What Is Perinatal Depression?

Pregnancy and the weeks immediately following birth are physically, emotionally, and mentally challenging. It’s not uncommon to experience feelings of elation and happiness one moment, only to feel sadness, fatigue, and anxiety the next. While these emotions can reflect normal mood swings during pregnancy and postpartum, there are instances when these changes in mood may be reflective of something more serious. 

What Is Perinatal Depression?

Perinatal depression is depression experienced during or after pregnancy. The condition affects one in seven women, making it one of the most common medical complications during pregnancy and the postpartum period. There are several terms used to describe mood disorders that result in depressive feelings during pregnancy or after birth, including postpartum depression, maternal depression, prenatal depression, and postnatal depression.

Symptoms

It’s natural to experience emotional ups and downs during pregnancy and the postpartum period; mild mood changes during pregnancy are common. However, if feelings of depression or anxiety during or after pregnancy persist for a few weeks or interfere with daily activities, it is time to ask for help. Symptoms of perinatal depression include:

• Persistent sadness
• Loss of interest in activities you once enjoyed
• Feelings of emptiness
• Feelings of hopelessness
• Frequent crying
• Reduced ability to think or concentrate
• Trouble sleeping
• Fatigue or low energy
• Irritability 
• Increased feelings of anxiety and worry
• Loss of interest in caring for self and/or child
• Poor bonding with baby
• Changes in appetite and weight
• Thoughts of death or suicide

Diagnosis 

Diagnosing pregnancy depression follows some of the same guidelines as diagnosing other forms of depression, but your doctor will consider the peripartum onset as an important specifier, often resulting in a diagnosis of major depressive disorder (MDD) with peripartum onset. That said, there are some slight discrepancies in the time frame of perinatal depression between the DSM-5 and other organizations such as the American College of Obstetricians and Gynecologists (ACOG).

Getting Screened for Pregnancy Depression

ACOG recommends:

• At least one screening for depression and anxiety symptoms during the perinatal period
• A follow-up screening during the comprehensive postpartum visit

ACOG and the American Academy of Pediatrics (AAP) both recommend:

• Screening with a validated tool such as the Edinburgh Postpartum Depression Scale (EPDS), which is a simple, 10-question screen that is completed by the mother
• A referral from a doctor for additional mental health services if further treatment is needed

Causes

The causes of perinatal depression involve a variety of medical, social, and psychiatric vulnerabilities. That said, depression in general is more common in women than men, with twice as many women being affected.

The initial onset of depression symptoms often peaks during the reproductive years, which points to hormonal activity as one of the causes of pregnancy depression. Shifting hormones during pregnancy and in the postpartum period may play a role in symptoms of perinatal depression. 

Several risk factors exist for perinatal depression, including:

• Personal or family history of depression
• Maternal anxiety
• Life stress
• Lack of social support
• Unintended pregnancy
• Smoking 
• Poor relationship quality
• History of physical or sexual abuse
• Pregnancy complications

Treatment

Even though the daily symptoms can feel overwhelming and permanent at times, depression during and after pregnancy is treatable. Through a combination of different therapies, medications, and self-care, you can begin to feel better. Since perinatal depression is under the umbrella of depressive disorders, adhering to the proven therapeutic options for treating depression should be followed.

Therapy and Counseling

Psychotherapy is often the first line of defense when treating perinatal depression. During therapy, you can begin to understand your diagnosis and how it impacts your life. A therapist will also work with you to develop strategies that decrease the severity of the symptoms. There are several forms of psychotherapy, but two, in particular, have been studied in treating perinatal depression.

• Cognitive behavioral therapy (CBT) emphasizes the link between thoughts and feelings. Through CBT counseling sessions, you will work to identify and reframe negative thinking patterns into positive thoughts. This can help you recognize how your thinking influences your emotions. 
• Interpersonal therapy has also been successful in treating perinatal depression. This type of therapy focuses on treating interpersonal issues that may contribute to the development of depression, with the goal of social adjustment and improving your relationships with other people.

Antidepressants

Your doctor may also talk to you about antidepressants, which are a group of drugs commonly prescribed for treating depression. They work by increasing levels of a group of chemicals in the brain called neurotransmitters (primarily serotonin, norepinephrine, and dopamine) which are involved in regulating mood. There are differing opinions on the use of antidepressants during pregnancy, and special consideration should also be given while breastfeeding.

• Selective serotonin reuptake inhibitors (SSRIs) are the most commonly prescribed antidepressants during pregnancy and the postpartum period.

Acupuncture

Additionally, preliminary research has shown that alternative therapies like acupuncture and acupressure may be helpful interventions for managing depression symptoms during pregnancy.

Coping

Managing the symptoms of depression while pregnant and caring for a newborn can feel overwhelming at times. In addition to any treatment plan that may involve therapy or medication, there are several self-care and coping tips you can try in order to alleviate some of the symptoms of pregnancy depression.

• Exercise and physical activity. Staying physically active and engaging in exercises that you enjoy not only benefits your health, but it can also help alleviate some of the symptoms of depression. Try to include some form of exercise most days of the week. Talk with your doctor if you’re unsure of the safety of a particular activity.
• Adequate rest. Quality sleep and rest during pregnancy and the postpartum period is critical to managing the symptoms of depression and the health of your baby. Insufficient sleep can make coping with the stressors of life more challenging. While waking up during the night is common, try to get seven or more hours of sleep each night, which is the recommended amount for adults. 
• Healthy diet and nutrition. Your body needs additional calories and nutrients when pregnant and breastfeeding. To support overall health, focus on a diet full of fresh fruit, vegetables, healthy fats, complex carbohydrates, and lean protein. What you eat can determine how you feel both physically and mentally.
• Support groups. One way to help ease some of the stress and feelings of loneliness is to find your community. Whether it’s friends, other women going through the same thing, family members, or a support group run by a therapist, sharing your experience with others can help you feel supported and find new ways to cope. 

A Word From Verywell

Pregnancy and motherhood can produce a range of feelings from sheer excitement and joyful celebration to sadness, loneliness, and emptiness. For some women, these ups and downs are temporary, but for others, these feelings persist or increase in intensity as time goes on.

If you’re experiencing any symptoms of perinatal depression, the most important thing to remember is that you are not alone. There are safe and effective ways to treat and manage the symptoms of depression. That’s why it’s important to talk to your doctor right away. Asking for help is the first step in finding ways to feel better so you can begin to fully enjoy this remarkable time in your life.