Perinatal Depression

Perinatal depression affects approximately 1 in 7 people during pregnancy or within the first year after childbirth, yet up to half of all cases remain undiagnosed. This common mood disorder is more than just “baby blues” and requires proper recognition and treatment to protect both parent and child.

Table of contents

• What Is Perinatal Depression
• Symptoms and Signs
• Causes and Risk Factors
• How Common Is Perinatal Depression
• Impact on Parent and Child
• Screening and Diagnosis
• Treatment Options

What Is Perinatal Depression

Perinatal depression is a mood disorder that affects individuals during pregnancy or within one year after childbirth^[2]. According to medical classification systems, the term perinatal depression now includes what was previously called postpartum depression. A major depressive episode that begins during pregnancy or within four weeks after delivery is classified as peripartum depression^[2].

Perinatal depression can occur during pregnancy (called prenatal depression), the year following birth (postpartum period), or both^[5]. This condition is different from the “baby blues.” The baby blues include mild, short-lasting feelings of sadness and mood swings that occur in up to 80% of new mothers within several days of delivery. These symptoms usually last no longer than 10 days and fade on their own^[5]. In contrast, perinatal depression is more severe, lasts more than 14 days, and impairs a person’s quality of life^[5].

It is important to understand that perinatal depression is not a character flaw or weakness. It is simply a medical complication that can occur with pregnancy and childbirth^[3].

Symptoms and Signs

Perinatal depression symptoms can vary from mild to severe and may appear within a week of delivery or gradually, even up to a year later^[4]. The symptoms often include persistent sadness, lack of interest, low self-esteem, sleep disturbances, loss of appetite, anxiety, irritability with a hostile attitude towards infants, self-blame, and feelings of humiliation^[2].

Common symptoms include:

• Persistent feelings of sadness, hopelessness, or emptiness
• Loss of interest in activities you once enjoyed
• Extreme fatigue and low energy
• Changes in sleeping patterns, including trouble sleeping at night or sleeping too much during the day
• Changes in appetite and unexplained weight changes
• Anxiety, excessive worrying, and panic attacks
• Difficulty concentrating and making decisions
• Feelings of guilt, worthlessness, or being a bad parent
• Withdrawing from family and friends
• Difficulty bonding with your baby
• Frequent crying or mood swings
• Irritability and anger

These symptoms don’t go away after a few days like the baby blues. They can last for weeks or months and may worsen over time without treatment^[4].

In rare, severe cases, some individuals may develop postpartum psychosis. This is an extreme mood disorder affecting about 1 in 1,000 women after delivery. Symptoms include severe agitation, confusion, paranoia, delusions or hallucinations, and rapid mood changes. Postpartum psychosis requires immediate medical attention since there is an increased risk of suicide and risk of harm to the baby^[4].

Causes and Risk Factors

The exact cause of perinatal depression is not completely clear. Perinatal depression likely stems from a combination of hormonal changes, genetic predisposition, and environmental factors^[2]. During pregnancy, hormone levels shift dramatically, which can affect mood. Depression can result from an imbalance of chemical levels in the brain^[4].

Several factors may make someone more likely to experience perinatal depression. You’re at higher risk if you or your family members have a history of anxiety disorders, panic disorder, mental illness including obsessive-compulsive disorder (a condition involving unwanted repetitive thoughts and behaviors), or mood disorders such as depression^[4].

Research has identified numerous risk factors, including fear of childbirth, tobacco use, adolescence, being single (not married or living with a partner), lower socioeconomic status, and age of 40 years or older^[13]. A history of depression is the strongest risk factor for developing perinatal depression^[13].

Additional risk factors include:

• Carrying a child with a health problem or special needs
• Dealing with stressful life events such as divorce, health problems, financial issues, or trouble at work
• Expecting twins or triplets
• An unplanned pregnancy
• Lack of a supportive partner or network of friends and family during pregnancy
• Trouble getting pregnant due to infertility
• Recent traumatic events
• Physical or psychological trauma, such as domestic violence

Having a baby is a life-changing event that can be stressful and overwhelming. Even without specific risk factors, the physical and emotional demands of caring for a baby, combined with hormonal changes, can sometimes trigger depression^[4].

How Common Is Perinatal Depression

Perinatal depression is surprisingly common. It affects approximately 1 in 7 people during pregnancy or within the first year after childbirth^[2]. In the United States, perinatal depression affects 10% to 20% of women during pregnancy, the postpartum period, or both^[5].

Worldwide, about 10% of pregnant women and 13% of women who have just given birth experience a mental disorder, primarily depression. In developing countries, this is even higher—15.6% during pregnancy and 19.8% after childbirth^[7].

Despite how common it is, up to 50% of cases remain undiagnosed due to the stigma surrounding the condition and patients’ reluctance to disclose symptoms^[2]. Many women do not realize they have perinatal depression because it can develop gradually^[3].

As many as 75% of women experience baby blues after delivery. Up to 15% of these individuals will develop postpartum depression^[4].

Impact on Parent and Child

Perinatal depression is associated with serious consequences for both the parent and child. It can cause intense sadness and anxiety in the mother and prevent her from bonding with or breastfeeding her baby^[5]. In severe cases, women may think about or actually harm themselves or their baby^[5]. Maternal suicide is a more common cause of death during the perinatal period than postpartum hemorrhage or hypertensive disorders^[13].

Untreated perinatal depression in the mother can result in low birth weight and impaired social, cognitive, and emotional development in the baby^[5]. Perinatal depression is associated with significant neonatal problems, such as failure to thrive, attachment disorder, and developmental delay at one year of age. Fortunately, treatment improves functioning in these children^[2].

For the parent, perinatal depression causes decreased energy, poor concentration, sleep disturbances, and disruption of maternal-infant bonding and healthy family dynamics^[2]. Depression causes ongoing or extreme sadness and can prevent someone from caring for their baby or themselves^[4].

In severe cases where mothers’ suffering is extreme, they may even commit suicide. The affected mothers cannot function properly, which negatively affects their children’s growth and development^[7].

Screening and Diagnosis

Screening for perinatal depression is recommended for all pregnant and postpartum women and is now a covered medical expense^[5]. Early diagnosis is crucial since the condition is essential for optimizing the health outcomes of both the parent and infant^[2].

Healthcare providers typically use screening tools like the Edinburgh Postnatal Depression Scale (EPDS), which can be completed by patients in 2 minutes in the waiting room^[5][2]. Both two-step and one-step screening strategies are effective in identifying perinatal depression^[13].

Your healthcare provider will usually talk with you about your feelings, thoughts, and mental health to help determine if you have a short-term case of postpartum baby blues or a more severe form of depression. It’s important not to be embarrassed—postpartum depression is common. Share your symptoms with your provider so together you can create a useful treatment plan^[11].

As part of the evaluation, your healthcare provider may do a depression screening, including having you fill out a questionnaire. Your provider may order other tests if needed to rule out other causes for your symptoms^[11].

Women with perinatal depression should be evaluated for bipolar disorder, postpartum psychosis, and suicide risk. Those with psychosis, active suicidal thoughts, or thoughts of harming their newborns should receive same-day psychiatric consultation and referral for possible inpatient treatment^[13].

Treatment Options

With the right support, most people make a full recovery from perinatal depression^[3]. Treatment and recovery time vary depending on how severe your depression is and what your individual needs are^[11].

Treatment typically involves psychotherapy (talk therapy or mental health counseling), support groups, and medications such as antidepressants, which are generally safe during pregnancy and lactation^[2]. Mild to moderate depression should be treated with psychotherapy or medications called selective serotonin reuptake inhibitors (medicines that help balance brain chemicals), whereas moderate to severe depression should be treated with a combination of psychotherapy and medication^[13].

Postpartum depression is often treated with psychotherapy—also called talk therapy or mental health counseling—medicine, or both^[11]. It may help to talk through your concerns with a psychiatrist, psychologist, or other mental health professional^[11].

Certain antidepressants appear to be safer than others during pregnancy and breastfeeding. Citalopram, escitalopram, and sertraline appear to be the safest during pregnancy, whereas fluvoxamine, paroxetine, and sertraline are preferred in breastfeeding women because they lead to the lowest medication levels in breastfed infants^[13].

Newly approved medications that work immediately to reduce symptoms in moderate to severe disease are also available^[5].

For first-time mothers, adolescent mothers, and mothers who have experienced a traumatic delivery, home health visits, telephone-based peer support, and psychotherapy may help prevent perinatal depression^[13]. Perinatal depression can be prevented in some patients with regular counseling sessions^[5].

Self-help strategies can also be beneficial and include:

• Talking to your family and friends about your feelings and what they can do to help
• Making time for yourself to do things you enjoy
• Resting whenever you get the chance
• Getting as much sleep as you can at night
• Exercising regularly
• Eating a healthy diet
• Accepting help from family and friends
• Connecting with other new moms
• Avoiding alcohol and recreational drugs, which can make mood swings worse

Local and national organizations can also be useful sources of help and advice^[5]. If you have prenatal depression, you are not alone. Depression is a common medical condition, and treatments can help^[4].