Postpartum Sadness and Anxiety: What's Normal and When to Get Help

Feeling weepy, overwhelmed or on edge in the first weeks after having a baby is very common. For many women this is the "baby blues," which usually eases on its own within about two weeks. When sadness or anxiety lasts longer, gets worse, or starts getting in the way of daily life, it may be postpartum depression or postpartum anxiety. Both are common, neither is your fault, and both respond well to treatment.

What are the baby blues?

Most new mothers go through some version of them: tearfulness, mood swings, irritability, feeling overwhelmed. They usually start in the first few days after birth and fade within a couple of weeks. They're linked to the big hormonal shift after delivery, along with sleep loss and the sheer size of the adjustment.

What is postpartum depression?

Postpartum depression is more intense and lasts longer. It can start any time in the first year, not only right after birth. Signs include:

•      Sadness, emptiness or numbness that doesn't lift

•      Losing interest in things you used to enjoy

•      Feeling disconnected from your baby

•      Guilt, shame, or feeling like a bad mother

•      Trouble sleeping even when the baby sleeps, or wanting to sleep all the time

•      Feeling hopeless

It affects roughly 1 in 7 new mothers.

What is postpartum anxiety?

Postpartum anxiety gets less attention, but it's about as common, and many women have both. It can look like:

•      Constant worry that something bad is going to happen

•      Racing thoughts you can't switch off

•      Checking and re-checking on the baby

•      Feeling on edge, restless, unable to settle

•      Physical symptoms like a tight chest, nausea or a racing heart

•      Intrusive thoughts: sudden, unwanted images of something happening to your baby

Intrusive thoughts are frightening, and they're common. Having a scary thought doesn't mean you want it to happen. Mothers who have them are usually horrified by them, which is a sign of anxiety, not of what you'd do. They're still worth talking about with someone.

How do I know when to get help?

Reach out if:

•      It's lasted longer than two weeks

•      It's getting worse instead of better

•      It makes it hard to take care of yourself or your baby

•      You're dreading each day

You don't need to be in crisis to deserve support. Earlier is easier.

When to get help right away

Call 911 or go to the emergency room if you have thoughts of harming yourself or your baby, or if you, or someone close to you, notice confusion, seeing or hearing things that aren't there, or going days without sleep. These can be signs of postpartum psychosis, which is rare but is a medical emergency.

For support any time, the National Maternal Mental Health Hotline is free, confidential and open 24/7: call or text 1-833-TLC-MAMA (1-833-852-6262). You can also call or text 988.

How therapy helps

Treatment works. For many women, therapy on its own helps a great deal. For others, therapy together with medication works best, and your OB or primary care doctor can talk through options that are safe while breastfeeding. In my work, we make room for the feelings themselves and also look at what's underneath them: expectations, history, and what this transition has stirred up.