Medically reviewed by Shahrzad Shadmani, PMHNP-BC, FNP-C, founder of Integrative Psychiatry and Wellness (IPW Health).
Most people have heard of postpartum depression. Fewer have heard of postpartum anxiety, even though it is at least as common, and many new parents with anxiety are told they are “just a worrier” or that it comes with the territory. The two can occur separately or together, and both are treatable. Knowing the difference can help you describe what you are going through and get the right help sooner.
First: the baby blues
In the first days after birth, most new parents have some tearfulness, mood swings, irritability and feeling overwhelmed. These “baby blues” usually begin within a few days of delivery and fade on their own within about two weeks. If symptoms are severe, last longer than two weeks, or start later, that points to something more than the blues.
Postpartum depression
Postpartum depression is depression that begins during pregnancy or in the months after birth. It affects roughly 1 in 7 people who give birth, and partners can develop it too. The core of it is a persistent low mood or loss of interest and pleasure, lasting most of the day, most days, for two weeks or more.
Common signs include:
- Sadness, emptiness or crying much of the time
- Losing interest in things you usually enjoy, or feeling numb
- Feeling disconnected from your baby, or like you are not a good parent
- Guilt, shame or feeling worthless
- Exhaustion beyond what a newborn explains, or being unable to sleep even when the baby sleeps
- Changes in appetite, and difficulty concentrating or making decisions
- Withdrawing from partner, family or friends
- Thoughts that others would be better off without you, or of harming yourself
Postpartum anxiety
Postpartum anxiety is not a separate diagnosis in the psychiatric manuals; it is an umbrella term for anxiety disorders that begin or worsen around pregnancy and birth, including generalized anxiety, panic attacks and perinatal obsessive-compulsive symptoms. Where depression tends to feel heavy and slowed down, anxiety tends to feel wired and on alert.
Common signs include:
- Constant worry that is hard to switch off, often about the baby’s health or safety
- Feeling that something bad is about to happen
- Checking repeatedly — breathing, feeds, locks, symptoms online
- Being unable to rest or sleep even when there is the chance
- Physical symptoms: racing heart, tight chest, nausea, dizziness, muscle tension
- Panic attacks
- Difficulty letting anyone else care for the baby
Intrusive thoughts
Many new parents have sudden, unwanted thoughts or images of their baby being harmed — sometimes even of harming the baby themselves. These thoughts are frightening precisely because they are the opposite of what the parent wants. When they are distressing and unwanted, they are a symptom of anxiety or perinatal OCD, not a sign that you will act on them. They are common, and they respond well to treatment. Tell your clinician about them; you will not be judged. Read more about OCD treatment.
How they differ, and how they overlap
A simple way to think about it: depression is mainly about low mood, loss of interest and hopelessness; anxiety is mainly about fear, worry and a body stuck on alert. In practice, many people have both. Anxiety that goes untreated can lead to exhaustion and low mood, and depression often brings anxious thoughts with it. You do not need to work out which one you have before asking for help — that is the job of an evaluation.
When it is an emergency
Postpartum psychosis is rare, but it is a medical emergency. Warning signs include confusion, seeing or hearing things that are not there, beliefs that do not match reality, extreme agitation, or going days without sleep. It usually starts within the first few weeks after birth. If you notice these signs in yourself or someone else, call 911 or go to the nearest emergency room.
If you are having thoughts of harming yourself or your baby, or of not wanting to be alive, call or text 988 now. The National Maternal Mental Health Hotline is available 24 hours a day by call or text at 1-833-852-6262. More options are on our crisis and support resources page.
Treatment works
Both postpartum depression and postpartum anxiety are highly treatable. Treatment usually combines several of these:
- Therapy — cognitive behavioral therapy and interpersonal therapy both have good evidence for perinatal depression and anxiety.
- Medication — several antidepressants have been used for years during breastfeeding, and a newer oral medication, zuranolone, is FDA-approved specifically for postpartum depression. The choice depends on your symptoms, history and feeding plans. See medication in pregnancy and breastfeeding.
- Practical support — protecting sleep, sharing night feeds where possible, and accepting help are part of treatment, not extras.
At IPW Health we treat mental health across pregnancy and the first year after birth by secure telehealth in California, Oregon, Washington and Colorado, and in person in Mission Viejo. Learn more about our postpartum mental health care, prenatal mental health care, and our wider women’s mental health services.
Sources
- American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR).
- American College of Obstetricians and Gynecologists. Screening and Diagnosis of Mental Health Conditions During Pregnancy and Postpartum (Clinical Practice Guideline No. 4, 2023) and Treatment and Management of Mental Health Conditions During Pregnancy and Postpartum (Clinical Practice Guideline No. 5, 2023).
- U.S. Food and Drug Administration. FDA approves first oral treatment for postpartum depression (August 2023).
- Postpartum Support International and the HRSA National Maternal Mental Health Hotline.
