Baby blues: course and management
The baby blues are a mild, self-limiting (settling without treatment) low mood in the first days after birth, managed with reassurance and support.
Remember
The baby blues are mild and short-lived: they usually settle within about two weeks with reassurance and support, and low mood that lasts longer needs medical assessment.
Memory aid
the blues pass, depression persists and psychosis is an emergency
Use it to tell the three mood conditions after birth apart by how they run their course.
The baby blues are a mild dip in mood after childbirth. They are thought to stem from the hormonal changes when the body returns to its non-pregnant state: pregnancy hormones fall quickly after delivery. Women are often tearful, irritable and anxious, with mood lability (mood that swings quickly from one state to another), and many mothers have some of these symptoms.
The condition is self-limiting (it settles without treatment) and usually clears within about two weeks. Management is therefore reassurance, explanation and support rather than medication. A clear explanation that these feelings are common and expected is itself part of the treatment, along with advice to seek help if the low mood continues, gets worse or she struggles to cope.
Two conditions are easily confused with the blues. Postnatal depression has the symptoms of depression, such as low mood and low motivation, lasts longer than two weeks and is treated like depression. Postpartum psychosis is rare and severe, with hallucinations (sensing things that are not there), delusions (fixed false beliefs) or mania (an abnormally high, overactive mood), and it is an emergency.
In the blues the tearfulness begins within days of birth and is mild and fluctuating. The mother is coping and bonding with her baby, and there are no thoughts of harm to her or the baby. With no hallucinations or delusions either, nothing points to a more serious illness.
Key facts
- Onset and course
- starts in the first few days after birth and usually settles within about two weeks.
- Thought cause
- pregnancy hormones fall quickly after delivery as the body returns to its non-pregnant state.
- Symptoms
- tearfulness, irritability, low mood and anxiety, which most mothers experience to some degree.
- Management
- reassurance, explanation and support, with advice to seek help if the low mood continues, gets worse or she struggles to cope.
- Postnatal depression
- low mood and loss of enjoyment lasting more than two weeks, treated like depression.
- Postpartum psychosis
- a rare emergency with hallucinations, delusions or mania.
- Red flags
- hallucinations, delusions, mania or thoughts of self-harm need urgent assessment, while low mood that continues or worsens, or struggling to cope, needs assessment.
Exam traps
- A selective serotonin reuptake inhibitor (SSRI, a common antidepressant that treats postnatal depression) straight away is not needed for the baby blues, because the symptoms are mild and she is coping; it would be considered if the low mood continued or worsened into postnatal depression.
- Tearfulness and anxiety with coping intact do not fit postpartum psychosis, because postpartum psychosis usually starts suddenly, with hallucinations, delusions, mania or severe confusion.
- The management is right in this description, but the duration is not: the baby blues usually settle within about two weeks, and low mood lasting longer points towards postnatal depression and needs a proper review.
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