Peripartum depression is a type of depression that affects pregnant and postpartum women.1 It is one of the most common complications that pregnant and postpartum women can experience. Peripartum depression can develop at any point during pregnancy and shortly after childbirth. Getting help is important, as untreated peripartum depression can be stressful for the mother and have long-term effects on the baby.
Peripartum Depression vs. Postpartum Depression?
Peripartum is a term for the entire period of pregnancy and a period of time after birth. It is sometimes referred to as perinatal as well (part of the spectrum of perinatal mood and anxiety disorders). The peripartum period is divided into antepartum (before birth), intrapartum (during birth) and postpartum (after birth).
Peripartum depression refers to depression that develops either during pregnancy or after childbirth.1 Some women with peripartum depression may become depressed during pregnancy. In some cases, these symptoms may go away prior to giving birth, but in other cases women may continue to feel depressed even after giving birth. These women have peripartum depression.
Postpartum depression is a type of peripartum depression that begins after childbirth.2 Both conditions can cause symptoms like depressed mood, low motivation, changes in sleep and appetite, postpartum rage and anger, and negative feelings like guilt and worthlessness. The distinction is in the timing of the symptoms.
How Common Is Peripartum Depression?
Peripartum depression is the most common peripartum condition that a woman can develop.3 It affects nearly one in five women during pregnancy and the postpartum period. While peripartum depression can affect any childbearing woman, women of certain ages and races have a higher risk of developing this condition.
- Approximately 18.4% of women experience depression during pregnancy3
- Around 19.2% of women experience depression during the first 3 months postpartum3
- Severe peripartum depression that requires treatment affects approximately 12.7% of pregnant women and 7.1% of postpartum women3
- Adolescent women ages 13 to 19 have the highest risk of developing peripartum depression during pregnancy, while women ages 31 to 35 have the lowest risk4
- In general, the risk of developing peripartum depression after childbirth decreases as women get older4
- African American women are more likely to report symptoms of peripartum depression compared to white and Hispanic women5
Common Signs & Symptoms of Peripartum Depression
Peripartum depression involves negative thoughts and feelings and a low mood. It can affect many areas of a woman’s life, including her physical health, relationships with other people, work and/or school performance, and ability to care for herself and her family. Peripartum depression is particularly concerning because it can hinder a woman’s ability to get proper prenatal care and bond with her baby.
Common symptoms of peripartum depression include:6
- Depressed or sad mood nearly every day for most of the day
- Less interest or pleasure in activities
- Significant increase or decrease in appetite or weight which is unrelated to pregnancy or recent childbirth
- Sleeping too much or too little
- An increase or decrease in movement, such as appearing agitated or sluggish
- Feeling more tired than usual
- Feelings of guilt or worthlessness
- Difficulty remaining focused or making decisions
- Suicidal thoughts, plans, or attempts
If you or someone you know is experiencing suicidal thoughts, be sure to get help immediately by calling 911 or the National Suicide Prevention Lifeline at 1-800-273-TALK (8255).
What Causes Peripartum Depression?
There are several different factors that may contribute to the development of peripartum depression during pregnancy and the postpartum period. Hormonal changes, sleep deprivation, and added stress during pregnancy may all play a role in causing this condition. Additionally, certain risk factors, like a history of depression or a complicated pregnancy or delivery, may also increase the likelihood that a woman develops peripartum depression.
Hormone Changes
Changes in certain hormone levels during pregnancy and childbirth are believed to play a role in why some women develop peripartum depression.4 Corticotropin-releasing hormone regulates steroid hormones like estrogen and progesterone in the body. It is produced in the part of the brain called the hypothalamus, as well as the placenta, uterus, and ovaries during pregnancy.
Higher levels of this hormone during pregnancy are linked to peripartum depression during the prenatal period.7 After delivery, levels of this hormone drop significantly, which also leads to abrupt decreases in estrogen and progesterone levels. Some women may be more sensitive to these rapid hormonal changes, which could put them at risk for peripartum depression after birth.
Sleep Deprivation
Sleep deprivation is common during the peripartum period, whether it is due to hormonal changes, feeling uncomfortable during pregnancy, or caring for a newborn.2 Studies have found that poor sleep is linked to a higher risk of peripartum depression.4 During the first month postpartum, decreased progesterone levels can negatively impact sleep. Over time, chronic sleep deprivation impacts a person’s glucose metabolism, immune system, and inflammatory processes, which can also have a negative impact on mental health and contribute to depression.
Stress
There is a strong link between added stress and peripartum depression. Women with a history of sexual abuse, higher levels of parenting stress, low self-esteem, and women who feel more negatively toward pregnancy or dissatisfied with the baby’s gender are at higher risk for this condition.4 Experiencing marital problems, a lack of support, or stressful life events, like death of a loved one or unemployment, can also put women at higher risk.2
The physical and emotional demands of pregnancy, childbirth and caring for a newborn alone are stressful, so experiencing additional stressors at the same time can make it more difficult to cope.
Risk Factors that Increase Likelihood of Peripartum Depression
Risk factors are experiences that increase the likelihood of developing a certain condition. One significant risk factor for peripartum depression is having a history of depression, anxiety, or premenstrual syndrome (PMS).4 Also, women who experience depression during pregnancy are more likely to experience depression during the postpartum period. Professionals believe that certain women may be more sensitive to the hormonal changes that occur during pregnancy and after childbirth, which can explain their higher risk for depression.
Women who experience a risky pregnancy or postpartum complications are also at higher risk for peripartum depression.4 For example, women who require hospitalizations during pregnancy, an emergency cesarean section delivery, or postpartum complications like umbilical cord prolapse, meconium passage, and excessive bleeding are more likely to develop this condition. In these cases, a woman’s expectations of her pregnancy or delivery are much different from her actual experience.
Does Peripartum Depression Affect the Baby?
Babies of mothers who suffer from peripartum depression may be affected in several ways. Women who experience peripartum depression during pregnancy face a higher risk of preterm birth, delayed fetal growth, and low birth weight.3
Higher Likelihood of Negative Coping Skills
Women who experience depression during pregnancy are also more likely to abuse drugs and alcohol, less likely to gain an adequate amount of weight, and show poorer attendance at prenatal visits. In some cases, these outcomes could have lifelong negative effects on a child.
Poor Mother-Baby Interaction
Mothers who suffer from peripartum depression during the postpartum period are more likely to interact with their babies in a negative way, such as by withdrawing or failing to attend to their cues.2 Babies of mothers with peripartum depression may experience more problems with sleeping and feeding, verbal and visual communication, and emotional regulation.3 These babies tend to show more signs of stress and arousal, colic, and difficult temperament.
Attachment Issues
As children get older and approach puberty, they may experience attachment issues and display poorer emotional, cognitive, and social skills. These children are also more likely to develop behavioral problems and mental health disorders.
Can Peripartum Depression Be Prevented?
If you are at risk for peripartum depression, there may be steps you can take to help prevent it. If you still develop peripartum depression despite taking preventative actions, rest assured that it is not your fault. You can help prevent it and minimize some of the symptoms, but there are no guarantees.
To help prevent depression during pregnancy, consider the following:
- Speak with your doctor or midwife about your risk so they can monitor your mood
- Practice good sleep hygiene and discuss any sleeping issues you have with your doctor
- Seek support from family, friends, or other mothers
- Practice self-care regularly through exercise, deep breathing, and relaxation
- Avoid taking on too many responsibilities at a time when you may feel more tired, sick, or overwhelmed
As much as you may try to lower your risk and prevent peripartum depression, it may still develop. If you have a mild case, you may be able to recover on your own by making some lifestyle changes and seeking support. However, if your peripartum depression is moderate to severe, does not go away within a few weeks, and is affecting your life in negative ways, then it may be time to seek help.
Also, if you are experiencing suicidal thoughts or thoughts of hurting yourself or your baby, you should seek help right away. Fortunately, there are many options available to treat peripartum depression.
How to Get Help for Peripartum Depression
If you think you may be suffering from peripartum depression, you can start by speaking with your OB-GYN or midwife. They will be able to assess you for signs of depression and guide you toward the next step. If you are already in therapy for depression, be sure to speak with your provider about how you are feeling. If they feel that they are not trained to treat peripartum depression, they can provide you with a referral to a professional who specializes in this area.
OB-GYNs Often Detect Signs of Peripartum Depression & Recommend Therapy
Choosing Therapy conducted a survey of 135 OB-GYNs on Sermo, a global data collecting platform of over 800,000 anonymous, verified physicians, about the mental health of their patients—they reported that about 11% of their patients present with peripartum or postpartum depression. Of those surveyed, 73% say that they’d ideally like the patients they recommend speak with a therapist have their first session within a week. However, the majority say that of the patients they recommend speak to a therapist, 30% or less actually make it to a first therapy session.
If you would like to get help for peripartum depression and are not already working with a mental health professional, you can contact your health insurance company and request a list of local providers. You can also conduct an online search of providers in your area. If you are interested in medication for your depression, then you will want to find a psychiatrist, psychiatric nurse practitioner, or in some states a psychologist that works with peripartum depression. If you are interested in talk therapy, then you will want to find a psychologist, social worker, counselor, or therapist.
When to Seek Treatment
If you are experiencing symptoms of peripartum depression, you may be wondering when might be the right time to seek treatment. Around 50 to 80% of women experience the baby blues, which can develop within the first few days after delivery and usually goes away within a few weeks on its own.8 Symptoms of the baby blues are mild and can include sadness, anxiety, irritability, and sleeping problems. If symptoms are moderate to severe and continue past the first few weeks postpartum, then this may be a sign that you are experiencing peripartum depression, rather than the baby blues.
For some women, taking actions on their own may be enough to recover from peripartum depression. However, other women may continue to experience the condition even after trying to overcome it on their own. In general, if your depression is moderate to severe and significantly impacting your life, you should seek help. If you are experiencing suicidal thoughts or thinking about hurting yourself or your baby, you should also get help right away. This may be a sign of severe depression or another perinatal disorder.
It is never too early to get help for peripartum depression. Not getting the proper treatment for peripartum depression can negatively impact your life and your baby. Whether you are experiencing one or several symptoms, you may benefit from many of the treatments available, like therapy, medication, and alternative approaches.
How Peripartum Depression Is Treated
There are several different treatment options available for peripartum depression. The type of treatment you choose may depend upon the severity of your symptoms and your personal feelings about these options. These treatments may be done on their own or combined with one another. If you are unsure which treatment might be right for you, you can discuss it further with your doctor or midwife.
Therapy
Several different types of psychotherapy, including cognitive behavioral therapy (CBT), interpersonal therapy (ITP), and supportive counseling are all effective treatments for peripartum depression.3 Therapy with pregnant and postpartum women may take place individually, in a group with several other women, or in couples therapy with the woman’s partner.
Medication
Women with moderate to severe peripartum depression may benefit from mental health medication, either alone or in combination with therapy. Selective serotonin reuptake inhibitors (SSRIs) are the most commonly prescribed antidepressant for postpartum women.8 If you are pregnant or breastfeeding, your provider will discuss the pros and cons of medication with you and help you find a medication that is safe.
Light Therapy
Light therapy is a safe alternative therapy that has shown some promise in helping improve depression symptoms in pregnant and postpartum women.3,9 During light therapy, a person spends time in front of a light box, which is a device that gives off an artificial form of light that resembles natural outdoor light.
Exercise
Exercise can be helpful in not only preventing peripartum depression, but also treating it. Approximately 30 minutes of exercise several days per week, when cleared by your doctor, can help reduce symptoms of depression during pregnancy and the postpartum period.9
Nutrition
Eating a diet or taking supplements that contain omega-3 fatty acids can help reduce depression symptoms in peripartum women.9 This type of fatty acid is found in certain fish, nuts and seeds, plant oils, and supplements. Pregnant women who would like to consume fish should first consult with their healthcare provider, since some fish contain high levels of mercury which can be harmful.
5 Tips for Peripartum Depression
Whether or not you choose to get treatment for peripartum depression, taking care of your mind and body can be helpful in recovering from this condition. If you are struggling with peripartum depression, you may be wondering what you should and should not do to help yourself recover:
1. Try to exercise at least three times a week
Exercise releases endorphins into your body, which can have mood boosting effects and help alleviate some symptoms of depression.9 Even 30 minutes of walking can provide significant benefits. Whether you are pregnant or postpartum, be sure to speak with your doctor before starting an exercise regimen.
2. Eat a healthy diet consisting of fruits, vegetables, protein, whole grain carbohydrates, and omega-3 fatty acids
While a healthy diet will not necessarily cure peripartum depression, eating well and getting adequate nutrition can help you feel better. If you are pregnant or breastfeeding, your body may require more calories to care for your growing baby and produce milk. If this is the case, be sure to turn to healthy foods, rather than processed snacks or sweets.
3. Seek breastfeeding support if you are struggling
Many new mothers are surprised to find that breastfeeding is more challenging than they expected. While breastfeeding can help protect against peripartum depression, experiencing problems with breastfeeding can contribute to depression.10 If you are having a hard time, seek out a lactation consultant or breastfeeding support group. You can ask your OB GYN, midwife, or child’s pediatrician for a list of local resources.
4. Don’t suffer alone
Staying connected with a support system, whether it be friends, family, or a support group, can help with peripartum depression.11 Make an effort to plan one social activity each week, like attending a mommy-and-me class or phoning a friend. If you feel like you do not have enough support, consider finding a local or online support group for pregnant or postpartum women.
5. Don’t try to do it all on your own
The stress of being pregnant or caring for a newborn can be physically exhausting and overwhelming. Now is not the time to take on new responsibilities and tasks. Instead, delegate what you can, like household chores and cooking. It’s important to know your limits and ask for help so you have time to focus on your own self-care and recovery.
