Baby Blues or Postpartum Depression? How to Tell the Difference

I cried at a diaper commercial on day four. I cried because the baby was asleep and I couldn’t sleep. I cried because my partner made me toast. That was the baby blues, and it was gone by the end of week two.

The thing worth knowing is where the blues end and depression starts, because from the inside they can feel the same, and “everybody feels like this” is what keeps people from getting help.

The baby blues

The National Institute of Mental Health describes the blues as mild, short-lasting mood changes and feelings of worry, unhappiness and exhaustion in the first two weeks after birth. Teary, touchy, overwhelmed, then better. What helped me: sleep, real food, and someone taking the baby for a few hours.

Postpartum depression

Perinatal depression is a mood disorder, not a rough patch. NIMH says most episodes begin within four to eight weeks after the baby is born. That’s often after the visitors stop coming and your partner goes back to work.

NIMH’s symptom list:

• A sad, anxious or “empty” mood that lasts at least two weeks
• Feeling hopeless, irritable or restless
• Feeling guilty, worthless or helpless
• Losing interest in things you used to enjoy
• Fatigue, and sleep problems beyond what the baby causes
• Trouble concentrating, remembering or making decisions
• Changes in appetite or weight
• Aches and pains with no clear physical cause
• Trouble bonding with the baby
• Thoughts of death, of harming yourself or the baby, or suicide attempts

The simple test

How long, and is it getting better? Under two weeks and easing off: probably the blues. Two weeks or more, or getting worse: tell a doctor. You don’t need to be sure which one it is. That’s their job.

Anyone can make that call for you: your OB or midwife, your primary care doctor, or the baby’s pediatrician, whom you’ll be seeing constantly anyway.

If it’s urgent

Thoughts of harming yourself or your baby are on the CDC’s list of urgent maternal warning signs. Don’t wait for an appointment.

• National Maternal Mental Health Hotline: call or text 1-833-TLC-MAMA (1-833-852-6262). Free, confidential, 24/7, in English and Spanish.
• 988 Suicide and Crisis Lifeline: call or text 988.
• If you or the baby are in immediate danger, call 911.

It gets treated, and it gets better

NIMH lists talk therapy, medication, or both, including two medicines approved specifically for postpartum depression. Asking for help is not failing at motherhood. Staying quiet because you think you should be able to handle it is the mistake.

If you’re the partner reading this: you’re often the first one who can see it. Use the list above.

Follow-up questions

How long do the baby blues last?

NIMH describes the baby blues as mild, short-lasting mood changes in the first two weeks after birth. If the low mood is still there past two weeks, or it's getting worse instead of better, talk to your doctor.

Can postpartum depression start months after birth?

Yes. NIMH says most episodes start within four to eight weeks after the baby is born, but perinatal depression covers depression during pregnancy as well as after delivery. It doesn't have to start the week the baby arrives to count.

Is postpartum depression my fault?

No. NIMH lists the hormone changes during and after pregnancy, the physical and emotional demands of a new baby, life stress, and personal or family history among the contributing factors. None of that is a personal failing.

How is postpartum depression treated?

NIMH lists talk therapy, medication (including antidepressants and two medicines approved specifically for postpartum depression, brexanolone and zuranolone), or both. Your OB, midwife, primary care doctor or the baby's pediatrician can all start that conversation.