Don’t blame it ALL on the hormones! Knowing the difference between “Baby Blues” and Postpartum Depression
In honor of recently celebrating Mother’s Day, I thought it would be appropriate to focus on moms for a bit. Especially during that special time when you first become a mom. The arrival of a baby is often portrayed as pure bliss, a time of unadulterated joy. And while it is a joyous time, it's also a period of immense change, sleep deprivation, and profound hormonal shifts. Your brain and body have been bathed in tremendous amounts of hormones that suddenly and abruptly tank. You no longer have any idea what your bra size anymore (which can change from hour to hour) and you feel like a milk cow. You suddenly look at your partner who you once thought hung the moon and stars and feel like being intimate with them is yet another chore on your to-do list and that’s ranking WAAAAAYYYYY below sleep. You can’t remember the last time you had a shower. You’re not even sure if you’ve eaten today. And your body is no longer your own. I’m a size WHAT?!?!? And suddenly you’re supposed to know what to do with another human that can barely communicate its needs to you but the default is cry and scream. It’s no wonder that a significant number feel like this time is a whirlwind of change, excitement, fear, and overwhelm. It’s also no wonder that many mothers experience “the baby blues.”
Today, we're going to demystify two often-confused terms: the "baby blues" and postpartum depression. We'll explore how to recognize the symptoms of each, understand the vital role of social support and delegation, and most importantly, know when it's time to reach out for professional psychiatric help. This isn't about judgment; it's about empowerment for you and the community around you, understanding, and getting the support you deserve.
First of all, let’s start with the "baby blues.” You’re definitely not alone if you’ve felt it….they are incredibly common, affecting up to 80% of new mothers. That's right, 8 out of 10 new moms will experience this to some degree. So, first and foremost, know that if you're feeling this, you are absolutely not alone, and it's a very normal part of the postpartum transition.
What does the baby blues look like? They typically begin within the first few days after childbirth, when you’re exhausted from labor and delivery or C-section, usually around day 3 or 4, and generally peak around a week or two postpartum. The key word here is that the feelings are temporary. The rapid drops in estrogen and progesterone (or the pregnancy hormone) are to blame. The feelings usually resolve on their own within about 2-3 weeks, without the need for medical intervention, which is around the time your hormones also start leveling out. Here’s what to expect:
• Mood Swings and emotional volatility: You might find yourself crying over seemingly small things – a sappy commercial, a kind word, or just because you're overwhelmed. You can feel happy one moment and tearful or fearful the next.
• Irritability: Feeling more easily annoyed or frustrated than usual. Remind your partner not to take things personally.
• Sadness: A general sense of sadness or tearfulness.
• Anxiety: Feeling a bit worried or overwhelmed by the responsibility of a new baby.
• Restlessness: Feeling keyed up or unable to relax, even when your partner or family member takes over this round of feedings and diaper changes.
• Difficulty Concentrating: Your brain might feel a bit foggy and you feel like you suddenly have instantaneous ADHD even if you didn’t suffer from it before.
• Sleep Disturbances: Even when the baby sleeps, you might find it hard to drift off.
Key takeaway for the baby blues: They are short-lived, generally mild, and do not interfere significantly with your ability to care for yourself or your baby. You'll likely still feel joy and connection with your baby, even amidst the tears. But you’re still experiencing the rollercoaster ride that is new motherhood!
But how do we know when it’s the “baby blues” which resolves on its own, versus when we should actively seek professional help and treatment…
Postpartum depression, or PPD is a clinical mood disorder that requires attention and often professional help. Unlike the baby blues, PPD is not temporary, and it can significantly impact a mother's well-being, her ability to function not only as a mother, but can also inhibit growth, connection, and bonding to her infant.
PPD affects approximately 1 in 7 new mothers, and it can begin any time in the first year after childbirth, not just immediately after. PPD can last for weeks, months, or even longer if left untreated.
There are significant differences between PPD and baby blues. First of all…
• Duration: The most significant differentiator. If symptoms of sadness, anxiety, or overwhelm persist beyond two weeks, or worsen, it's a red flag for PPD. Two weeks if often the magic time frame in psych.
• Severity: PPD symptoms are more intense and pervasive than the baby blues. They don't just come and go; they are persistent and deeply interfere with daily life, and it’s less of an up and down rollercoaster…because it’s mostly all down.
• Loss of Interest/Joy (Anhedonia): A hallmark of depression. You might lose interest in activities you once enjoyed, or even feel numb towards your baby or partner. You may be indifferent to your baby crying or your partner trying to talk to you. You may space out or numb out instead of engaging in relationships.
• Intense Sadness & Emptiness: A profound, persistent sadness, often accompanied by feelings of hopelessness or emptiness.
• Irritability & Anger: While baby blues can have irritability, PPD can manifest as intense anger, rage, or resentment, often directed at a partner or other children.
• Overwhelming Anxiety/Panic Attacks: Far beyond typical new-parent worry. This can include panic attacks, excessive worrying about the baby's health or safety to the point of perseveration, or even obsessive thoughts.
• Guilt & Shame: Feelings of inadequacy as a mother, feeling like you're failing, or believing your baby or your partner or family would be better off without you.
• Hopelessness & Worthlessness: A profound sense of despair about the future, feeling like you're a bad mother or a burden.
• Difficulty Bonding with the Baby: This is a particularly distressing symptom. You might feel detached, indifferent, or even resentful towards your baby, which can lead to immense guilt.
• Significant Sleep Disturbances: Beyond just waking to feed the baby, you might have insomnia even when the baby sleeps, or conversely, want to sleep all the time to escape.
• Appetite Changes: Significant weight loss or gain, loss of appetite or overeating, outside of just needing to maintain extra calories for milk production.
• Fatigue: Exhaustion that doesn't even improve with rest.
• Thoughts of Self-Harm or Harming the Baby: This is a medical emergency. If you or someone you know experiences these thoughts, seek immediate help by calling 911, the National Suicide Prevention Lifeline (988), or going to the nearest emergency room or calling 911.
Who is more likely to develop PPD?
While hormonal shifts do play a role, PPD is also influenced by a complex interplay of factors:
• Biological: Genetics, personal history of depression or anxiety, thyroid dysfunction.
• Psychological: Perfectionism, high expectations, unrealistic ideals of motherhood.
• Social: Lack of social support, relationship conflict, financial stress, isolation, previous trauma.
• Situational: Difficult birth experience, premature baby, baby with special needs, or breastfeeding challenges.
When to Seek Psychiatric Help?
This is perhaps the most critical part of our discussion. While social support is vital, there are times when it's simply not enough, and professional psychiatric help becomes necessary. If you are experiencing what sounds like PPD, reaching out to a psychiatrist or a mental health professional specializing in perinatal mental health is a sign of incredible strength, not weakness.
• History: If you have a personal or family history of depression, anxiety, or bipolar disorder, you may be at higher risk for PPD and should have a lower threshold for seeking help. This would be a perfect example of seeing a professional when you become pregnant so they can follow you though the duration of the pregnancy for therapy and or medication management, and you establish a relationship with them so if things go wrong quickly, they can act quickly instead of waiting several months to be seen by a provider that is unknown to you.
• Duration and severity of symptoms as previously discussed
• AN ABSOLUTE medical emergency is when the mom is feeling actively suicidal or homicidal towards the baby or another family member.
So what can be done in the meantime?
Whether you're navigating the baby blues or are concerned about you or your partner having PPD, one of the most powerful tools in your arsenal is building a strong support system and actively seeking and accepting help. As a society, we put so much value on being independent I feel like we’ve lost the sense of community we once had. As they say, “it takes a village.” We also put immense pressure on new mothers to be self-sufficient and heroic. You see this all the time on Facebook and Instagram reels. People living their best lives, while finding the time to exercise and eat organic nutritious whole foods and you’re thinking the only version of self-care you’re getting to is a shower…maybe. The idea that we have to do it all on our own desperately needs to change.
• Connect with other moms to combat isolation, especially in those early weeks when your hormones are wreaking havoc with your body and mind. It can normalize how you’re feeling and help you recognize you aren’t alone.
• DELEGATE DELEGATE DELEGATE!!! It's not about "asking for help," it's about assigning tasks. "Can you watch the baby for an hour while I shower?" "Can you pick up groceries?" "Can you handle dinner tonight?" Partners, grandparents, friends – be specific about what you need.
◦ Accepting Help: When someone offers to bring a meal, do a load of laundry, or watch the baby while you nap, say yes TO IT ALL, even if it’s not how you’d normally do it. Drop the guilt. This is not a time for martyrdom. Drop the perfectionism. Who the hell has the time for that?!?!?
◦ Meal Trains/Food Delivery: Nourishment is fundamental. If you have the time in advance, you can prepare a few freezer meals for yourself and your family. If you don’t, have a meal “shower” and let people bring you preprepared foods that can go in the freezer for when you just don’t have the energy.
◦ Housework: Let standards slide. Or better yet, delegate. If you have the money, hire help to come in once a week, every two weeks, or once a month. You’re not going out on the town right now much anyway, so use the money you once put aside for entertainment to go towards saving your sanity and get somebody else to help with the dishes and the laundry. So much effing laundry!
• Protects Sleep: This is probably the single most impactful thing a support system can provide. Even a few consecutive hours of sleep can dramatically improve mood and resilience. Partners taking overnight shifts, or a trusted friend watching the baby for a morning nap. Friends coming in from out of town? Let them know they will be taking at least one overnight shift. You don’t have the energy to entertain them. Let them show their love for you by helping you to pick up the slack. Even if only briefly.
• Emotional Processing: Having someone to talk to about the overwhelming emotions, the fears, the struggles, without judgment, is therapeutic in itself. This can be a partner, a trusted friend, or a postpartum doula.
• Allows for Self-Care: Even small moments of self-care – a warm shower, a walk around the block, reading a chapter of a book – become possible when others step in.
• START SAYING NO: people want to come over and see the baby and you haven’t showered in a week and don’t remember when you last slept or ate? SAY NO. You’re allowed to set that boundary.
• And speaking of boundaries: stop scrolling on social media. It’s wired to depress you and get you hooked onto the dopamine rush. You’re going to be less connected to your baby, your partner, your family, and it will also leave you feeling “less than” because “so and so could do all this and lose her baby weight in just 6 weeks.” Well Sally so and so can go hang. Don’t let social media screw with your well-being. Put it down. Read or listen to a book or a meditation. Or just be silent and take a nap. You likely need one!
To partners, family, and friends listening: Don't just ask, "How can I help?" Often, overwhelmed new mothers don't even know what they need or feel too guilty to ask. Instead, offer specific help: "I'm coming over with dinner on Tuesday," "Can I take the baby for an hour so you can shower?", "Let me load the dishwasher." Be proactive. And don’t take it personally if they say no or if they’re irritable with you. They just brought a new human into the world…give them a little grace, ok?
What kind of help can a psychiatrist provide?
As a psychiatrist, my approach is always comprehensive and tailored to the individual.
1. Diagnosis and Assessment: A thorough evaluation to differentiate between PPD, anxiety disorders, or other conditions.
2. Various types of Psychotherapy
3. Medication Management:
◦ Antidepressants (SSRIs are commonly used), anti-anxiety medications, or mood stabilizers may be prescribed, especially for moderate to severe PPD.
◦ We always discuss the risks and benefits, especially concerning breastfeeding, to make an informed decision together. There are many safe options.
◦ Zulresso (brexanolone): The first FDA-approved medication specifically for PPD, administered intravenously in a healthcare setting. This is a powerful option for rapid relief for some women.
Advanced Therapeutic Modalities (Your Specialties):
◦ Ketamine Infusions: For more severe, treatment-resistant depression or anxiety. We discussed this in a previous episode, but it can provide rapid relief and promote neuroplasticity, helping to "reset" brain pathways that are stuck in depressive cycles. But you’d have to pump and dump your milk as it wouldn’t be viable on the days you receive the infusions.
◦ PrTMS (Personalized repetitive Transcranial Magnetic Stimulation): Building on our earlier discussion about "tuning the brain," PrTMS uses magnetic pulses guided by an EEG to normalize specific brainwave patterns. For PPD, it can be incredibly effective in reducing symptoms of depression, anxiety, and improving brain fog and fatigue, without systemic side effects. It's a non-invasive way to optimize brain function when traditional methods fall short or aren't tolerated. The other cool part about PrTMS is you don’t have to stop taking any meds you may already be on AND you don’t have to stop breastfeeding.
5. Coordinated Care: We work collaboratively with your OB/GYN, primary care physician, therapists, and other support systems to ensure holistic care.
What’s really important to remember is that PPD is a treatable medical condition. It is not your fault, and it is not a sign of weakness. Early intervention makes a significant difference in recovery and the connection you grow and maintain with your baby. It will also change the dynamic and stress level in the family that you’re growing together.
The journey into motherhood is profound, beautiful, and undeniably challenging. It's OK to not be OK all the time. The baby blues are a normal, fleeting response to enormous change. But if those feelings deepen, persist, or become overwhelming, and you notice the symptoms of PPD, please hear this: you deserve help. Your baby deserves a healthy you. Your family deserves a healthy you. YOU deserve a healthy you.
Reaching out for help is an act of love – for yourself, for your baby, and for your family. Don't suffer in silence.
If you or someone you know is struggling, talk to your OB/GYN, your primary care doctor, or a mental health professional. Organizations like Postpartum Support International (PSI) are also wonderful resources with helplines and local support groups.
And if you're exploring options for more advanced, personalized care, my team and I at The Anderson Clinic are here to guide you through comprehensive assessments and treatment plans, including psychotherapy, medication management, ketamine infusions, Spravato and PrTMS. Maybe it’s time to schedule a consultation!
Let's continue to foster open conversations about mental health, break down stigmas, and ensure that every new mother receives the support she needs and deserves.
So, if you found this information helpful, please like, subscribe, and follow us! Tell your friends. We’re @AndersonClinicCincy on Facebook, Instagram, and TikTok. And you can find our Psych Waves podcast on Apple and Spotify. And if you happen to be in the Cincinnati area and are looking for assistance with treatment-resistant depression, anxiety, concussions, or PTSD, give us a call at (513) 321-1753. Start feeling better faster.