Pregnancy and the time after the birth of your child can be physically, emotionally, and mentally challenging. It's common to experience extreme sadness, stress, fatigue, anxiety, and so on when you're supposed to be happy, excited, and joyful.
While this reflects normal mood swings for expectant and new mothers, there are instances when these changes in emotions can represent a mental health problem called perinatal depression. This includes having depressive symptoms during pregnancy and after childbirth.
While postpartum depression is discussed quite a lot, little is known about its pregnancy equivalent when it can be just as dangerous to the mother and baby.
This article discusses the different forms of perinatal depression, its symptoms, causes, treatment options, and coping mechanisms. There's also information for friends and family members on how they can help and what to do in a crisis.
So, let's jump right in!
What Is Perinatal Depression?
Perinatal is the period from when you become pregnant to up to a year after giving birth.
So, perinatal depression describes the depression symptoms people experience at any time during pregnancy, after childbirth, and during the early months of the infant's life — from start to finish.
Most mothers will have some sort of emotional issue or mental illness during the perinatal period. In fact, the medical field has found several terms to describe the mood changes women can have during this time. They include prenatal (antenatal) depression, baby blues, postnatal (postpartum) depression, and postpartum psychosis.
Let's look at each term individually, so you know what you may be dealing with.
What Is Prenatal Depression?
Prenatal is the time during pregnancy and before birth occurs. Therefore, prenatal depression, also called pregnancy depression, is a type of clinical depression that can affect pregnant women.
The problem is that many pregnancies include symptoms associated with depression, such as insomnia, fatigue, weight gain, mood changes, and so on. As a result, many moms-to-be don't even realize they're experiencing prenatal depression. Also, most prenatal check-ups tend to focus on improving physical health and not so much on the emotional and mental well-being of the mother.
You may want to watch out for common symptoms of prenatal depression before birth, such as:
- Trouble sleeping (note that your sleep may be disrupted during pregnancy by frequent urination)
- Extreme fatigue or low energy
- Increased anxiety
- Frequent crying or weeping
- Not enjoying once pleasurable activities
- Trouble connecting to your developing baby (poor fetal attachment)
- Changes in appetite
Many discussions tend to focus on postpartum depression while overlooking the combination of biological and emotional factors, which can lead to anxiety and depression during pregnancy. But according to a 2021 review, the prevalence of prenatal depression is as high as 20% to 40% compared to 17% for postpartum depression. The same review notes that many pregnant women experience depression in the second and third trimester.
Baby Blues
All new parents go through a transition period as they try to adjust to the changes a newborn comes with. Additionally, your body experiences a dramatic drop in pregnancy hormones after childbirth, which can significantly impact your mood swings.
Postpartum blues tend to occur between the third and tenth day after birth. You might feel tearful, moody, anxious, sad, angry, overwhelmed, and highly sensitive, but this usually passes within a few days. No specific care is needed, just emotional support and understanding to help you get through the mild mood changes.
Perinatal Vs. Postpartum Depression
If your feelings of sadness, anger, frustration, irritability, and so on last longer than two weeks after the birth of your child, you may be experiencing postpartum depression.
As mentioned earlier, depression can start before or during pregnancy and continue long after the baby is born. That's why the term perinatal depression is used to cover the whole period. However, the most talked about perinatal depression is postpartum depression, also known as postnatal depression.
According to the CDC, 1 in 8 women experience symptoms of postpartum depression, ranging from mild to severe depression. Common symptoms of postpartum depression are similar to other depressive mood disorders and include:
- Feeling down and upset
- Crying all the time
- Feeling anxious
- Feeling restless, agitated, or irritable
- Isolated and unable to relate to other people
- Feelings of guilt, worthlessness, or helplessness
- Finding no pleasure in life or things that you used to enjoy
- Loss of concentration
- Low libido
- Changes in appetite
- Difficulty sleeping even when you can “find the time”
- No self-confidence or self-esteem
- Having suicidal thoughts
- Having trouble bonding with your baby
Some people experience a few symptoms of prenatal depression or postpartum depression, while others may experience more — if not all of them. You know you're experiencing a postpartum major depressive disorder when these intense symptoms last over two weeks.
Postpartum Psychosis
Postpartum psychosis is the most severe form of perinatal depression after childbirth. It is rare, though, only occurring in about 0.1% of new moms. Severe symptoms of perinatal depression can include:
- A loss of touch with reality
- Drastic mood changes
- Confusion
- Hallucinations
- Delusions
- Paranoia
- Suicidal thoughts
- Thoughts about harming your baby
The risk of self-harm and infanticide is real and quite high in mothers suffering from psychosis. As a result, this is considered a medical emergency, and the mother may need hospitalization to keep her and the baby safe.
What Causes Perinatal Depression?
Several factors cause depression with perinatal onset. For starters, pregnancy, childbirth, and the postpartum period involve a lot of physical changes, including weight gain, stretch marks, enlarged breasts, labia changes, excess skin, etc. All these changes can make a woman feel less attractive, unworthy of love, and even lose their identity.
Secondly, the pressure of caring for a newborn and the financial, social, and environmental stressors accompanying this new role can be overwhelming. New mothers constantly worry about their baby's health and well-being and beat themselves up for any small mistake. All of these stressors can contribute to perinatal depression.
Lastly, the shifting hormones during pregnancy and after delivery can have a powerful effect on brain chemistry, mental health, and mood.
While anyone can suffer from symptoms of perinatal depression, some things can increase your risk factor, such as:
- Inadequate support
- Personal or family history of previous depression or other mood disorders
- Life stress, such as work or financial problems
- Unplanned or unwanted pregnancy
- Smoking and drinking alcohol during and after pregnancy
- History of substance abuse
- Pregnancy complications
- Having multiple births
- A traumatic or difficult pregnancy or birth
- If the baby has any health problems
- History of physical or sexual abuse
Perinatal Depression Diagnosis
Our online depression test can help you know the likelihood that you're dealing with depression. But please note that the results are not a diagnosis; you'd have to visit your doctor for a proper diagnosis.
Perinatal depression is often diagnosed like other forms of depression, although the doctor looks at the peripartum onset as a significant specifier. The American College of Obstetricians and Gynecologists (ACOG) acknowledges that perinatal depression symptoms can occur any time during pregnancy up to 12 months after delivery.
The ACOG recommends that all pregnant women receive perinatal screening at least once during pregnancy and a follow-up screening during the comprehensive postpartum visit. During the screening, your healthcare provider will ask a set of questions to help determine the mental health of the pregnant person.
How to Treat Perinatal Depression
While it may be common, depression during and after pregnancy is treatable. Treatment will be based on the type of depression and the severity of one's symptoms. You must talk with your doctor about the best treatment option for you. For example, pharmaceutical interventions for pregnancy depression and postnatal depression may differ because of the risk that antidepressant medication can cause birth defects in the developing baby.
Without further ado, here are some common treatment options for perinatal depression:
Therapy and Counseling
Talk therapy and counseling is often the first line of defense when treating mild to moderate depression. It involves talking to your healthcare provider about your mental health so they can help you develop the proper coping mechanisms.
There are two forms of talk therapy commonly used for treating depression — Cognitive Behavioral Therapy and Interpersonal Therapy. Family therapy may be added depending on the situation.
Cognitive Behavioral Therapy (CBT)
In Cognitive Behavioral Therapy, your healthcare provider will help you to identify and change your negative thoughts into positive ones. CBT works on the principle that our thinking greatly affects our emotions. And if you can change your thinking pattern to be positive, you can improve your depressive and anxious feelings and emotions.
Interpersonal Therapy (IPT)
As the name suggests, Interpersonal Therapy focuses on treating a patient's interpersonal issues that may contribute to depressive symptoms. The goal is to help you improve your communication skills and develop social support networks. You'll also learn how to set realistic expectations that allow you to deal with your stressors.
Medication
Taking medication to treat depression during pregnancy is always weighed against the risk to the baby. There are several antidepressant drugs used for treating perinatal depression, including:
- Selective serotonin reuptake inhibitors (SSRIs)
- Serotonin and norepinephrine reuptake inhibitors (SNRIs)
- Tricyclic antidepressants
- Atypical antidepressants
- Brexanolone
These medications improve how the brain uses certain chemicals that regulate stress and mood. It's important that you take the medication as prescribed. Suddenly stopping can cause withdrawal symptoms, and depression might return.
Any medication the mother takes can be passed to the baby through breastfeeding. Even so, prolonged depression can be more harmful to both the mother and baby than the side effects of any treatment. Be sure to talk with your doctor about any concerns, and don't skip follow-up treatment appointments.
For mothers with postpartum psychosis, drugs used to treat the psychotic symptoms may be added for effective treatment.
Electroconvulsive Therapy (ECT)
If you have severe perinatal depression that doesn't respond to the above treatment options, brain stimulation therapies like ECT may be considered.
What Are the Effects of Perinatal Depression on The Infant?
Women with prolonged perinatal depression have trouble caring for themselves and their babies. This means you may not follow healthy guidelines during pregnancy and after birth, like eating healthfully and exercising.
You may even miss prenatal and postnatal appointments with your doctor. Of course, this will have adverse effects on the infant/baby.
Health experts associate perinatal depression with an increased risk of:
- Low birth weight
- Premature birth
- Preeclampsia (high blood pressure during pregnancy)
- Neonatal depression
- Behavioral issues
- Developmental delays
Self-Care and Mental Health for Perinatal Depression
Besides medication and therapy, there are some self-care tips that you can try to help alleviate perinatal depressive symptoms. For starters:
- Get adequate rest and as much sleep as possible.
- Ask for and receive help.
- Have a healthy diet — remember you are eating for two. Good nutrition also helps reduce stress.
- Engage in simple exercises like yoga and light walking.
- Be kind to yourself. Your body and mind are going through a lot, and you may not be as calm, patient, and collected as usual.
- Make time for yourself to engage in your favorite hobby.
- Talk it out with friends, family, therapist, or support group.
- Look after your hygiene. Simple things like showering and getting dressed can greatly improve your mood and reduce symptoms of depression.
- Join a support group for people with similar experiences. They may be the only ones who understand what you're truly going through and validate your feelings.
- Practice positive affirmations to make you feel better about yourself. For instance, "I am enough, I am exactly who my child needs, I am beautiful, my body is healing, etc.”
- Use grounding and relaxation techniques to reduce symptoms of stress.
Most importantly, instead of looking at the negative, focus on small moments of gratitude each day. Recognizing even one positive thing can help lift your spirits and foster resilience through challenging times
Where to Find Help for Perinatal and Postnatal Depression
Unless you've previously suffered from depression or another mood disorder, it's not easy to recognize symptoms of perinatal depression. For most women, this is their first episode of depression, and it's unexpected, considering it should be a joyous time.
Most people are afraid and ashamed to talk about it, especially when they're constantly having negative thoughts. How do you admit to someone else that you don't feel connected to your baby or that you're having thoughts of harming them?
But we want to assure you that you're not alone.
Your feelings are valid and never your fault. Don't wait to seek treatment if you are experiencing perinatal depression - talk to your family doctor, obstetrician, or a mental health professional. You can also check out one of the many "Moms' Mental Health Matters" programs to learn about local support groups and resources.
If you are thinking of harming yourself or your baby, are having hallucinations, or are in a suicidal crisis, there's immediate help available.
You can find assistance from a trained counselor by calling or texting 988, the US Suicide & Crisis Lifeline (you can also chat with someone online). And if you or a loved one is in immediate danger, call 911. For more mental health resources, find a helpline on the International Association for Suicide Prevention database.
It's important to understand that perinatal depression is a mental health condition that affects the mother, the child, and the people around them.
If your loved one is pregnant or recently had a baby, this information can also help you recognize signs of perinatal depression. You can offer emotional support, help with daily tasks, encourage the mother to speak to a healthcare provider, and get emergency help when necessary. You may also want to read “Ways You Can Help a Loved One With Depression.”
Remember, if the baby blues last longer than 2 weeks or a low mood turns to extreme sadness, it's better to be safe than sorry — talk to someone!
Mild untreated depression symptoms during and after pregnancy can get worse and turn into a major depressive disorder.
