Perinatal depression is depression that occurs during or after pregnancy. The symptoms can range from mild to severe. In rare cases, the symptoms are severe enough that the health of the mother and baby may be at risk. Perinatal depression can be treated. This article describes the signs and symptoms of perinatal depression and how you or a loved one can get help.

What is perinatal depression?

Perinatal depression is a mood disorder that can affect women during pregnancy and after childbirth. The word “perinatal” refers to the time before and after the birth of a child. Perinatal depression includes depression that begins during pregnancy (called prenatal depression) and depression that begins after the baby is born (called postpartum depression). Mothers with perinatal depression experience feelings of extreme sadness, anxiety, and fatigue that may make it difficult for them to carry out daily tasks, including caring for themselves or others.

How is postpartum depression different from the “baby blues”?
The “baby blues” is a term used to describe mild mood changes and feelings of worry, unhappiness, and exhaustion that many women sometimes experience in the first 2 weeks after having a baby. Babies require around-the-clock care, so it’s normal for mothers to feel tired or overwhelmed sometimes. If mood changes and feelings of anxiety or unhappiness are severe, or if they last longer than 2 weeks, a woman may have postpartum depression. Women with postpartum depression generally will not feel better unless they receive treatment.

What causes perinatal depression?

Perinatal depression is a real medical illness and can affect any mother—regardless of age, race, income, culture, or education. Women are not to blame or at fault for having perinatal depression: it is not brought on by anything a mother has or has not done. Perinatal depression does not have a single cause. Research suggests that perinatal depression is caused by a combination of genetic and environmental factors. Life stress (for example, demands at work or experiences of past trauma), the physical and emotional demands of childbearing and caring for a new baby, and changes in hormones that occur during and after pregnancy can contribute to the development of perinatal depression. In addition, women are at greater risk for developing perinatal depression if they have a personal or family history of depression or bipolar disorder or if they have experienced perinatal depression with a previous pregnancy.

Postpartum Psychosis
Postpartum psychosis (PP) is a severe mental illness that occurs after childbirth. PP is a medical emergency, and it is important to seek help immediately by calling 911 or going to the nearest emergency room. Women who have PP can have delusions (thoughts or beliefs that are not true), hallucinations (seeing, hearing, or smelling things that are not there), mania (a high, elated mood that often seems out of touch with reality), paranoia, and confusion. Women who have PP also may be at risk for harming themselves or their child and should receive help as soon as possible. Recovery is possible with professional help.

Signs and Symptoms

Some women may experience a few symptoms of perinatal depression; others may experience several symptoms. Some of the more common symptoms of perinatal depression include:

• Persistent sad, anxious, or “empty” mood
• Irritability
• Feelings of guilt, worthlessness, hopelessness, or helplessness
• Loss of interest or pleasure in hobbies and activities
• Fatigue or abnormal decrease in energy
• Feeling restless or having trouble sitting still
• Difficulty concentrating, remembering, or making decisions
• Difficulty sleeping (even when the baby is sleeping), awakening early in the morning, or oversleeping
• Abnormal appetite, weight changes, or both
• Aches or pains, headaches, cramps, or digestive problems that do not have a clear physical cause or do not ease even with treatment
• Trouble bonding or forming an emotional attachment with the new baby
• Persistent doubts about the ability to care for the new baby
• Thoughts about death, suicide, or harming oneself or the baby

Only a health care provider can help a woman determine whether the symptoms she is feeling are due to perinatal depression or something else. It is important for women who experience any of these symptoms to see a health care provider.

If You Know Someone in Crisis:

• Dial 911 in an emergency.
• Call the toll-free, 24-hour hotline of call the Canada Suicide Prevention Service at 833-456-4566 24 hours a day, 7 days a week. The service is available to everyone. All calls are free and confidential.

Treatment

Treatment for perinatal depression is important for the health of both the mother and the baby, as perinatal depression can have serious health effects on both. With proper treatment, most women feel better and their symptoms improve.

Treatment for perinatal depression often includes therapy, medications, or a combination of the two. A doctor or health care provider can help women choose the best treatment based on their symptoms.

Psychotherapy

Several types of psychotherapy (sometimes called “talk therapy” or “counseling”) can help women with perinatal depression. Two examples of evidence-based approaches that have been used to treat perinatal depression include cognitive behavioral therapy and interpersonal therapy.

Cognitive Behavioral Therapy (CBT)

CBT is a type of psychotherapy that can help people with depression and anxiety. It teaches people different ways of thinking, behaving, and reacting to situations. People learn to challenge and change unhelpful patterns of thinking and behavior as a way of improving their depressive and anxious feelings and emotions. CBT can be conducted individually or with a group of people who have similar concerns.

Interpersonal Therapy (IPT)

IPT is an evidence-based therapy that has been used to treat depression, including perinatal depression. It is based on the idea that interpersonal and life events impact mood and vice versa. The goal of IPT is to help people to improve their communication skills within relationships, to develop social support networks, and to develop realistic expectations that allow them to deal with crises or other issues that may be contributing to their depression.

Medication

Women with perinatal depression are most commonly treated with antidepressants, which are medications used to treat depression. They may help improve the way the brain uses certain chemicals that control mood or stress. Women who are pregnant or breastfeeding should notify their doctor before starting antidepressants so their doctor can work to minimize the baby’s exposure to the medication during pregnancy or breastfeeding. The risk of birth defects and other problems for babies of mothers who take antidepressants during pregnancy is very low; however, women should work with their doctor to weigh the risks and benefits of treatment and to find the best solution for their situation. Women may need to try several different medications before finding the one that improves their symptoms and has manageable side effects.

Antidepressants take time—usually 6 to 8 weeks—to work, and symptoms such as sleep, appetite, and concentration problems often improve before mood lifts. It is important to give medication a chance before deciding whether or not it works.

Do not stop taking antidepressants without the help of a doctor or other health care provider. Sometimes people taking antidepressants feel better and then stop taking the medication on their own, and the depression returns. Stopping medications abruptly can cause withdrawal symptoms. When a woman and her health care provider have decided it is time to stop the medication, the health care provider will help her to decrease the dose slowly and safely. To find the latest information about antidepressants, talk to a health care provider.  

Please Note: In some cases, children, teenagers, and young adults under the age of 25 may experience an increase in suicidal thoughts or behavior when taking antidepressants, especially in the first few weeks after starting or when the dose is changed. Patients of all ages taking antidepressants should be watched closely, especially during the first few weeks of treatment.

• If suicidal behaviors are observed, notify a health care provider right away. If you or a loved one is in crisis, call 911 for emergency services or contact the Call the toll-free, 24-hour hotline of call the Canada Suicide Prevention Service at 833-456-4566 24 hours a day, 7 days a week. The service is available to everyone. All calls are free and confidential.

Researchers continue to study treatment options for perinatal depression. A health care provider can explain the different treatment options and help women choose the treatment that is right for them.

How can family and friends help?

It is important to understand that depression is a medical condition that impacts the mother, the child, and the family. Spouses, partners, family members, and friends may be the first to recognize symptoms of perinatal depression in a new mother. Treatment is central to recovery. Family members can encourage the mother to talk with a health care provider, offer emotional support, and assist with daily tasks such as caring for the baby or the home.

Support or advocacy groups can offer a good source of support and information. One example of this type of group is Postpartum Support International; others can be found through online searches.

Adapted from the National Institute of Mental Health (NIMH)