Postpartum Anxiety vs Postpartum Depression-How to Tell the Difference (and Why It Matters)

Most new parents know about postpartum depression, but postpartum anxiety is less well-known. Anxiety is just as common and often overlaps with depression. As a result, many mothers and fathers are overlooked or left struggling to describe their symptoms.

In my work as a Perinatal Mental Health Certified therapist, I see this often. A client senses something is wrong, but her words don’t fit "depression"; she isn’t sad—she’s frantic. Sometimes both occur. Sometimes her partner struggles but hasn’t been asked to help. Knowing the difference between postpartum anxiety (PPA) and postpartum depression (PPD) is the first step to getting the right support. They may overlap, but each needs a different approach.

This article will show you what each condition looks like, how to tell them apart, what to do if you have one or both, and what helps with each.

FIRST: THE BABY BLUES VS A PERINATAL MOOD DISORDER

Up to 80% of new mothers get the baby blues: weepiness, mood swings, and emotional sensitivity in the first 2 weeks after birth (Rezaie-Keikhaie et al., 2020, pp. 127-136). This is normal, driven by a hormone drop after delivery, and resolves on its own.

If your symptoms last over two weeks, worsen, or match the patterns below, you may have a perinatal mood or anxiety disorder. This does not mean you failed or love your baby less. It is a treatable medical condition.

WHAT POSTPARTUM DEPRESSION LOOKS LIKE

Postpartum depression affects about 1 in 7 birthing parents and 10% of non-birthing partners (Bauman et al., 2020). The main signs are a low, flat, or empty mood and a loss of interest or pleasure in things. Common symptoms include:

• Persistent sadness, emptiness, or numbness

• Loss of interest in things you previously enjoyed, including the baby

• Feelings of worthlessness, guilt, or being a "bad mother"

• Fatigue that doesn't improve with rest

• Difficulty bonding with the baby

• Withdrawal from partner, family, and friends

• Changes in appetite (eating much more or much less)

• Sleep disturbance even when the baby is sleeping

• Difficulty making decisions or concentrating

• Thoughts of death or suicide

The main feeling is a sense of being down—sadness, hopelessness, or numbness.

WHAT POSTPARTUM ANXIETY LOOKS LIKE

Postpartum anxiety is less discussed but just as common. It affects about 1 in 5 new parents (Paul, 2019). The main signs are not sadness but constant worry and physical tension. Common symptoms include:

• Constant, uncontrollable worry, often centred on the baby's safety, health, or wellbeing.

• Racing thoughts you can't switch off, especially at night

• Inability to sleep even when exhausted and the baby is sleeping.

• Physical symptoms: rapid heart, tight chest, nausea, restlessness, dizziness

• Intrusive thoughts or images about harm coming to the baby (these are distressing and unwanted, not desires).

• Hypervigilance: feeling like you can't relax or hand the baby off to anyone.

• Avoidance: refusing to leave the house, let others hold the baby, or go to sleep.

• Panic attacks

• Compulsive checking (breathing, temperature, latching, etc.)

The dominant feeling is being wired, frantic, and unable to settle.

In my practice

Many of my postpartum anxiety clients describe themselves as "high-functioning" they're still getting through the day, the baby is fed and clean, the house looks fine. From the outside, nothing is wrong. Inside, they're exhausted from constant vigilance and convinced something terrible is about to happen. PPA often hides this way, which is why screening for depression alone misses it. When I ask new mothers, "How often is your mind quiet?", the answer is usually "never" and that's often the clearest sign.

HOW TO TELL THEM APART (AND WHY IT MATTERS FOR TREATMENT)

In short, depression feels heavy, slow, and emotionally flat, while anxiety feels fast, tense, and restless. About half the time, people experience both sets of symptoms together (Ou et al., 2025). Here’s a practical breakdown to help distinguish them:

Mood

PPD: low, flat, empty, numb. PPA: anxious, racing, on-edge.

Energy

PPD: exhausted, slowed down. PPA: wired even when exhausted.

Thoughts

PPD: hopelessness, guilt, worthlessness. PPA: worry, catastrophic thinking, intrusive images.

Sleep

PPD: sleeping too much, or unable to sleep due to depression. PPA: physically unable to sleep due to alertness.

Behaviour

PPD: withdrawing, disengaging. PPA: checking, controlling, refusing help.

Treatment emphasis

PPD: behavioural activation, mood-focused therapy. PPA: cognitive restructuring around catastrophic thinking, nervous system regulation, exposure.

This is important because some treatments work better for one condition than the other. For example, the antidepressant bupropion (Wellbutrin) helps with depression but is not very useful for anxiety. Interpersonal therapy (IPT) is well-studied for depression but less so for anxiety. According to the National Library of Medicine, cognitive behavioural therapy (CBT) can greatly reduce depression symptoms right after treatment and for up to six months. A skilled perinatal therapist will determine which condition is the primary issue and adjust treatment accordingly.

RISK FACTORS

Some people are more likely to experience a perinatal mood and anxiety disorder. Risk factors include:

• Previous history of anxiety, depression, or OCD

• Family history of mood or anxiety disorders

• Traumatic birth or NICU stay

• Pregnancy or infant loss

• Fertility struggles

• Lack of social or partner support

• Financial stress

• Sleep deprivation (universal, but more impactful for some)

• Thyroid issues postpartum

Having these risk factors does not guarantee you’ll have a perinatal mood disorder. You can still develop one without any risk factors. Use these as signs to seek support early.

WHAT ACTUALLY HELPS

Elizabeth Schane, LPC, LCMHC, LMHC, PMH-C, TN-C

Founder of Well Roots Counseling and Perinatal Mental Health Specialist

Learn More About Elizabeth

1. Therapy with a perinatal specialist

Not every therapist is trained in perinatal mental health, and this makes a difference. A Perinatal Mental Health Certified (PMH-C) therapist has special training in pregnancy, postpartum, and the unique mental and emotional patterns of new parenthood (Certification in Perinatal Mental Health, 2024). CBT, mindfulness-based therapy, and somatic approaches all have strong evidence (Li et al., 2022). For trauma from birth, EMDR or other trauma-focused therapies can be especially helpful (Chiorino et al., 2020, pp. 795-810; Li et al., 2022).

2. Medication, when appropriate

SSRIs and SNRIs are the main medications for both PPD and PPA, and many are safe to use while breastfeeding (Postpartum Depression | Breastfeeding special circumstances | CDC, 2025). A newer medication, zuranolone (Zurzuvae), works quickly for postpartum depression, with or without anxiety (Administration, 2023). Medication choices should be made with a provider knowledgeable about perinatal medications.

3. Practical support

Lack of sleep worsens symptoms. Ask a partner, family, postpartum doula, or paid helper to take a night feed or hold the baby so you can sleep deeply. This is necessary treatment. Support with meals, chores, and time off also helps.

4. Peer support

Postpartum Support International (PSI) has free support groups for PPA, PPD, postpartum OCD, postpartum PTSD, and birth trauma. Talking with other parents who have been through it can help you feel less alone, sometimes right away, especially when you first reach out (Shah et al., 2024, pp. 652-664).

5. Don't wait

Symptoms usually won’t go away on their own. If they last more than two weeks or interfere with daily life, get help now to keep them from getting worse. The right treatment will help you feel better.

When to seek help immediately

Call your provider or go to an emergency room if you experience:

• Thoughts of harming yourself or your baby

• Hallucinations, delusions, or feeling disconnected from reality

• Feeling you can no longer care for yourself or your baby

• Severe confusion or paranoia

These can be signs of postpartum psychosis — a rare but serious condition that requires urgent treatment. In the US, you can call or text 988 (Suicide & Crisis Lifeline) or the Postpartum Support International HelpLine at 1-800-944-4773.

Frequently Asked Questions About Postpartum Anxiety vs Postpartum Depression

Can I have both postpartum anxiety and postpartum depression at the same time?

A recent study looked at a short-term therapy for women at risk for both postpartum depression and anxiety. The focus was on treatments that can help with both issues at the same time, rather than treating them separately, according to research by Valverde and colleagues.

How long after birth can postpartum anxiety or depression start?

Symptoms usually start four to six weeks after birth, but they can begin in the first year or even during pregnancy. Late-onset postnatal mood disorders (three to twelve months after birth) often happen after the usual six-week checkup (32- 1261).

Do fathers and non-birthing partners get postpartum anxiety or depression?

Yes. About 10% of new fathers have postpartum depression, and rates of postpartum anxiety in fathers are similar (Leiferman et al., 2021, pp. 152-161). Symptoms in men can look different, such as more irritability, pulling away, working too much, or using substances. These signs are often missed because the focus is usually on the birthing parent. Both partners should be screened and supported.

Will medication or therapy affect breastfeeding?

Many treatments are safe to use while breastfeeding. Most commonly prescribed SSRIs have been studied and are considered low risk. According to a review by Kaufman, Carlini, and Deligiannidis, the choice to use medication for postpartum depression should be made together with a healthcare provider. They can help weigh the risks of untreated illness against the possible risks of medication, since untreated postpartum depression can also affect both the parent and the baby.

How do I find a therapist who actually understands perinatal mental health?

Look for the PMH-C (Perinatal Mental Health Certified) credential, which means the therapist has special training and supervision. Postpartum Support International has a directory of certified providers (Certification in Perinatal Mental Health | Postpartum Support International (PSI), 2024). At Well Roots Counseling, perinatal mental health is a main focus. Elizabeth Schane holds the PMH-C certification and works with new parents in NC, CO, VT, MA, and SC.

Will I always feel this way?

No. Both PPD and PPA respond well to treatment. With the right care, most people feel much better within weeks to a few months. This is a treatable condition with a high recovery rate—it is not how parenthood has to feel (Psychological Treatment for Postpartum Depression, n.d.).

If you recognise yourself in this article, please don't wait. Well Roots Counseling specialises in perinatal mental health — Elizabeth Schane is Perinatal Mental Health Certified (PMH-C) and works with new parents experiencing postpartum anxiety, depression, and birth trauma across North Carolina, Colorado, Vermont, Massachusetts, and South Carolina. Online sessions mean you can attend from home with the baby nearby. Book a free 20-minute consultation →

REFERENCES

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• Paul, I. (March 19, 2019). Postpartum anxiety more common, less recognised than postpartum depression. Penn State University. https://www.psu.edu/news/research/story/postpartum-anxiety-more-common-less-recognized-postpartum-depression

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• Administration, U. F. (August 4, 2023). FDA Approves First Oral Treatment for Postpartum Depression. FDA. https://www.fda.gov/news-events/press-announcements/fda-approves-first-oral-treatment-postpartum-depression

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