Characteristics of Postpartum Blues, Perinatal Depression, and Postpartum Psychosis

Postpartum bluesOnset in first few wk after labor, peaks at 3–5 d postpartum (with lactation), and usually resolves in <2 wk.50%–80% of mothersCrying, weeping
Exaggerated sense of empathy
Mood lability (“ups and downs”)
Feeling overwhelmed
Fatigue and/or exhaustion
Perinatal depression 15%–20% of mothers from conception to 1 y postpartumPersistent sadness, emptiness, hopelessness, frequent crying, irritability
Loss of interest in caring for self and/or child, enjoyable activities, and/or poor bonding with infant (attachment)
Changes in appetite or wt
 Prenatal depressionOnset during pregnancy, peaks in first trimester, then declines. Symptoms last at least 2 wk.Up to 13% of mothers (incidence: 2%–7%)Insomnia or hypersomnia
Fatigue and/or exhaustion, decreased motivation
Poor concentration or indecisiveness; difficulty remembering
 Postpartum depressionAfter delivery, rates increase and peak at 3 mo postpartum. Symptoms present any time in the first y after delivery and last at least 2 wk.Up to 10% mothers (incidence: about 7%). Up to 4% of fathers (incidence 4%–25%)32Feelings of worthlessness, guilt, inadequacy
Suicidal thoughts
Possibly anxiety, including bizarre thoughts, obsessions, and/or fears
Postpartum psychosisOnset 1–4 wk postpartum.1–2 cases in every 1000 new mothersAuditory hallucinations and delusions (including commands and/or beliefs that need to harm the infant)
Visual hallucinations
Agitation, irritability, anger
Mood lability or highly elevated mood
Disorganized thoughts and behaviors
High levels of anxiety
Paranoia; distrusting of others
Thoughts of harming or killing self, others, or the infant
  • Adapted from Santoro K, Peabody H. Identifying and Treating Maternal Depression: Strategies and Considerations for Health Plans. NIHCM Foundation Issue Brief. Washington DC: National Institutes of Health Care Management; 2010:3.