When Baby Blues Is Something More

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Did you know that most new mothers experience some baby blues? First, there’s the anxiety and stress they feel because there’s so much they don’t know about what’s coming next. Next, there’s the likelihood that they are getting very little sleep! In addition, more than 70 percent of new mothers also react to the quick drop in estrogen and progesterone after birth and the quick increase in prolactin levels (for breastfeeding). All of these chemical changes affect the brain’s emotional stability centers and can trigger the mood swings we call baby blues.¹

The good news is that the changes are time-limited and self-correcting; after two to four weeks post-natal, baby blues usually lift on their own. But postpartum depression (PPD) is not a form of baby blues gone wild. PPD is different from baby blues in many ways:

Although baby blues can mean unexpected and unexplained sadness, fatigue, and heightened worrying, the symptoms are usually mild enough to allow for daily functioning and bonding with the new baby. The symptoms of PPD, on the other hand, are more severe and usually include feelings of hopelessness, guilt about not feeling happy, or even suicidal thoughts. Since daily functioning is impaired, PPD can affect children as well as mothers.²

The triggers for PPD are not time-limited and self-correcting like the estrogen and progesterone changes that trigger baby blues. In addition to the post-birth hormonal imbalances involved in the baby blues, PPD triggers may include disruptions of thyroid function, disruptions of serotonin and dopamine neurotransmitter pathways in the brain (which regulate our mood), activation of a possible genetic predisposition, or reactivation of previous depression, interacting with poor nutrition and a difficult pregnancy. The symptoms of postpartum depression, therefore, can last much longer—months to even years—and can get worse over time without diagnosis, emotional support, and or medical treatment.

Furthermore, the onset of PPD may not immediately follow delivery like baby blues. The onset may be a month to a year after the baby is born and take the new mother and her family completely by surprise.³ Since PPD is less common than baby blues, only about one or two in 10 new mothers are estimated to experience PPD, friends and families are much less aware of its symptoms and less likely to guide those new mothers suffering from PPD to help.

Unfortunately, before the PPD triggers were identified, my patients who had PPD would tell me their family and even friends would sometimes blame their depression and anxiety on hypothetical emotional conflicts:

• “She must have mixed feelings about her new role.”
• “She must have unresolved issues from her own upbringing.”
• “She must be insecure about being a mother.”

If those were the real reasons for PPD, we’d probably all have PPD because we all have some of those issues! Not only was this blaming the victim, but it was also not supported by solid research. We now know that not enjoying your newborn or not bonding initially with your baby is not the cause of PPD; it is the result of PPD.

If guilt, sadness, anxiety, mood swings, crying jags, or panic attacks are preventing you from living your daily life, relating to your friends, family, or job, and caring lovingly for your child, it’s time to find help and treatment so you can enjoy your parenthood the way you want to.

Start by speaking to your obstetrician or family doctor about getting a diagnosis and finding resources and referrals. Although self-care is always important, it is usually not enough to manage PPD on your own and will invite self-blame if you are not successful. The National Institute of Mental Health reports that a combination of early diagnosis, talking therapy (with a cognitive-behavioral or interpersonal therapy PPD specialist), medication (studies find selective serotonin reuptake inhibitor antidepressants most effective), and lifestyle support (group meetings with others who are going through PPD or have successfully managed PPD) is the most effective approach so far. The American Psychiatric Association also encourages proactive PPD screening during pregnancy as well as postpartum to ensure that intervention is ready if needed.⁴

Don’t confuse some natural fatigue, passing moodiness, worries, or even sadness during the first few weeks after giving birth with postpartum depression. And don’t forget that PPD is a medical condition that can be managed and not a measure of your love for your child—or for yourself.