Baby Blues, Postpartum Depression, and Postpartum Psychosis: How They Differ

A lot of people are talking about postpartum mental health right now, many of them for the first time. The terms get used interchangeably, but they describe very different things.

I'm Christopher Schuman, a board-certified psychiatric nurse practitioner serving patients in Texas, Washington, and New Mexico. Here's how I explain the difference.

The Baby Blues

In the first several days after childbirth, hormones like estrogen and progesterone shift quickly. That can cause dramatic mood changes.

It can include crying, and not necessarily because someone is sad. Giving birth and coming home with a newborn is an overwhelming experience. There can also be sadness and tearfulness. The baby blues center on that first week or so.

Postpartum Depression

Postpartum depression comes after the baby blues, often within the first six weeks, though it can show up any time in the first year after birth.

It looks like depression: loss of interest in usual activities, hopelessness, low mood. It can include difficulty bonding with the baby. Basic things become hard. Bathing, showering, brushing your teeth, cooking a meal, even making small decisions.

There isn't one simple cause. Sleep deprivation, hormonal changes, stress, and being disconnected from other people can all contribute. Sometimes a person has an underlying mood condition they didn't know about. I think of it as involving biological, psychological, social, and existential factors. Enough disruption in any one of those, or a combination, can produce it.

Postpartum Psychosis

Postpartum psychosis is less common and much more severe. I sometimes describe it as postpartum depression on steroids.

There are significant mood changes, often with intense anxiety, paranoia, and extreme fear. Then come psychotic symptoms. Hallucinations can happen, but more often I see delusions: fixed, false beliefs, such as a belief that something is wrong with the baby.

It's worth knowing that these fears are often not violent. Quite the opposite. People with postpartum psychosis are often terrified that something bad will happen to the people they love, especially their children.

Postpartum psychosis is treatable. But it can be very severe, and it's a medical emergency. It needs care right away, not at the next scheduled appointment.

When to Reach Out

If you or someone you love is struggling after a baby, don't wait for it to pass on its own.

• For signs of postpartum depression or anxiety, talk to your obstetrician, your primary care provider, or a mental health provider.
• The National Maternal Mental Health Hotline is free and confidential, by call or text, any time, at 1-833-TLC-MAMA (1-833-852-6262).
• If there are signs of psychosis, thoughts of suicide, or thoughts of harming the baby, get help immediately. Call or text 988, or call 911.

Postpartum conditions are common and treatable. Getting help is a way of taking care of your family, not a sign of failing it.