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.

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.

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.

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.

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. If these treatments do not reduce symptoms, brain stimulation therapies, such as electroconvulsive therapy, may be an option to explore. Learn more about these therapies by visiting the National Institute of Mental Health’s (NIMH) Brain Stimulation Therapies webpage. 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 and visit this U.S. Food and Drug Administration (FDA) webpage on the use of medications during and after pregnancy.

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 National Suicide Prevention Lifeline at 1-800-273-TALK (8255).

After the birth of a child, many women experience a drop in certain hormones, which can lead to feelings of depression. FDA has approved one medication, called brexanolone, specifically to treat severe postpartum depression. Administered in a hospital, this drug works to relieve depression by restoring the levels of these hormones.

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.

Don’t wait for your health care provider to ask about your mental health. Start the conversation. Here are five tips to help prepare and guide you on how to talk to your health care provider about your mental health and get the most out of your visit.

1. Don’t know where to start for help? Talk to your primary care provider.

If you’re going to your primary care provider for other health concerns, remember to bring up your mental health concerns. Mental health is an integral part of health. Often, people with mental disorders can be at risk for other medical conditions, such as heart disease or diabetes. In many primary care settings now, you may be asked if you’re feeling anxious or depressed, or if you have had thoughts of suicide. Take this opportunity to talk to your primary care provider, who can help refer you to a mental health specialist.

2. Prepare ahead of your visit.

Health care providers have a limited amount of time for each appointment. Think of your questions or concerns beforehand, and write them down.

• Prepare your questions. Make a list of what you want to discuss and any questions or concerns you might have.
• Prepare a list of your medications. It’s important to tell your health care provider about all the medications you’re taking, including over-the-counter (nonprescription) drugs, herbal remedies, vitamins, and supplements.
• Review your family history. Certain mental illnesses tend to run in families, and having a close relative with a mental disorder could mean you’re at a higher risk. Knowing your family mental health history can help you determine whether you are at a higher risk for certain disorders. It also can help your health care provider recommend actions for reducing your risk and enable both you and your provider to look for early warning signs.

3. Consider bringing a friend or relative.

Sometimes it’s helpful to bring a close friend or relative to your appointment. It can be difficult to absorb all the information your health care provider shares, especially if you are not feeling well. Your companion can be there for support, help you take notes, and remember what you and the provider discussed. They also might be able to offer input to your provider about how they think you are doing.

4. Be honest.

Your health care provider can help you get better only if you have clear and honest communication. It is important to remember that communications between you and a health care provider are private and confidential and cannot be shared with anyone without your expressed permission. Describe all your symptoms with your provider, and be specific about when they started, how severe they are, and how often they occur. You also should share any major stresses or recent life changes that could be triggering symptoms.

Examples of symptoms include:

• Persistent sad, anxious, or “empty” mood
• Feelings of hopelessness or pessimism
• Irritability
• Feelings of guilt, worthlessness, or helplessness
• Loss of interest or pleasure in hobbies and activities
• Decreased energy or fatigue
• Moving or talking more slowly
• Feeling restless or having trouble sitting still
• Difficulty concentrating, remembering, or making decisions
• Difficulty sleeping, early-morning awakening, or oversleeping
• Appetite or weight changes (or both)
• Thoughts of death or suicide, or suicide attempts
• Aches or pains, headaches, cramps, or digestive problems without a clear physical cause and/or that do not ease even with treatment

5. Ask questions.

If you have questions or even doubts about a diagnosis or treatment your health care provider gives, ask for more information. If your provider suggests a treatment you’re not comfortable or familiar with, express your concerns and ask if there are other options. It’s okay to disagree with your provider on what treatment to try. You may decide to try a combination of approaches. You also may want to get another opinion from a different health care provider. It’s important to remember that there is no “one-size-fits-all” treatment. You may need to try a few different health care providers and several different treatments, or a combination of treatments, before finding one that works best for you.