What is Maternal Depression?

New motherhood is full of new experiences, including not-so-great ones like pregnancy, acne, and hair loss. 

Pregnancy and giving birth can also affect your mental health — triggering anxiety and depressive disorders. If you’re having depression symptoms during pregnancy or in the year after giving birth, you could be dealing with maternal depression. 

Our guide will go over the basics of maternal depression, including causes, symptoms, and your treatment options.

Maternal depression refers to mood disorders affecting women throughout pregnancy and up to a year after giving birth. 

A Quick Word on Depression

Depression (or major depressive disorder) isn’t just feeling down or sad periodically — it’s a common and serious mood disorder that typically lasts for months and interferes with everyday life.

Depression is also different from a condition known as the “baby blues”. Baby blues are the mild changes in mood women experience after giving birth. Up to 75% of all new mothers have the baby blues after giving birth.

The symptoms of baby blues — which differ from major depression — include feelings of anxiety, worry, or unhappiness typically during the first few weeks or even days after delivery. Maternal depression lasts longer and feels more intense.

Let’s cover some of the different types of depressive disorders, including various types of maternal depression. 

Perinatal Depression

Perinatal depression (AKA peripartum depression) is depression that occurs during or after pregnancy.

Perinatal depression includes two subtypes of depression: prenatal depression (which occurs before giving birth) and postpartum depression (which occurs after giving birth).

Perinatal depression occurs during pregnancy or within the four weeks after giving birth, according to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5).

Maternal Postpartum Depression

Postpartum depression is depression that occurs after giving birth and up to a year after 

Similar to other depressive disorders, postpartum depression can disrupt your day-to-day life in many ways. 

Postpartum depression can affect your relationships and physical and mental health. It can also impact your child’s health in the following ways:

• It can interfere with newborn care and bonding 

• It can slow child development

• It can lead to behavioral problems

A report from the Centers for Disease Control and Prevention (CDC) found that around one in eight women experiences symptoms of postpartum depression.

Mothers can also experience anxiety disorders while pregnant or after delivery.

“Anxiety and depression often go together, with anxiety causing agitation and stress while depression makes it hard to cope. The two conditions feed into each other, creating a cycle where excessive worry leads to exhaustion, and low mood ramps up fears,” says Dr. Daniel Lieberman, the senior vice president of mental health at Hims & Hers and clinical professor of psychiatry and behavioral sciences at George Washington University.

Researchers estimate that 6.1% to 27.9% of women experience anxiety in the first six months after giving birth.

Postpartum Psychosis

Postpartum psychosis is a rare but severe form of maternal depression. When someone experiences psychosis, they can develop delusions (believing things that are obviously untrue), hallucinations (hearing voices), or both. It’s a frightening experience. And it affects between 1 and 2 out of 1,000 new mothers.

Postpartum psychosis typically develops within days or up to six weeks after delivery. 

Although rare, it’s a serious psychiatric emergency that requires immediate medical attention.

Many factors can play a role in maternal depression, from hormones to past trauma. 

Hormones

Your hormone levels go through major changes during pregnancy and birth. 

The female hormones estrogen and progesterone are at their highest levels ever when you’re pregnant. After delivery, hormones quickly drop back to pre-pregnancy levels. This drastic shift can sometimes lead to postpartum depression.

Genetics

Genetics may play a role in whether a new mother develops maternal depression. If you have a family history of depression or maternal depression, you may have a higher risk of developing it yourself.

Serotonin, dopamine, and norepinephrine all play a role in depression. Variations in genes that affect the production of these neurotransmitters may impact their levels or activity, increasing depression risk.

The results of a 2023 meta-analysis published in the American Journal of Psychiatry suggest that multiple, heritable genes contribute to postpartum depression.

Mental Health

Having a history of the following mental health conditions could also affect whether you develop maternal depression:

• Depression

• Anxiety

• Previous maternal depression 

• Premenstrual dysphoric disorder (PMDD)

Past trauma due to sexual or domestic abuse or negative life events can also elevate your risk of maternal depression. 

You’re also at higher risk of developing postpartum psychosis if you have a history of bipolar disorder or other psychiatric disorders. 

Lifestyle Conditions

Researchers have found that the following factors may also influence maternal depression risk:

• Complications during pregnancy and childbirth

• Having unplanned pregnancy

• Low levels of support from a partner, family members, or friends

• High stress levels 

• Intense worry about raising a child or childcare

• Concerns about money or a low income

• Experiencing domestic abuse

Many symptoms of maternal depression are similar to the symptoms of major depressive disorder. 

Symptoms of depression can include:

• Constant sad or empty mood

• Feeling hopeless

• Irritability

• Loss of interest in typical activities

• Fatigue or decreased energy

• Difficulty focusing or concentrating

• Trouble sleeping

• Thoughts of death or suicide

Symptoms of postpartum depression may also include:

• Crying more often

• Isolating from loved ones

• Feeling like you’re not connecting with your baby

• Feeling overly anxious

• Thinking about hurting yourself or the baby

Unwanted, intrusive thoughts of wanting to harm your baby can be extremely frightening, but they’re quite common, affecting about half of all new mothers. The good news is these thoughts are not associated with an increased risk of actual harm. 

If you’re experiencing peripartum depression, you may also notice appetite changes.

Postpartum psychosis can cause symptoms like:

• Extreme confusion

• Rapid mood swings

• Paranoia

• Hallucinations

• Restlessness

• Trying to hurt yourself or the baby

Maternal depression can be overwhelming. Fortunately, there are ways to find help and relief.

It’s not uncommon to experience mood changes after giving birth. But if your feelings and symptoms last longer than two weeks, consider talking with a healthcare provider. They can screen you for maternal depression. 

One of the most common and effective maternal depression screening tests is the Edinburgh Postnatal Depression Scale (EPDS). 

Once a healthcare provider confirms a maternal depression diagnosis, they can recommend a treatment plan tailored to your needs.

Therapy

Psychotherapy or talk therapy is a research-backed treatment for postpartum depression and other mood disorders.

Evidence-based therapies for maternal depression include:

• Cognitive behavioral therapy (CBT)

• Interpersonal therapy (IPT)

CBT can help new or expecting mothers identify negative thought patterns affecting their well-being and learn to replace them. 

IPT helps mothers deal with all the changes motherhood brings, improve communication, and strengthen social support. 

Medication

Antidepressant medications are another treatment option for maternal depression. 

Selective serotonin reuptake inhibitors (SSRIs) are a first-line treatment for depression. But some might not be safe for people who are pregnant or breastfeeding. This is because some SSRIs come with a risk of birth defects. In general, though, most doctors recommend using these medications if clinical depression is present. In most cases, treating the depression leads to an overall decrease in risk for both the baby and the mother.

According to a 2016 review, SSRIs like citalopram (Celexa®), escitalopram (Lexapro®), and sertraline (Zoloft®) are the safest SSRIs to use during pregnancy.

SSRIs like paroxetine (Paxil®) and sertraline (Zoloft®) are the best options for people who are breastfeeding because they’re unlikely to pass through breastmilk. Paroxetine, however, should usually be avoided during pregnancy.

The Food and Drug Administration (FDA) has also approved two medications specifically for postpartum depression.

• Zuranolone (Zurzuvae®) is the first oral medication approved to treat postpartum depression.

• Brexanolone (Zulresso®) is an IV injection that treats severe postpartum depression.

If you’re pregnant or breastfeeding it’s important to have an open conversation with your healthcare provider to discuss the risks and benefits of taking antidepressant medication.

Your body goes through a lot during pregnancy and after delivery. And it can take a toll on your mental health.

Having worries or doubts when you’re a new parent is normal. But when those feelings of worry, fear, or sadness are persistent and extreme, you might be experiencing maternal depression.

Let’s recap what we know about maternal depression:

• It’s an umbrella term for different types of pregnancy-related conditions. It can happen during pregnancy or in the year after giving birth. 

• It can cause symptoms similar to depression. And it can impact your ability to bond with your baby — and care for yourself.

• It’s treatable. If you think you’re dealing with maternal depression, help is available. 

Not sure where to start? Consider bringing up your symptoms with your primary care provider. They can guide you through your treatment options and, if appropriate, give you a referral to a mental health professional.  

We can also connect you with a mental health professional for a virtual assessment.

Looking for more info? Check out our postpartum resources.