You’re sitting in your car after a Starbucks run, your 3rd coffee of the day and it’s only 10am. Your baby is finally asleep in the car seat, and for the first time today, it’s quiet. But instead of feeling peaceful, you feel… empty. Overwhelmed. It’s groundhogs’ day over and over again and you feel like you are drowning.

Sound familiar?

If you’re a new mom reading this at 2am (again), you’re probably wondering: Is this just normal new parent exhaustion, or is something more serious going on? It’s one of the most common questions I hear from the new parents in my practice, and honestly, it’s a really important one to ask.

The Reality: They Often Look Exactly the Same

Here’s what makes this so confusing: postpartum depression and severe exhaustion share many of the same symptoms. Sleep deprivation and postpartum depression are both characterized by irritability, difficulty concentrating, tiredness, and trouble sleeping at night. No wonder you’re confused.

Both can make you feel:

• Completely drained, even after rest
• Irritable or quick to anger
• Unable to concentrate or make decisions
• Disconnected from yourself
• Like you’re just going through the motions

But Here’s Where They Differ

Normal Postpartum Exhaustion Usually:

• Gets better with consistent rest
• Fluctuates throughout the day
• Doesn’t make you question your worth as a parent
• Allows for moments of joy, even if they’re brief
• Improves gradually as your baby’s sleep patterns stabilize

Postpartum fatigue affects between 40-60% of new birthing parents and typically stems from the physical recovery of childbirth, hormonal changes, and the obvious sleep disruption that comes with a newborn.

Postpartum Depression, However:

• Persists even when you do get rest
• Feels heavy and constant, like a gray filter over everything
• Comes with persistent feelings of guilt, shame, or inadequacy
• Makes it hard to feel connected to your baby or partner
• Affects up to ~20% of birthing parents and ~10% of non-birthing parents and involves more than just being tired
• Can come with other symptoms like suicidal thoughts and other somatic symptoms

Without treatment, postpartum depression symptoms can hang on for months, even years. In one study, 25% of participants were still experiencing depression three years after the birth of their babies.

The Questions That Help You Tell the Difference

Ask yourself these honest questions

About your mood:

• When you do get a break, do you feel any relief? Or does the heaviness stay?
• Are you able to enjoy small moments (your baby’s smile, a good cup of coffee)?
• Do you feel guilty or ashamed about your parenting, even when others reassure you?
• Are you having a lot of anxiety or even panic attacks?
• Have you lost your appetite or eating way more than usual that is not due to breastfeeding or something else?

About your thoughts:

• Are you having scary thoughts about harm coming to your baby?
• Do you worry constantly, even about things that used to feel manageable?
• Are you having thoughts of wanting to disappear or escape?
• Do your thoughts make it hard to fall asleep or stay asleep?

About your relationships:

• Do you feel disconnected from your baby, like you’re just going through the motions?
• Are you avoiding friends and family because it feels too hard?
• Is your partner expressing concern about changes in you?

Did you answer yes to 5 or more of those questions? It might be time to seek help.

The Gray Area (And Why That’s Okay)

Sometimes it’s both. Research shows that 38.8% of women experienced fatigue at 10 days postpartum, 27.1% at 1 month, and 11.4% at 3 months, and fatigue can contribute to depression just as depression can worsen exhaustion.

You don’t need a perfect diagnosis to deserve support. You don’t need to wait until you’re “bad enough” to reach out for help.

When to Reach Out for Help

Trust your gut. If you’re wondering whether this is more than exhaustion, that wondering itself is worth exploring with a professional. Studies have shown that many women with postpartum depression are ashamed of their symptoms, but there’s absolutely nothing to be ashamed of.

Consider reaching out if:

• Your exhaustion isn’t improving even when you do get rest
• You’re having thoughts that scare you
• People close to you are expressing concern
• You don’t feel like yourself, and it’s been more than a few weeks
• You’re struggling to bond with your baby

You Don’t Have to Choose Between “Fine” and “Crisis”

Here’s what I want every new mom to know: there’s a whole spectrum between “I’m fine, just tired” and “I’m in crisis.” Most of the women I work with fall somewhere in that middle space – not quite fine, but not in immediate danger either.

That middle space? It’s still worth caring for. It’s still worth getting support for.

What Helps (Whether It’s Depression or Exhaustion)

While you’re figuring things out:

• Accept help when it’s offered (yes, even the imperfect help)
• Prioritize sleep whenever possible -the minimum goal is 4 hours of uninterrupted sleep at any time of the day.
• Eat regularly, even if it’s just snacks
• Get outside for a few minutes each day
• Light therapy, like getting outside in the morning light
• Connect with other new parents who get it
• Move your body. It seems counterintuitive but gentle movement can help fatigue and moderate movement (like a stroller walk) can be as effective as medication management for depression.

What Types of Professional Should I seek

Medication management and Psychotherapy together are the most recommended treatment. Many pharmacological treatments are safe while pregnant and breastfeeding. A psychiatrist or nurse practitioner can guide you through the best options.

CBT, ACT, and IPT Therapies are the most well researched psychotherapies for postpartum depression. Looking for a therapist with a PMH-C credential, perinatal mental health – certification, can help you find someone who specializes in postpartum depression. Perinatal Support International: Postpartum Support International – PSI has a great directory of therapists in all states.

Other treatments like acupuncture, massage, and occupational therapy might help. While many swear by them, there is not enough research studies backing these treatments yet.

The Bottom Line

You know yourself better than anyone. If something feels off, trust that feeling. Perinatal depression begins to affect individuals during pregnancy or within 1 year after childbirth, and recognizing it early makes treatment more effective.

Whether you’re dealing with the normal (but still brutal) exhaustion of new parenthood or postpartum depression, you deserve support. You deserve to feel like yourself again. And most importantly, you deserve to know that whatever you’re experiencing right now doesn’t define your worth as a mother.

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If you’re in the state of Washington, struggling and need someone to talk to, consider reaching out to Sumi Garg LMFT PMH-C at Kahaani Therapy for support. You don’t have to figure this out alone.

References:

Wilson, N., Lee, J. J., & Bei, B. (2019). Postpartum fatigue and depression: a systematic review and meta-analysis. Journal of affective disorders, 246, 224-233.

Paulson JF, Bazemore SD. Prenatal and Postpartum Depression in Fathers and Its Association With Maternal Depression: A Meta-analysis. JAMA. 2010;303(19):1961–1969. doi:10.1001/jama.2010.605

Putnick, D. L., Sundaram, R., Bell, E. M., Ghassabian, A., Goldstein, R. B., Robinson, S. L., Vafai, Y., Gilman, S. E., & Yeung, E. (2020). Trajectories of Maternal Postpartum Depressive Symptoms. Pediatrics, 146(5), e20200857. https://doi.org/10.1542/peds.2020-0857

Henderson, J., Alderdice, F., & Redshaw, M. (2019). Factors associated with maternal postpartum fatigue: an observationalstudy. BMJ open, 9(7), e025927. https://doi.org/10.1136/bmjopen-2018-025927

Place, J. M. S., Renbarger, K., Van De Griend, K., Guinn, M., Wheatley, C., & Holmes, O. (2024). Barriers to help-seeking for postpartum depression mapped onto the socio-ecological model and recommendations to address barriers. Frontiers in global women’s health, 5, 1335437. https://doi.org/10.3389/fgwh.2024.1335437

Fitelson, E., Kim, S., Baker, A. S., & Leight, K. (2010). Treatment of postpartum depression: clinical, psychological and pharmacological options. International journal of women’s health, 1-14.