Postnatal Depression and Baby Blues

When to call

Get help the same day — call your GP, midwife or health visitor — if you have thoughts of harming yourself or your baby. The HSE is unambiguous: "If you have any thoughts of harming yourself or your baby, contact your GP immediately." It also names why people stay quiet: "Thoughts of harming the baby are very distressing. They can happen if you have postnatal depression. This can be treated."

Call your local emergency number (999 in the UK and Ireland, 911 in the US and Canada, 000 in Australia, 111 in New Zealand), or go to your nearest emergency department, if you feel you are in danger of acting on those thoughts. In the UK you can also call NHS 111 and choose the mental health option at any hour. In the US and Canada you can call or text 988. In the UK and Ireland, Samaritans answer free on 116 123, day or night.

Ask for an urgent assessment, not a routine appointment, if symptoms came on suddenly within the first two weeks and include confusion, hallucinations, unusual beliefs or feeling elated. That is not depression — it is a different and more urgent illness. See our page on postpartum psychosis.

Everything below is about the more common picture, which is not an emergency but should not be waited out either.

Baby blues and postnatal depression are not the same thing

The Royal College of Psychiatrists separates them cleanly. Baby blues "affects more than half of new mothers. It usually starts 3 to 4 days after birth. Your mood swings up and down, you burst into tears easily. You can feel irritable, low and anxious at times." Crucially: "It usually stops by the time your baby is about 10 days old. You don't need any treatment for baby blues."

The NHS gives the same two-week boundary: feeling down, anxious or irritable for a few days "is very common. This is sometimes called the baby blues, and it usually goes away within 2 weeks of the birth. But if it continues, gets worse or you're struggling to cope, it's important to get help."

Postnatal depression is a depressive illness. The RCPsych says it "affects between 10 to 15 in every 100 women having a baby," with symptoms "lasting at least two weeks."

What the symptoms actually are

The NHS lists: low mood; finding it hard to enjoy anything; feeling hopeless or that you cannot cope; feeling guilty, worthless, or that you are a bad parent; feeling fearful, anxious or worrying all the time; feeling restless or irritable; difficulty sleeping even when you get time to rest; difficulty concentrating or making decisions; difficult feelings about, or difficulty bonding with, your baby; and thoughts of suicide, harming yourself or your baby.

Two details from the RCPsych are worth holding onto because they are the ones people dismiss. First, sleeplessness in depression is not ordinary newborn tiredness: "Even though you are tired, you can't fall asleep... You may wake very early, before your baby wakes up." Second, on intrusive thoughts: "Depressed mothers often worry that they might [harm their baby], but it is very rare... In spite of having these feelings at times, most mothers never act on them. If you do feel like this, tell someone."

When it starts

Later, and more variably, than most people expect. The NHS says symptoms "can begin while you're pregnant, soon after birth, or up to a year after your baby is born." ACOG says postpartum depression "can occur up to 1 year after having a baby, but it most commonly starts about 1–3 weeks after childbirth." The RCPsych notes that "about a third of women with PND have symptoms which started in pregnancy and continue after birth."

So a six-week check that went fine does not rule it out, and neither does a happy first month.

What treatment looks like

The NHS names two main routes: talking therapies such as cognitive behavioural therapy, and antidepressants. "Many antidepressants are safe to use while breastfeeding. Tell your doctor if you're breastfeeding and they will prescribe you a medicine that's suitable for you."

On the likely course: "Postnatal depression usually gets better in 3 to 6 months, but it can sometimes last for much longer. It's more likely to get better with treatment."

You do not have to go through a GP for the first step. In England, if you are 18 or over (16 or over in some areas) you can refer yourself directly to an NHS talking therapies service.

NICE's guideline on antenatal and postnatal mental health (CG192) explains what a clinician should do at that first conversation: ask two depression identification questions — "During the past month, have you often been bothered by feeling down, depressed or hopeless?" and "During the past month, have you often been bothered by having little interest or pleasure in doing things?" — and then consider a fuller assessment using the Edinburgh Postnatal Depression Scale or the PHQ-9. If you want to prepare for the appointment, those are the questions coming.

The fear that stops people asking

NICE names it directly: women may be "unwilling to disclose or discuss their problem because of fear of stigma, negative perceptions of them as a mother or fear that their baby might be taken into care." The NHS answers it just as directly: "You may be scared that your baby will be taken away if you ask for help or share how you're feeling, but this is very rare. Your care team will give you the support you need to care for your baby."

What actually helps alongside treatment

The NHS suggests talking about how you feel to someone you trust, asking for practical help with shopping, chores and childcare, some regular exercise even if it is a short walk, a local parent and baby group, as much sleep as you can get, and small things you enjoy. It also advises against using alcohol or drugs to manage symptoms. None of that is a substitute for treatment, and the NHS does not present it as one.

PANDAS Foundation runs support groups, a text line and a callback service for families affected by perinatal mental illness in the UK. Samaritans are on 116 123 free, at any hour, if you need someone now. In the US, Postpartum Support International's helpline is 1-800-944-4773, and 988 reaches the Suicide and Crisis Lifeline.

Fathers and partners get postnatal depression too — the NHS says so explicitly — and the same routes to help apply.