Perinatal depression is depression that occurs during pregnancy or the first year after childbirth. This depression could be caused by hormonal shifts, increased stress, physical and environmental changes, as well as other factors.
Pregnancy is often described as a beautiful time of life. However, that’s just not true for everyone. Sometimes, the inability to meet the unrealistic expectations of a totally joyous pregnancy can even contribute to symptoms of depression.
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Definition of Perinatal Depression
Perinatal depression is a mood disorder, specifically major depressive disorder, which occurs during or in the first 12 months following pregnancy.
You might better recognize the terms “prenatal depression” (depression during pregnancy) or “postnatal depression” (depression in the year after birth). The term “perinatal depression” encompasses both pre and postnatal depression.
Perinatal depression might be more common than you think. Historically, doctors believed that pregnancy acted as a protective mechanism against mood disorders. However, recent research shows that this is a false belief.
Statistics
Anywhere from 9.7{d9cf345e272ccae06ddf47bdd1d417e7fd8f81a9d196cc6ace4cb20fad8f4c22} to 23.5{d9cf345e272ccae06ddf47bdd1d417e7fd8f81a9d196cc6ace4cb20fad8f4c22} of people who are pregnant will experience perinatal depression symptoms. Demographic groups at the highest risk of perinatal depression are women aged 19 years and younger, American Indian/Alaskan Native women, those who smoke during or after pregnancy, and those whose babies died after birth.
Research also shows that the risk of perinatal depression is even higher (30-40{d9cf345e272ccae06ddf47bdd1d417e7fd8f81a9d196cc6ace4cb20fad8f4c22}) among low-income women.
Symptoms
There are many symptoms of perinatal depression, but not everyone will experience the same symptom profile.
Symptoms of perinatal depression include:
- Irritability
- Feeling sad, empty, hopeless, guilty, or worthless
- Significant fatigue or increase in tiredness
- Difficulty with concentration, memory, and decision-making
- Changes in sleep pattern
- Loss of interest in activities you previously enjoyed
- Trouble bonding with baby, or lack of interest in baby
- Persistent doubts about caregiving abilities
It is normal to have feelings of anxiety, doubt, or fatigue when experiencing the huge changes of pregnancy or caring for a newborn.
“Baby blues,” a milder form of depression, is experienced by 50-80{d9cf345e272ccae06ddf47bdd1d417e7fd8f81a9d196cc6ace4cb20fad8f4c22} of women in the first few days after delivery. However, if your symptoms persist for a few weeks, or impair your daily functioning, then talk to your doctor.
If you are having suicidal thoughts, hallucinations, or are a risk to yourself, your baby, or others, there is help available. Contact the National Suicide Prevention Lifeline at 1-800-273-8255 for support and assistance from a trained counselor. If you or a loved one are in immediate danger, call 911.
For more mental health resources, see our National Helpline Database.
Identifying
It can be particularly difficult to identify perinatal depression because symptoms of depression and normal pregnancy can overlap. These common symptoms include fatigue, weight gain, or alteration in sleeping pattern. That is why targeted screening and assessment for perinatal depression is crucial for identification.
The American College of Obstetricians and Gynecologists (ACOG) advises that obstetric care providers screen people who are pregnant for perinatal depression at least once during pregnancy, using a standardized and validated tool.
The Edinburgh Postnatal Depression Scale (EPDS) is the most common screening tool used during the prenatal period. It asks how the person felt during the previous seven days.
ACOG also advises physicians to perform a full assessment of mood and emotional wellbeing during the comprehensive postpartum visit. This assessment identifies perinatal depression, along with milder forms of depression (the “baby blues”) and postpartum psychosis.
Causes
When you think about it, it is not so surprising that nearly 20{d9cf345e272ccae06ddf47bdd1d417e7fd8f81a9d196cc6ace4cb20fad8f4c22} of women experience perinatal depression. Pregnancy involves physical changes that can be uncomfortable, such as fatigue and nausea.
The prospect of caring for a newborn, as well as the financial or environmental stressors that accompany that, can be overwhelming. All of these factors can contribute to perinatal depression.
Perinatal depression is not caused by anything the mother did or didn’t do, and you shouldn’t blame yourself if you experience this mental health condition.
In addition to physical changes and life stressors, some research indicates that perinatal depression is caused by hormonal shifts, and particularly the interplay of estrogen, progesterone, and the hypothalamic–pituitary–adrenal axis.
Genetics and epigenetics are also believed to contribute to perinatal depression. There is also a theory that increased inflammation during and after pregnancy can cause perinatal depression, but more research is needed to support it.
Treatment
There is some controversy among medical professionals on how best to treat perinatal depression. However, most people do feel better with treatment, and it is important to seek treatment for the health of both the parent and baby.
Psychotherapy
Psychotherapy can be very effective at treating various types of depression, including perinatal depression. In particular, cognitive behavioral therapy (CBT) and interpersonal psychotherapy (IPT) have been studied as methods of perinatal depression treatment.
- CBT involves becoming aware of your thought patterns, and positively changing your behavior. It is used to treat depression and anxiety, and can be done individually or in groups.
- IPT approaches depression treatment through acknowledging the impact of changes in social roles, life events, and relationships.
Medication
Antidepressant medication, including both selective serotonin reuptake inhibitors (SSRIs) and selective serotonin norepinephrine reuptake inhibitors (SNRIs), is often prescribed during pregnancy. In fact, about 13{d9cf345e272ccae06ddf47bdd1d417e7fd8f81a9d196cc6ace4cb20fad8f4c22} of women take an antidepressant during pregnancy.
These medications take about six to eight weeks to work, and can help balance chemicals in the brain and improve depressive symptoms. They are often used in conjunction with psychotherapy and lifestyle changes.
It’s very important to talk to your doctor before starting antidepressant medication during pregnancy, or while breastfeeding. Although the risk of birth defects from antidepressants is very low, there is still a risk for adverse effects.
Your doctor can help you make a decision regarding SSRIs or SNRIs, while minimizing the potential of side effects or impacts on your baby.
Coping
While some people may describe pregnancy as the happiest time of their lives, know that you are far from alone if that is not your experience. Your body, hormones, social roles, and much more are in flux, so it is natural for your mental health to be impacted.
If you are experiencing perinatal depression, there are a few things you can do day-to-day to help cope. These include:
- Reach out for help from your support network.
- Join a support group for expecting or new parents.
- Schedule time to rest.
- Eat regular, frequent, and healthy meals.
- Exercise regularly, including pre or postnatal yoga, or aquatic exercise.
- Explore complementary therapies, including St John’s wort, light therapy, massage, and acupuncture, but always in conversation with your doctor.
A Word From Verywell
Depression before or after giving birth is a difficult thing to go through, but you are not alone in this experience. This can be a stressful time, but remember that it is important to care for yourself, as well as your baby.
Perinatal depression is treatable through medication, psychotherapy, complementary therapies, and lifestyle changes. If your depressive symptoms are getting in the way of your daily life, or you’ve lost interest in activities you used to love, speak to your doctor about diagnosis and treatment.