Is it the baby blues or something more serious?

Did you know that 1 in 5 birthing people will experience perinatal mood and anxiety disorders during pregnancy or the first year after?

For some, it’s just a case of the baby blues — a term providers use to describe a brief period of mild mood changes many new moms experience after giving birth.

For others, it’s more serious.

Perinatal mood and anxiety disorders, or PMAD, can affect anyone regardless of age, race, ethnicity, religion, culture, income or education level. It can even affect partners.

Anne Lawson, CNM, a certified nurse midwife with Atlantic Health System, explains the difference between baby blues and PMAD and how to get help.

The difference between baby blues and PMAD

Baby blues is described as short-term feelings of worry and sadness within the first two weeks of giving birth. It’s often the result of being physically and emotionally overwhelmed and tired. Symptoms usually go away on their own and don’t require medical treatment.

“Baby blues occur in up to 80% of new parents,” reports Anne. “It’s very common.”

Perinatal mood and anxiety disorders (PMAD) are mental health conditions that can emerge during and/or in the first year after pregnancy. The most common forms are: perinatal depression, perinatal anxiety and panic disorder, bipolar disorder, obsessive-compulsive disorder (OCD) and postpartum psychosis.

“It’s important to know PMAD is not your fault. It’s not the result of anything you did or didn’t do,” says Anne.

Risk factors for PMAD

PMAD doesn’t discriminate. It can happen to anyone. However, people with the following risk factors have a greater chance of developing the condition:

History of mood disorders (when not pregnant)
History of alcohol or substance misuse
Life stressors such as work demands or money problems
Physical and emotional changes related to pregnancy, childbirth and caring for a newborn
Pregnancy-related hormone changes
Trauma during birthing process

PMAD types and symptoms

Each form of PMAD has its own symptoms, which can range from mild to severe.

Perinatal depression

What sets perinatal depression apart from baby blues is the intensity and duration of the symptoms. Most episodes of perinatal depression begin within 4–8 weeks after childbirth, but you can experience it during pregnancy. Symptoms appear nearly every day and last for at least two weeks.

You may have perinatal depression if you are experiencing feelings of persistent sadness, hopelessness and helplessness accompanied by severe fatigue, trouble bonding with your baby and even thoughts of harming yourself or your baby.

Perinatal depression can improve with therapy and medication.

Perinatal anxiety and panic disorder

Perinatal anxiety often shows up as excessive worrying and rumination, irritability or rage, restless sleep, even heart palpitations, muscle tension, shortness of breath and digestive issues.

Perinatal panic disorder can also manifest physically with shortness of breath and chest pain, as well as hot or cold flashes and trembling. Fear of losing control and spiraling thoughts of not being able to protect your baby are also common.

Both conditions can be treated with therapy, medication and lifestyle adjustments.

Perinatal bipolar disorder

Perinatal bipolar disorder is characterized by significant shifts in mood, energy and activity. These manic and depressive swings are the same as in nonpregnancy-related bipolar disorder and can significantly impact your ability to care for your baby.

Bipolar disorder can be managed with the help of a mental health professional.

Perinatal obsessive-compulsive disorder (OCD)

Perinatal obsessive-compulsive disorder is a form of OCD that develops during pregnancy or after childbirth. Intrusive, unwanted thoughts (obsessions) and repetitive behaviors (compulsions) related to the baby may look like excessively checking on the baby, scrubbing floors and surfaces constantly to avoid germs, or having intense fear that you (or someone else) will harm your baby.

With the help of a mental health professional, OCD can be managed. Exposure and responsive prevention (ERP) is the gold standard treatment for OCD.

Postpartum psychosis (PPP)

Postpartum psychosis (PPP) is a rare but life-threatening emergency. It usually occurs days to 6 weeks after childbirth. Symptoms include delusions, hallucinations, mania, paranoia and confusion.

PPP is not a result of untreated perinatal depression and requires immediate medical attention. Do not leave a person with PPP alone or alone with the baby. Call 911 or go to the nearest emergency room.

Where to get help

Unresolved PMAD can put you and your baby’s health and well-being at risk, so it’s vital you seek professional help.

Start with your primary care provider or your OB/GYN provider. Other resources include:

National Maternal Mental Health Hotline — Free confidential support before, during and after pregnancy available 24/7 in English and Spanish (1-833-TLC-MAMA)
Postpartum Support International — Free confidential support in English and Spanish, 7 days a week from 8:00 am–11:00 pm (1-800-944-4773). Online support groups at postpartum.net.
NJ Family Health Line — Freel helpline available Monday–Friday from 8:00 am–6:00 pm
988 Suicide and Crisis Lifeline — Free emergency crisis help available 24/7/365. Call or text 988.

Remember, you are not alone. Help is available.

Postpartum Depression Support and Resources

Published: February 10, 2025

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