Why this sadness? Baby blues, depression and postpartum psychosis

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Baby blues, depression and postpartum psychosis

It can happen, after giving birth, to feel sad, a little down: it is probably the baby blues, a mild form of sadness, temporary and considered non-pathological. At other times, this sadness can become more and more intense and lasting. We then speak of real postpartum depression, which can manifest itself at various levels of severity up to postpartum psychosis, the most serious form.

Let's see what are the symptoms, causes and treatments for these three different forms.

In this article

  • Baby blues o maternity blues
  • Postpartum or postpartum depression
  • Postpartum or puerperal psychosis

Baby blues or maternity blues: a mild melancholy

The expressions baby blues or maternity blues, coined by the English pediatrician and psychoanalyst Donald Winnicott, indicate a condition of inner discomfort of the new mother: a mild and transient emotional disturbance typically without long-term psychological consequences.

The percentage of women affected is very high and ranges from 50 to 80%, therefore more than one in two. Of these, one in five will also develop postpartum depression.


Unstable and hypersensitive mood, easy tendency to cry, tiredness, sadness, anxiety, loss of concentration which can give the feeling of some mental confusion. In some women, especially their first child, there is an overestimation of breastfeeding difficulties.


Onset and duration

The baby blues is a problem of a transitory nature, usually occurs in the first days after delivery, and in any case within the first week and lasts for a week - 10 days.

The causes

They are different, although probably the lion's share is played by the sharp drop in hormone levels - estrogen and progesterone - which occurs after childbirth. However, the psycho-physical stress caused by labor and childbirth, the fact of being in a completely new situation, which can create a certain anxiety about the increase in responsibilities, possible conflicts with the partner and family members also contribute.


How to cure

This is a short-term disorder and tends to be without consequences there is no medical or psychiatric intervention. However, it is important to have adequate support for the mother, to whom the partner and family members should make all their parents feel warm emotional closeness. If the baby blues is already recognized in the hospital, it may be useful to schedule a check-up after a month, to assess the progress of symptoms. In the vast majority of cases they should have disappeared, but if they were still present the situation should be analyzed better to understand if it could be real postpartum depression.

Why this sadness? Baby blues, depression and postpartum psychosis

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Postpartum or postpartum depression: when the situation becomes more serious

It suffers about the 10-15% of new mothers and it is a real pathology which, if neglected, tends to become chronic.


Some symptoms are common to all forms of depression: irritability, anxiety and excessive worry, depressed mood, sleep disturbances (for example insomnia) or appetite (loss of appetite or excessive appetite), physical complaints such as muscle aches and weakness, lack of self-confidence, loss of interest or pleasure in doing things, difficulties in attention, concentration and memorization.

Other symptoms, however, are specifically linked to the condition of maternity: lack of emotions or a feeling of discomfort towards the child, which is often felt as a burden, a feeling of inadequacy in the care of the child, up to the aversion towards him and the fear of being alone with him.

Onset and duration

Postpartum depression usually appears during the 3rd or 4th week after birth and comes to highlight itself as an actual problem 3 or 6 months after its onset, sometimes lasting for over a year.

The causes

Although the causes are not yet fully understood, we know that various types of factors are involved: hormonal, physical, such as fatigue caused by the new rhythms imposed by the child, psychological (personality with low self-esteem or perfectionist), social (lack of help and support) e cognitive, for example, cultivating unrealistic expectations about being a mother or a child.

Among the main risk factors for postpartum depression are the fact of having suffered from it after previous pregnancies or having suffered in the past from anxiety or depression, family history of psychiatric disorders; bereavement or very stressful situations, economic precariousness. Some studies suggest that a traumatic childbirth may influence the risk of postpartum depression, but there is still no definitive consensus on this aspect.

How to cure

Depending on the severity, various therapeutic solutions may be proposed. Sometimes it can be enough some interviews with a specialist, psychiatrist or psychologist, to clarify some aspects and dispel some doubts, making the woman understand that what is going on is not a fault or something to be ashamed of. Other times it will take one more structured psychotherapy, for example of a cognitive behavioral type. Still other times, they will be prescribed specific medications, perhaps in association with psychotherapy.

Don't worry: there are formulations of antidepressant and anxiolytic drugs that can be safely taken even while breastfeeding.

The importance of dialogue

Once the expectations of living motherhood have collapsed, you show the tendency to withdraw into yourself by refusing to admit all your weaknesses and limitations. Despite the strong feeling of inner discomfort you continue undaunted to say that everything is fine, even with a smile on your lips to want to exorcise your discomfort. Unfortunately, this is not enough to solve the problem. Such an attitude is a source of imbalance in your emotional sphere and inevitably negatively affects your child's growth. Therefore don't be afraid to talk to someone. Remember that dialogue is an effective solution to counteract postpartum depression.

And therefore: converse with your partner, serenely confess your anxieties and fears remembering that it is two to raise a child; share the experience of motherhood with friends or relatives.

It is scientifically proven that dialogue is a very effective strategy to reduce the risk of postpartum depression: a study published in the British Medical Journal in 2009, for example, showed the usefulness in this sense of a simple "mother to mother" telephone support intervention. The researchers divided approximately 700 women potentially at risk of postpartum depression into two groups: some received standard postpartum care, while others were supported by telephone support from mothers who had had postpartum depression and they had managed to overcome it. The results of the analysis found that women who had the opportunity to talk on the phone showed a significant decrease in the risk of postpartum depression compared to those followed with classical care.

Post partum or puerperal psychosis: the most serious cases, fortunately very rare

It is the most serious form of postpartum depression also in terms of potential danger for the mother and the baby, because it can be correlated with the risk of suicide and infanticide. This is why it is considered one true psychiatric emergency. It strikes one or two women for every 1000 births.


Agitation, restlessness, disorganized behavior, resistant insomnia, mood swings from depression to euphoria, hallucinations involving the senses of sight and hearing in particular (mother may hear voices who order them how to behave or denigrate their behavior), excessive and irrational concerns about the child, delusions, which may affect the child specifically, with the belief that he is ill or has special powers.


Onset and duration

Postpartum psychosis usually occurs quickly and suddenly between 48 hours and 2-3 weeks after delivery, but can occur up to 12 weeks after delivery. As for the duration, it depends on the subject and the type of medical treatment adopted.

The causes

They are currently still unknown. Look for half of the affected women who have experienced psychotic symptoms even before giving birth (in pregnancy or before) and are familiar with psychiatric illnesses. In about half of the cases, however, it occurs without any previous signs of emotional distress.

How to cure

Symptoms that suggest the presence of a postpartum psychotic disorder must be investigated carefully and as soon as possible by a psychiatrist specialist, so that, if necessary, the appropriate treatments, which are mainly pharmacological. Since this is a very serious pathology, hospitalization is often essential in a protected environment.

Sources for this article:

consultancy by Roberta Anniverno, psychiatrist in charge of the Women's Psyche Center, at the Macedonio Melloni Hospital (Fatebenefratelli Hospital) in our city; consultancy from Franca Aceti, psychiatrist in charge of the Mental Hygiene Unit for emotional relationships and post-partum at the Umberto I polyclinic in the city; material from the volume The discomfort of motherhood, by the psychologist Maria Zaccagnino; document Prevention, diagnosis and treatment of perinatal psychopathology promoted by ONDA, National Observatory on Women's Health.

Read also: Postpartum depression: what it is, how to recognize it, how to overcome it

  • postpartum depression
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