Baby blues are considered a normal part of postpartum adjustment (up to 85% of new mothers!) The blues are related to the hormonal shifts following delivery. They self-limiting and require no treatment. Symptoms generally appear within three to four days after delivery and remit spontaneously within 2-3 weeks. The blues do not interfere with your day-to-day functioning. If emotional vulnerability lasts beyond 2-3 weeks postpartum, it is not the blues. ​ Warning Signs (temporary) You feel sad and happy, alternately You feel anxious You cry more easily than usual You be weepy You feel emotional You feel overwhelmed You feel irritable You feel exhausted

Postpartum Stress Syndrome (This Isn’t What I Expected by Kleiman and Raskin) is another term for an adjustment disorder. You may notice yourself struggling to get through the day with constant feelings of distress which do not resolve with reassurance or self-help measures. You may be overwhelmed by feelings of self-doubt and feel pressure to be the perfect mother who is in control at all times. Most of the time, women with postpartum stress syndrome feel like they are imposters, or like they are going through the motions without anyone noticing how bad they are really feeling. Postpartum stress syndrome can lead to depression if symptoms linger without supportive attention to them. ​ Warning signs You feel more anxious than usual You are worried that you are not bonding with your baby the way you should be You are exhausted You are trying to “fake it ‘til you make it” You are overly concerned with how you are feeling You compare yourself to how other women are doing/looking/feeling You wonder if you might be depressed You may avoid social situations You are experiencing an increase in physical complaints

Prenatal or postpartum depression (perinatal) is characterized by a depressed mood most of the day nearly every day. It can present with symptoms similar to baby blues, but symptoms of depression are more disruptive and last beyond the first two weeks after delivery. Onset is usually within the first three months postpartum, but symptoms can emerge any time during the first postpartum year. Symptoms of postpartum depression can be difficult to distinguish from “normal” postpartum conditions associated with being a new mother because most new mothers are tired, overwhelmed and anxious. The determining factor is how much distress the feelings cause you and how much they interfere with your ability to function during the day. Perinatal depression can range from mild to severe. Even mild depression requires treatment. If left untreated, perinatal depression can have serious adverse effects on you and your relationship with significant others, and on your baby’s emotional and psychologic development. Your baby deserves a healthy mom. ​ Warning signs You are worried about the way you are feeling You feel tired all the time You are unable to sleep even when the baby is sleeping You feel inadequate and compare yourself to others You feel guilty about how you are feeling You feel nervous much of the time You are not eating as much as I usually do Your mind races with thoughts and worries You are unable to focus or concentrate on anything You have thoughts that are scaring you You are afraid if you tell anyone how you are really feeling you will be judged You worry that if anyone knew what you were thinking, they would take your baby away You are afraid that people will think you are not a good mother You are confused about how you are feeling You are obsessing about how you are feeling, what you are thinking and how your baby is doing You feel irritable and enraged some of the time You cry more often that you usually do Sometimes you think it would be better if you were not here You feel guilty or embarrassed about the way you are feeling The way you are feeling is interfering with your ability to function day to day You are experiencing physical problems like headaches, stomach aches, dizziness, unexplained pains You have way more anxiety than you usually do You have lost pleasure in doing the things that used to give you pleasure You are consumed by how you are feeling. You wonder why nothing you do seems good enough You are afraid to be alone You are worried that you might be over attached or not attached enough with your baby You wonder if you will ever feel better You have thoughts of disappearing, sleeping forever, running away, waking up someplace else You are having suicidal thoughts and believe your baby would be better off without you

Perinatal Anxiety is the presence of excessive worry during pregnancy and the postpartum period. While anxiety is normal during this time too much worry can make you feel tense and irritable more of the time, than not. ​ Warning signs Your heart is racing, palpitating, skipping beats You have a sense of pending doom You have pressure or pain in your chest You feel preoccupied with uncontrollable worries You have thoughts that are scaring you about your baby, about yourself, about your partner and anyone you love You ruminate about how you physical wellbeing or the health of your baby You are consumed by “what ifs” and feel anxious about future events You have lost your appetite, nothing tastes good You are exhausted Thoughts race in your head You have difficulty sleeping You find it challenging to quiet your mind Relaxing feels impossible You questions your decisions You overthink, overanalyze, over process everything You have an increase in physical symptoms, such as nausea, dizziness, blurry vision You having feelings of being “unreal” or dissociated from self or the environment

Postpartum OCD is an anxiety disorder characterized by obsessive, intrusive thoughts, images or urges which may or may not be accompanied by compulsive behaviors. These unwanted thoughts appear “out of nowhere” and are extremely distressing. You might be worried that if you tell anyone about the thoughts you are having, something terrible will happen, like someone will take your baby away. While it is understandable that you would worry about these thoughts because they feel so bad, these thoughts are a common manifestation of acute anxiety and are not associated with any negative outcomes. Most new parents experience unwanted negative thoughts about their infants, even women who do not have OCD. The anxiety you feel about these thoughts tells us that they are anxiety-driven and this is a symptom that is very treatable. ​ Warning signs You have scary thoughts of hurting your baby (stabbing, suffocating, sexual abuse, dropping) You might experience some of these common obsessions: The idea that your baby could die while sleeping in the crib The thought or image of dropping the baby from a high place An image of your baby dead Unwanted impulses to shake or yell at your baby Thoughts of drowning your baby during a bath You are afraid that you might inadvertently harm your baby through your inattentiveness You are preoccupied with thoughts of harm to your baby from exposure to medications, environmental toxins, germs, crowds, chemicals, foods You worry that you will be responsible for something horrible happening to your child You are afraid you are making bad decision which may lead to a catastrophic outcome You may avoid certain places, things, or actions for fear harm may come to your baby You may check, count, clean, repeatedly to reassure yourself that things are in control You find that you ask the same things repetitively and are not reassured by what you are told You have lost your appetite You have difficulty sleeping because the of the thoughts whirling around your head

Postpartum PTSD is an anxiety disorder that can follow an experience involving a threatened, perceived or actual serious injury or death to you or your baby. Witnessing an event involving death and reacting with horror or feelings of helplessness contribute to the definition of trauma. Examples of trauma which can lead to PTSD after childbirth are: history of previous sexual trauma, birth trauma related to medical complications or injury, birth loss or NICU experience, any unexpected outcome. ​ Warning signs You have nightmares of the traumatic event You have flashbacks of the traumatic event You are angry You have pervasive anxiety You cannot sleep You cannot concentrate You feel emotionally numb You avoid things or places that remind you of the traumatic event Your anxiety is triggered by cues of the traumatic event You re-live the traumatic event in your mind which causes you to become more agitated, more irritable, more distressed You may feel detached

Perinatal panic is when the anxiety manifests as distinct periods of intense fear. These periods are often marked by subsequent fear and avoidance of another attack. ​ Warning signs You cannot breathe Your heart is racing, palpitating, skipping beats You feel weak and lightheaded You feel terrified for no particular reason You feel numbness or tingling and wonder if you are becoming paralyzed You are terrified of losing control You wonder if you are going insane You feel like pacing as a result of excessive negative energy You are afraid you will die You are having thoughts that are scaring you You are worried about your ability to be a good mother if you have these unwanted thoughts You believe your physical symptoms are dire and perhaps you should go to the emergency room You believe no one understands how bad you feel or how scared you are You are fearful of having an anxiety attack You avoid places or things because you are fearful you will panic You are unable to calm yourself You have been told you are overreacting or majorly misinterpreting your bodily sensations

Bipolar disorder during the perinatal period is characterized by periods of extreme highs (mania) and lows (depression). Bipolar I is primarily distinguished by the presence of manic episodes, while bipolar II is characterized by hypomanic episodes. Although postpartum hypomania may not be associated with major impairment in functioning, it is not uncommon for it to be linked with a subsequent, significant depression. If you have a history or family history of bipolar disorder you are at an increased risk of experiencing an episode during pregnancy and postpartum. You are also at risk for postpartum psychosis so please inform your healthcare providers so you be carefully monitored. Warning signs You experience persistent elevated or irritable moods (hypomania) You have a family history of bipolar disorder in a close relative You feel you need less sleep You feel more energetic than usual You feel abnormally talkative or hyper You are being told that your speech is pressured and you are not talking like yourself Your irritability is interfering with your relationships You experience periods of severe depression Your thoughts race and you seem to be thinking faster You feel overconfident or unusually social You feel quick to anger or chronically irritable You are told by others that your behavior is problematic You have started a new antidepressant and feel strangely good You have a heightened interest in sex or spending money You are told you are not acting like yourself You are told that your overly inflated sense of self interferes with work or relationships

Postpartum psychosis is the least common, but most serious, postpartum mood disorder. It affects one to two per thousand deliveries and typically appears within the first month after delivery. The presence of psychotic symptoms necessitates aggressive medical treatment and most likely, hospitalization. Psychosis is strongly associated with bipolar disorder; therefore, if you have a personal or family history of bipolar disorder you should be carefully assessed. ​ Warning signs You report seeing things that others do not see You believe things that others say are not true You hear voices other than your own (often religious in nature) telling you to do things (often telling you to harm your baby) Your thoughts race constantly Your speech is rapid You are paranoid and question the loyalty or intentions of those closest to you You feel extraordinarily agitated You are told by others that you are not in touch with reality or the word “bizarre” is used to describe your thinking You have difficulty expressing yourself and have trouble making sense to others You do not understand what others close to you are telling you You are unable to sleep or you do not feel the need to sleep You have suicidal thoughts You have thoughts of directly harming your infant