Real Talk: Baby Blues and Postpartum Depression

A no-b.s. Q&A with Perri Shaw Borish, psychotherapist and perinatal mood disorder specialist.

by Christy on Aug 7, 2014

While most of us have at least a baseline understanding of postpartum depression these days (most doctors are doing a good job educating us, no?), it’s also true that the whole world turns upside down in those weeks and months after you give birth. Suddenly, things you might know intellectually don’t necessarily translate into your new reality, and so It’s easy to question your feelings, to feel overwhelmed about reaching out to someone, and to just worry about the logistics of dealing with your own anxiety, depression, or mood issues. In short: There can be so many questions about everything, including your own feelings.

So. We hit up Wee friend, mom of three and psychotherapist Perri Shaw Borish (Perri specializes in anxiety and perinatal mood disorders: you can read about her private practice here), and asked the nitty-gritty detail things that we never really thought to ask until we were moms with new babies. 


I mentioned to my pediatrician that I was a bit more irritable with my husband in the few months after having the baby. She startled me by suggesting I might have been suffering from a bit of postpartum depression. This makes me think that as much as most of us think we know the symptoms, maybe there’s some confusion between baby blues, postpartum depression and postpartum anxiety?
Yes, that is true. The “baby blues” are very common (about 85 percent of women experience them), and it is a temporary state. Symptoms of the “blues” — which might include (but aren’t limited to) weepiness, a lack of energy, negative thoughts, feeling sad — that last longer than 2-3 weeks should be referred to for assessment and treatment.

Postpartum Depression is best defined on a continuum. There is a large spectrum of postpartum mood disorders which range from mild to severe and usually occur within the first year. Some examples of symptoms of PPD might include feelings of anger, sadness, irritability, guilt, lack of interest in baby, changes in eating and sleeping habits, thoughts of hopelessness and even sometimes, thoughts of hurting oneself or the baby.

Symptoms of Postpartum Anxiety usually manifest as extreme worries or fears – often over the health or safety of the baby. Some women have panic attacks, a feeling of loss of control, racing thoughts and often disturbance of sleep.

If a mom does go to you — or any professional — to deal with anxiety or depression, what does she do with the baby for the duration? I ask this because I think some moms might find trying to find the time and the energy to take care of themselves stressful in a moment when they’re also learning to deal with a new baby.
I always encourage women to bring their babies (up to a certain age). If they have childcare and can come alone, that’s great, but that’s not always possible. Additionally, I really like to see how a woman engages with her baby – it helps give me a better sense of her attachment to the child and therefore where she may be on the continuum.

Are there long-term effects of not being treated? Do some people just snap out of it?
There can be major risks to the mental health of the mother and the child if Postpartum Depression/Postpartum Anxiety goes untreated. Again, it depends where on the continuum you are. For example, we know that children of depressed mothers have been found to have impaired cognition and emotional abilities, and bonding with the baby can become an issue. Anxiety Disorders that go untreated can lead to impaired functioning, panic and agoraphobia, to name a few. If you feel you may be suffering from some type of Postpartum Depression, the important thing to remember it is not your fault. You are not to blame and with help, you can feel well again. Even if it’s just a mild case, you can still benefit from talking to someone. In fact, mild cases especially are treated quickly once people seek professional help. 

Is there an alternative to seeing a therapist ? Hotlines? Support groups? Phone calls with a therapist instead of in person visits? I’m just curious if there are varying levels and methods of support for varying levels of need.
There are alternatives to seeing a therapist, and depending on the person’s situation and needs, the alternatives may or may not be recommended … or they may be used as complements to other therapies. It’s best to first at least talk to a qualified therapist or doctor to determine what’s going on. Once that happens, some alternatives to therapy might be medication (prescribed by an M.D., of course), exercise, massage, meditation, good nutrition, adequate rest, and social interaction. (Exercise, massage, meditation, good nutrition, adequate rest, social interaction and support are always recommended, and for some new moms that might be enough, however, for many moms, much more clinical work is needed.) There are also hotlines and support groups (depending where you are – many of the support groups are peer groups run by other moms).

Sometimes these types of alternatives can make a difference, however that’s often not the case, and seeking professional help with a qualified therapist can make a huge difference. Often people don’t seek professional help because they feel ashamed or because they think they should “be able to handle it on their own,” but the quickest way to feel better is to talk to someone. Also, one thing to remember when seeking professional help is that you have the right to ask about the therapist’s qualifications, training, and approach and confidentiality policies. It’s your treatment and you need to be comfortable with whomever is going to treat you.

Are there any preventative steps a new mom can take so she doesn’t feel anxiety or depression?
Yes, there are lots of preventative steps that may help — although there is a lot we can’t plan for, such as what kind of birth one might have. Working with a therapist trained in Perinatal Mood and Anxiety Disorders before the birth can actually help with this, too. If, for example, you have a lot of worries going into the birth, or there is unresolved trauma or loss (since those things put you at higher risk for PPD), it can be very helpful to process those things before the baby arrives with a therapist. Also if you’ve had any kind of postpartum mood disorder before, going to a therapist when you’re planning for a second child or when you’re pregnant with a second or third child can help tremendously to cut down on potential risk for that postpartum period.

Other examples of preventative steps include working on letting go and being okay with not doing everything perfectly once baby comes home; making sure the lines of communication are open between mom and her partner, or whomever her support people are; working on processing any major losses and any parenting issues before the birth; having a plan in place for taking care of oneself; and divvying up responsibilities once the baby comes home so mom can find pockets of time to rest and nurture herself. Also, have your thyroid checked within first few months postpartum, because thyroid disease often looks like Postpartum Depression. Sometimes OB/GYNs miss it because they often only see a postpartum mother once or twice in first year postpartum.

Aside from you, any other thoughts on where Philly folks can turn for help, even if it’s just an initial phone call to ask a question? is a really great, free, local resource that includes free weekly chats for moms, and also monthly chats for dads, and they have a map of local coordinators who can help connect women with local resources. And there’s the, which is great (215-573-8886), and they take most insurance providers. There are loads more locally; you can also ask your OB/GYN office for a list of local professionals who take your insurance. There is also the very helpful Postpartum Support International Warm Line: 1-800-944-4773, as well as the suicide prevention hotline: 1-800-273-TALK (8255). And you might remember the Hall Mercer Parent Child Center, which isn’t specifically for postpartum issues, but they have groups for new moms and their babies, which is a great way to get support in your own community and meet new moms who are potentially going through similar things.