Postnatal Depression: Symptoms, Baby Blues, and When to Get Help

Postnatal depression (PND), also called postpartum depression, is a common mental health condition that can develop after having a baby, and it usually gets better with treatment [1]. It can happen to anyone, and it is not your fault [2][3]. It is not caused by anything you have or have not done, and it can affect women of any age, background or income [3].

Baby Blues or Postnatal Depression?

In the days after giving birth, many new mothers feel weepy, worried, low, anxious, irritable or exhausted, often with quick swings in mood. This is commonly called the baby blues [1][2][3][4], and more than half of new mothers go through it [2]. The baby blues are short-lived [1][2][3][4] and do not need treatment [2][4], although the CDC, RCPsych, NHS and NIMH give different lengths: typically within a few days for the CDC [4], usually starting 3 to 4 days after birth and stopping by the time the baby is about 10 days old for RCPsych [2], and within the first 2 weeks for the NHS and NIMH [1][3].

Postnatal depression feels more intense and lasts longer [4]. Mood changes, anxiety or unhappiness that are severe or last longer than 2 weeks after the birth may be signs of postnatal depression [3], and your health visitor or GP can check whether you have it [2]. If low feelings continue, get worse or you are struggling to cope, it is important to get help [1]. Try not to dismiss these feelings as the baby blues or assume they are a normal part of coping with a new baby [2].

When Postnatal Depression Can Start

Postnatal depression does not always begin straight after the birth. Symptoms can start during pregnancy, soon after the baby arrives, or at any point up to a year later [1]. It often starts within one or two months of giving birth [2], and most episodes begin within 4 to 8 weeks after the baby is born [3].

For some women the illness begins before the baby is born: about a third of women with PND first had symptoms in pregnancy that carried on after the birth [2]. Depression before or during pregnancy is itself a risk factor for postpartum depression, and anxiety disorders are also common before, during and after pregnancy [5].

How Common Is Postnatal Depression?

Estimates differ because they measure different things. In the UK, RCPsych puts postnatal depression at between 10 and 15 in every 100 women having a baby [2]. In the US, about 1 in 8 women with a recent live birth reported symptoms of postpartum depression in CDC research [4]. Worldwide, WHO estimates that about 10% of pregnant women and 13% of women who have just given birth experience a mental disorder, primarily depression, with higher figures in developing countries of 15.6% during pregnancy and 19.8% after child birth [6].

Signs of Postnatal Depression in New Parents

The symptoms are much like those of depression at other times, with low mood and other symptoms lasting at least two weeks [2]. Some signs, though, are closely tied to life with a new baby:

• Sleep that will not come even when you can rest. You may lie awake even when the baby is asleep, or wake very early [1][2].
• Exhaustion beyond normal tiredness. Every new mother is tired, but depression can leave you utterly drained of energy [2][3].
• Difficult feelings about your baby. You may find it hard to bond with your baby, feel distant from them, or struggle to work out what they need [1][2][3][4].
• Doubting yourself as a parent. You may keep doubting that you can care for your baby, or feel that you are a bad parent or that your baby does not love you [1][2][3][4].
• Overwhelming worry about the baby. Most new mothers worry, but with PND the anxiety can be overwhelming, for example fearing the baby is very ill or has stopped breathing, or being afraid to be left alone with them [2].
• Irritability and tears. You may cry more often than usual, or feel angry or irritable with your partner, your baby or other children [2][4].
• Struggling with everyday tasks. Sadness, anxiety and fatigue can make it hard to look after yourself and your baby [2][3].
• Pulling away from other parents. You may find it hard to go to postnatal support groups [2].

You do not need to have every sign. It is important to get help even if you only have some of them [1].

Frightening Thoughts

Thoughts of suicide or of harming yourself or your baby can be part of postnatal depression [1]. If you have thoughts of harming yourself, ask your doctor for help, and if the urge is strong, get urgent help [2].

Many depressed mothers worry that they might harm their baby, but this is very rare. Through sheer tiredness and desperation, some parents occasionally feel like hitting or shaking their baby; many mothers and fathers have this feeling at times, not only those with PND, and most mothers never act on it. If you feel like this, tell someone [2].

You may fear that your baby will be taken away if you say how you feel. This is very rare: your midwife, health visitor and GP want to help you get better, and your care team will support you to look after your baby [1][2].

Who Is More Likely to Get Postnatal Depression?

The exact cause is not known, but the stress of caring for a new baby, lack of sleep and hormonal changes in pregnancy may all play a part [1]. Things that can raise the risk include [1][2][3][4][6]:

• depression or another mental health condition before or during pregnancy
• depression with a previous pregnancy
• a personal or family history of depression or bipolar disorder
• difficult life events, such as losing a job or the death of someone close to you
• having a premature or unwell baby
• having twins or multiples
• little or no social support
• relationship problems
• domestic violence or abuse
• arriving in a developed country as a refugee or to seek asylum
• for mental health problems around pregnancy more broadly, poverty, migration, extreme stress, exposure to violence (domestic, sexual and gender-based), emergency and conflict situations, and natural disasters

Even so, postnatal depression can start for no obvious reason, and having risk factors does not mean you will definitely get it [2]. Sometimes there may be a physical cause, such as an underactive thyroid [2].

Fathers and Partners

Fathers and partners can also become depressed after a baby is born [1][2]. This may be more likely when the mother has postnatal depression, and a father who thinks he may be depressed should talk to his GP [2].

Partners, family and friends may be the first to notice the signs [3]. They can help by encouraging a conversation with a health professional, helping with appointments, offering emotional or practical support, and taking on everyday jobs such as caring for the baby or the home [2][3]. It helps to remember that this is an illness, not something a person can snap out of or think their way past. If she talks about not wanting to live or about harming herself, take it seriously and make sure she gets help urgently. Partners need support for themselves too [2].

Postpartum Psychosis: A Psychiatric Emergency

Postpartum psychosis is the most severe mental illness that can follow childbirth. It affects around 1 in 1000 women, usually starts within days or weeks of the birth, can develop within a few hours and can be life-threatening [2]. Signs include a high or low mood with rapid swings, believing things that are not true (delusions), seeing, hearing or smelling things that are not there (hallucinations), mania, paranoia and confusion [2][3]. It is a psychiatric emergency that requires hospital care [3] and needs urgent treatment [2]. Recovery is possible with professional help [3], and women usually recover completely [2].

How Postnatal Depression Is Recognised

Midwives, health visitors and doctors usually ask new mothers how they have been feeling, and may ask you to fill in a short questionnaire [1][2]. Typical questions ask whether, over the last month, you have been bothered by feeling down, depressed or hopeless, or by having little interest or pleasure in doing things, and whether you would like help [2]. Answering honestly means you can be offered help if you need it [2].

A health professional can also work out whether your symptoms come from postnatal depression or something else [3]. After the birth, see your health care provider for postpartum care and mention anything that does not feel right, including sadness, anxiety or exhaustion that makes it hard to look after yourself or others [5].

Getting Help

It is never too late to ask for help, and even if you have been depressed for a while, you can get better [2]. Depression after having a baby is treatable [4][6].

In the UK, start by speaking to your GP, midwife or health visitor [1]. If you're 18 or over (or 16 or over in some areas), you can refer yourself directly to an NHS talking therapies service without a referral from a GP [1]. Care may come from your GP, a talking therapies service or a specialist community perinatal mental health team, which looks after women during pregnancy and for up to 12 months after the birth [1]. A few women need hospital care, and they should usually be admitted with their baby to a specialist Mother and Baby Unit [2].

In the US, start with an appointment with a health care provider, who can examine you, talk through treatment options and next steps, and refer you to a mental health professional [3][4].

Talking therapies can help [2][3]. Because it can be hard to open up to someone close to you, talking to a trained counsellor or therapist can feel easier [2]. Evidence-based therapies for perinatal depression include cognitive behavioral therapy and interpersonal therapy, and several types of talk therapy can help by teaching new ways of thinking and behaving and helping you change habits that contribute to depression [3]. Milder depression can also ease with more support from family and friends, and support groups can be a useful source of help and information [2][3].

How Long It Lasts

The NHS, NIMH and RCPsych each describe recovery differently:

• NHS: Postnatal depression usually gets better in 3 to 6 months, but it can sometimes last for much longer. It's more likely to get better with treatment [1].
• NIMH: Women with postpartum depression generally will not feel better without treatment. However, with proper treatment, most women feel better and their symptoms improve [3].
• RCPsych: 1 in 4 mothers with PND are still depressed when their child is one-year-old [2].

Things That Can Help Day to Day

Alongside support from your care team, small steps can help [1][2]:

• talk about how you feel with a friend, family member, health professional or counsellor, or call Samaritans on 116 123 if you need someone to talk to
• accept help with shopping, chores, childcare and other practical jobs
• get some regular exercise, even a short daily walk
• try a local support group or parent and baby group
• sleep and rest whenever you can
• eat regularly, even if you do not feel like eating
• do less, and avoid trying to be superwoman or getting over-tired
• make time for things you enjoy, however small

When to Get Urgent Help

In the UK

The NHS gives this urgent advice [7]. Get advice from 111 or ask for an urgent GP appointment if:

• you need urgent help for your mental health

Get help from 111 online or call 111 and select the mental health option [7].

Immediate action required [7]. Call 999 or go to A&E now if:

• someone's life is at risk - for example, they have seriously injured themselves or taken an overdose
• you do not feel you can keep yourself or someone else safe

A mental health emergency should be taken as seriously as a physical one. You will not be wasting anyone's time [7].

RCPsych says: "If you cannot look after yourself or your baby, or if you have plans to harm yourself, you should be seen urgently by:" [2]

• your GP
• a mental health service - your GP can arrange this. You may already have a crisis number to call
• your local Emergency Department - open 24 hours.

In the US

• The CDC says: "If you or someone you know is in crisis, tell someone who can help immediately. In crises, call 911, call or text 988, or call or text 1-833-9-HELP4MOMS." [4]
• The CDC also says: "If you have thoughts of harming yourself or your baby, seek medical care immediately." [5]
• NIMH says: "Women experiencing symptoms of postpartum psychosis should seek immediate help by calling 911 or going to the nearest emergency room." [3]

Conclusion

Postnatal depression is an illness, not a sign that you are failing as a parent, and it can get better. If you are unsure whether what you feel is still the baby blues, tell your midwife, health visitor or doctor, especially if it has lasted more than 2 weeks or is getting worse, and partners can help by making sure that conversation happens.

Medical Disclaimer

This article is for general information and does not replace advice from a qualified health professional. If you think you need urgent medical care, get emergency help straight away.