Postpartum Depression or Baby Blues: Which is Which?

Pregnant women and their families may look forward to the postpartum period - one that begins soon after delivery and can extend up to 12 weeks, to celebrate the arrival of the baby. However, it is also a demanding period that is characterised by biological, emotional, physical, and social changes that may be overwhelming. One can only imagine the myriad thoughts and emotions that mothers go through during this time - concerns about their mothering abilities, concerns about their recovery from delivery, expectations of how their entire lifestyles will change following the birth of their child, worries for the health and wellbeing of their children, to name a few. All this, combined with the social expectation that all mothers have an “innate ability”, or instinct, even to nurture and mother their children. Imaginably, the first few weeks after childbirth is nothing short of a roller coaster for new mothers. During this period, new mothers are vulnerable to developing a range of anxiety and mood symptoms.

What Are Baby Blues?

Although there is no exact definition for “baby blues'' or postpartum blues (PPB), it is associated with a short term mood disturbance that lasts for a few days after delivery (Kennerly & Gath, 1989). It usually shows signs within 10 days after childbirth and peaks between days 3 to 5 (Ntaouti et al., 2018). Symptoms of postpartum blues include negative thinking, low confidence, sleeplessness, low concentration, headache, and irritability. Studies suggest that 60-80% of all new mothers suffer from this condition (Beck, 2003). The exact cause of PPB is unknown and can be quite complex - including hormonal changes such as fluctuations in levels of oxytocin, oestrogen, and progesterone. Those who have a lack of social support or live in poor economic conditions may be at risk for developing this condition. The diagnosis for this condition may be difficult to make due to the lack of appropriate assessment tools and diverse literature. But, postpartum blues are not of huge concern and are self-limiting with support and education, and very rarely require medication. Nevertheless, follow-up is recommended as 20% of cases are likely to progress to postpartum depression, a more serious psychiatric condition (Beck, 2003; Patel et el., 2002).

What Is Postpartum Depression?

Postpartum depression (PPD) is a complex mix of physical, emotional, and behavioural changes that happen in some women after giving birth. While some mothers describe the postpartum period as the happiest stage in their lives, others may experience sleep disorders, mood swings, changes in appetite, fear of injury, serious concerns about the baby, much sadness and crying, sense of doubt, difficulty in concentrating, lack of interest in daily activities, thoughts of death and suicide as manifestations of postpartum depression (Aswathi et al., 2015). The condition has a prevalence of around 5-60% worldwide (Klainin, & Arthur, 2009). Shockingly, several studies report that 20% of maternal deaths after delivery is caused due to feelings of hopelessness that later lead to suicide (Chaudron, 2003). Five factors are generally associated with postpartum depression; they are - psychiatric risk factors such as the previous history of anxiety or depression, obstetric risk factors like risky pregnancy, biological and hormonal risk factors, social risk factors, and lifestyle risk factors.

How do Postpartum Depression & Baby Blues Differ?

While we have established the course, symptoms, and risk factors of "baby blues" and postpartum depression, it is important to understand the differences between the two.

When it’s Baby Blues:

• Timeline: The timeline in the case of baby blues is much shorter. Changes occur for a few hours every day and ideally resolve by themselves within14 days post-delivery.

• Symptoms: The symptoms in Baby Blues are often not very severe. The mother’s mood may shift constantly from happy to sad. She may feel irritable, anxious, tired, sad and overwhelmed.

• Lack of Self Care: They may not feel the need to take care of themselves through the period, due to the exhaustion that might accompany the transition to motherhood.

• Relationship with Others: In the case of baby blues, it is important to note that it mostly does not affect the relationship between the mother and her child/partner.

However, when it’s Postpartum Depression:

• Timeline: The timeline for Postpartum Depression is generally much longer. Fluctuations can occur within four to several weeks after delivery and can last up to a year, at times.

• Symptoms: The symptoms of Postpartum Depression are more severe and long-lasting. The mother may feel angry, hopeless, extremely stressed, sad, worthless, and lonely. The mother might also experience cognitive symptoms like poor concentration and confusion and may find it difficult to remember details. Apart from this, Postpartum Depression is characterised by possible suicidal ideation

• Relationship with Others: A significant defining factor in the case of Postpartum Depression is the inability to bond with one's child and self-doubt about not doing a good job as a mother or over-attentiveness towards the newborn. Some women may experience feelings of isolation and withdrawal from their partner and others.

As a mother, one may feel the need to not tell anyone about the rather unpleasant journey they may be going through post-delivery. However, the family should be aware of the importance of seeking help quickly based on what the condition is.

References

1. Aswathi, A., Rajendiren, S., Nimesh, A., Philip, R. R., Kattimani, S., Jayalakshmi, D., Ananthanarayanan, P. H., & Dhiman, P. (2015). High serum testosterone levels during postpartum period are associated with postpartum depression. Asian journal of psychiatry, 17, 85–88. https://doi.org/10.1016/j.ajp.2015.08.008

2. Beck C. T. (2003). Postpartum depression predictors inventory--revised. Advances in neonatal care : official journal of the National Association of Neonatal Nurses, 3(1), 47–48. https://doi.org/10.1053/adnc.2003.50014

3. Chaudron L. H. (2003). Postpartum depression: what pediatricians need to know. Pediatrics in review, 24(5), 154–161. https://doi.org/10.1542/pir.24-5-154

4. Ghaedrahmati, M., Kazemi, A., Kheirabadi, G., Ebrahimi, A., & Bahrami, M. (2017). Postpartum depression risk factors: A narrative review. Journal of education and health promotion, 6, 60. https://doi.org/10.4103/jehp.jehp_9_16

5. Kennerley, H., & Gath, D. (1989). Maternity blues. I. Detection and measurement by questionnaire. The British journal of psychiatry : the journal of mental science, 155, 356–362.

6. Klainin, P., & Arthur, D. G. (2009). Postpartum depression in Asian cultures: a literature review. International journal of nursing studies, 46(10), 1355–1373. https://doi.org/10.1016/j.ijnurstu.2009.02.012

7. Manjunath, N. G., Venkatesh, G., & Rajanna (2011). Postpartum Blue is Common in Socially and Economically Insecure Mothers. Indian journal of community medicine : official publication of Indian Association of Preventive & Social Medicine, 36(3), 231–233. https://doi.org/10.4103/0970-0218.86527

8. Ntaouti, Eleftheria & Gonidakis, Fragiskos & Nikaina, Eirini & Varelas, Dionysios & Creatsas, George & Chrousos, George & Siahanidou, Tania. (2018). Maternity Blues: risk factors in Greek population and validity of the Greek version of Kennerley and Gath's Blues Questionnaire. The journal of maternal-fetal & neonatal medicine: the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians. 33. 1-11. 10.1080/14767058.2018.1548594.

9. Okunola, Temitope & Awoleke, Jacob & OLOFINBIYI, Dr & Rosiji, Babatunde & OMOYA, Dr & OLUBIYI, Dr. (2021). POSTNATAL BLUES: A MIRAGE OR REALITY. Journal of Affective Disorders Reports. 6. 100237. 10.1016/j.jadr.2021.100237.

10. Patel, V., Rodrigues, M., & DeSouza, N. (2002). Gender, poverty, and postnatal depression: study of mothers in Goa, India. The American journal of psychiatry, 159(1), 43–47. https://doi.org/10.1176/appi.ajp.159.1.43

11. Rai, S., Pathak, A., & Sharma, I. (2015). Postpartum psychiatric disorders: Early diagnosis and management. Indian journal of psychiatry, 57(Suppl 2), S216–S221. https://doi.org/10.4103/0019-5545.161481

12. https://www.webmd.com/depression/postpartum-depression/postpartum-depression-baby-blues