can include crying for no clear reason and doubting you can care for a baby, with feelings that come and go in the first days. NIMH says people with postpartum depression generally will not feel better without treatment. The OWH says feeling hopeless after childbirth is not a regular or expected part of being a mother. It also says some normal changes after pregnancy can cause symptoms similar to depression; how your body changes after birth covers the physical ones.

When does postpartum depression start?

ACOG says postpartum depression most commonly starts about 1 to 3 weeks after childbirth and can occur up to 1 year after having a baby. NIMH says most episodes begin within 4 to 8 weeks after the birth, and the NHS says symptoms can also begin during pregnancy.

You are more likely to have it if you had depression before or during pregnancy, have had a difficult life event recently, have a premature or unwell baby, or do not have enough support, according to the NHS. NIMH says perinatal depression is not caused by anything a mother has or has not done.

ACOG says to tell your ob-gyn early in prenatal care, ideally before pregnancy, if you have ever had depression or take an antidepressant; they may suggest starting treatment right after the birth to prevent postpartum depression. Fatigue may be a major contributor too, ACOG says, and recovery can take even longer after a cesarean birth.

How is postpartum depression treated?

Postpartum depression is treated with talk therapy, medicine, or both, according to NIMH and ACOG. NIMH names cognitive behavioral therapy and interpersonal therapy as evidence-based options.

ACOG says antidepressants may take 3 to 4 weeks before you start to feel better, and NIMH says usually 4 to 8 weeks. ACOG says zuranolone is the first medicine approved by the FDA for postpartum depression in adults and is taken by mouth for 14 days. The NHS says many antidepressants are safe while breastfeeding and to tell your doctor if you are breastfeeding. NIMH advises talking to a health care provider before starting or stopping any medicine.

The NHS says that if you are 18 or over (16 in some areas), you can refer yourself to an NHS talking therapies service without a GP referral. It also says you may be scared that your baby will be taken away if you ask for help, and that this is very rare.

Where can you get help for postpartum depression right now?

ACOG says to call your ob-gyn or another health care professional right away if you think you have postpartum depression, without waiting for your postpartum checkup. In the UK, the NHS says to speak to your GP, midwife or health visitor.

In the US:

• National Maternal Mental Health Hotline: call or text 1-833-TLC-MAMA (1-833-852-6262). The OWH says it gives free access to professional counselors 24/7, and NIMH says it is confidential, open to mothers and their families, and has English- and Spanish-speaking counselors.
• 988 Suicide & Crisis Lifeline: call or text 988, or chat on its website. The Lifeline says it is available 24/7/365, and conversations are free and confidential.

In the UK:

• NHS 111: the NHS says to call 111 and choose the mental health option, use 111 online, or ask for an urgent GP appointment if you need urgent help for your mental health.
• Samaritans: call 116 123, free from any phone, day or night, according to Samaritans.

How can a partner or family help?

Partners, family and friends may be the first to notice the signs, according to NIMH, and can help by encouraging you to talk to a health care provider, getting you to appointments, offering emotional or practical support, and helping with the baby and the home. The OWH suggests asking your partner or a loved one to call your doctor for you if you need to.

The NHS says fathers and partners can also have depression after having a baby. ACOG says to call right away if your partner or family members are worried you may have postpartum depression.

When to call your doctor or midwife

The OWH says to call your doctor, nurse, midwife or your baby's pediatrician if:

• the baby blues have not gone after 2 weeks, or are very intense
• symptoms of depression start within a year of the birth and last more than 2 weeks
• it is hard to work or get things done at home
• you cannot care for yourself or your baby, such as eating, sleeping or bathing
• you have thoughts about hurting yourself or your baby

ACOG says to call your ob-gyn, another health care professional or emergency services right away if your depression gets worse soon after you start medicine, or if you have thoughts of hurting yourself or others.

Postpartum psychosis is a separate illness that the NHS says should be treated as a medical emergency. It affects around 1 in 1,000 mothers and usually starts suddenly within the first 2 weeks after birth, with hallucinations, delusions, a very high or very low mood, or feeling very confused, the NHS says.

For symptoms of postpartum psychosis, NIMH says to call 911 or go to the nearest emergency room; the NHS says to see a GP immediately for a same-day assessment, call 111 if you cannot, or call 999 or go to A&E if someone may be in danger of imminent harm. The NHS notes that a person with postpartum psychosis may not realize they are ill, so a partner, family or friends may have to act.