What is the difference between Postnatal Depression and Baby Blues?

The Baby Blues or Postpartum dysphoria is an emotional state of sadness that can appear between the third and fifth day after childbirth. It is seen in 70% of mothers following the significant biological changes that occur before, during and after childbirth and with the effort to adapt to new motherhood habits, such as breastfeeding and bonding with and taking care of the baby. The symptoms of Baby Blues can be very variable, from sadness, crying easily, concern about the care of the baby, insecurity or anxiety. “It is not abnormal to feel sad. In fact, having a child, especially the first, is a very important life change,” says Dr Susana Andrés, clinical psychologist at the Hospital Clínic.  

Normally, these symptoms disappear spontaneously within two weeks. However, for 20-25% of women, the symptoms can remain or even increase in intensity. If these symptoms persist, professional help should be sought, as it may be postnatal depression.  

Current treatment for postnatal depression 

The treatment of mental illness during pregnancy and breastfeeding is complex. Postnatal depression requires a multidisciplinary intervention. An individualised plan should be devised for each patient, based on scientific evidence and the needs of the mother.  

Firstly, there is psychological treatment, focused on cognitive-behavioural therapy (CBT) and interpersonal therapy, which have been shown to be effective. Secondly, there is pharmacological treatment, which is more feared among patients due to possible side effects. However, data have been collected over the last 30 years suggesting that the drugs recommended in postnatal depression can be used safely during breastfeeding. Dr Alba Roca, a psychiatrist at the Clínic's Perinatal Mental Health Unit, points out that there are treatments whose indications during pregnancy can be assessed, "precisely to prevent any complications that may occur due to untreated depression, we have many drugs compatible with breastfeeding. Therefore, whether or not breastfeeding is discontinued after birth should depend more on the mother's condition and preferences than the drug itself." 

Experimental treatment 

There are also new therapies, such as brexanolone, a specific intravenous drug for the treatment of postnatal depression that has not yet been approved or marketed in Spain. One of the main properties of brexanolone is its speed of action, with improvement being seen 48-60 hours after administration. However, it is expensive, its administration is intravenous and a hospitalisation regime is required. 

In short, perinatal mental disorders are more frequent than is thought, but they can be treated. Postnatal depression is still a challenge for medicine, due to the complications imposed by the limitation of the use of medication, so as not to affect the foetus or the breastfeeding baby. However, the safety of new drugs and non-pharmacological therapies under development represent new ways of treating this problem, which affects thousands of women each year.