Peripartum Depression: Symptoms, Causes and Treatments

There are many, many things to expect when you’re expecting. From pregnancy acne to experiencing a wide variety of emotions and so much more, pregnancy delivers a lot.

But while a bundle of emotions may be expected along with your new bundle of joy, what you may not be expecting is peripartum depression.

Peripartum depression — a type of depression that affects pregnant women and new mothers — can certainly affect a woman’s mental and emotional health, as well as their relationship with their newborn babies.

While many women experience the “baby blues” — a short-lasting condition that doesn’t interfere with daily life — an estimated 10 to 20 percent of women in the U.S. will experience peripartum depression.

Peripartum depression is a serious mood disorder, and symptoms can be similar to those of postpartum depression and other depressive disorders, although with a few differences.

We’ll cover the causes and symptoms of peripartum depression, as well as treatment options.

Peripartum onset depression is a kind of depression that affects women during or after pregnancy.

Perinatal refers to the time before and after childbirth and recognizes that depression associated with having a baby can start during pregnancy.

You’ve likely heard of postpartum depression, and may be wondering what the differences are. The main difference between peripartum depression, also referred to as perinatal depression, and postpartum depression is when you first experience a major depressive episode.

The Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) classifies peripartum depression as a major depression that occurs while pregnant or within four weeks after giving birth. Postpartum depression, however, refers to major depression that starts within the first four weeks after delivery.

However, some evidence suggests that peripartum depression and postpartum depression can even start within a year after giving birth. 

A review of postpartum depression has found that 50 percent of major depressive disorder episodes begin before delivery, which means they can be classified as peripartum depression.

Peripartum depression is different from the “baby blues,” a condition commonly experienced by new mothers that causes mild mood changes and feeling exhausted, unhappy or more worried than usual.

The “baby blues” typically lasts an average of 10 days, while peripartum depression is a kind of severe depression with mood changes lasting more than two weeks.

Fathers of newborns can also experience perinatal depression, with an estimated four percent of fathers experiencing depression in the first year after childbirth.

Peripartum onset depression and postpartum depression have many similar symptoms.

Pregnant women or new mothers experiencing peripartum depression typically experience feelings of extreme sadness, fatigue and anxiety that may make it difficult for them to carry out daily tasks, such as caring for themselves or others.

Other symptoms of peripartum depression can include:

• Loss of interest or pleasure in activities

• Feeling worthless or guilty

• Appetite changes

• Trouble sleeping or sleeping too much

• Increased fatigue or loss of energy

• Difficulty thinking, concentrating or making decisions

• Crying for “no reason”

• Lack of interest in the baby, not feeling bonded to the baby or feeling very anxious about/around the baby

• Feelings of being a bad mother

• Thoughts of death or suicide 

• Fear of harming yourself or the baby

Many women with peripartum depression also experience symptoms of anxiety — one study found that nearly two-thirds of women with peripartum depression also had anxiety disorders.

Some women may experience a few symptoms of peripartum depression, while others experience many. New mothers may also feel ashamed or guilty if they’re feeling any of these symptoms when they believe they should be happy.

If you are experiencing any of these symptoms during pregnancy or for more than two weeks after giving birth, a healthcare provider can help determine if you have peripartum onset depression or something else. Please remember that these feelings are nothing to be ashamed of, and getting help is important.

Any pregnant woman or new mother can experience perinatal depression or other mood disorders. It is a mental illness, and is not brought on by anything a new mother has or hasn’t done. It can affect any woman regardless of age, ethnicity, culture or education.

Peripartum onset depression doesn’t have one single cause. Research suggests this depressive disorder could be brought on by a combination of genetics and environmental factors.

Hormonal Changes

Pregnancy and childbirth bring on a drastic change in hormone levels.

During pregnancy, your levels of estrogen and progesterone are the highest they’ll ever be. After childbirth, they quickly drop back to normal, pre-pregnancy levels. This hormonal change is similar to the way hormones change during the menstrual cycle, but with a more drastic swing.

Researchers believe this drastic change in hormone levels can lead to depression.

Thyroid hormone levels may also drop after delivery, causing symptoms of peripartum depression. Your healthcare provider can do a blood test to see whether a drop in your thyroid hormone levels is causing peripartum onset depression symptoms.

History of Mental Disorders

If you have a mental health condition or have experienced one in the past — especially major depressive disorder, bipolar disorders or anxiety disorders — you may have an increased risk of developing perinatal depression.

A family history of depression or perinatal disorders can also make you more likely to experience peripartum onset depression.

Genetics

Depending on her genetics, a woman may be more prone to developing peripartum depression.

Serotonin, dopamine and norepinephrine are known to regulate mood and happiness, and a deficiency of these chemicals can increase one’s risk of depression.

Although more research is required, certain genes may prevent the activities of these neurotransmitters and be connected to peripartum depression.

Lifestyle

Lifestyle factors that may increase the risk of peripartum depression include smoking during pregnancy, unintended pregnancies, doing very minimal physical activity and poor eating and sleeping habits. Births that require hospitalizations or emergency surgery and premature births may also increase the risk of peripartum depression. 

Untreated perinatal depression affects both the health of the mother and the newborn baby.

A review found that this depressive disorder can lead to premature birth, cause bonding issues with the baby and contribute to sleeping and feeding problems.

Peripartum depression can also put the newborn at a greater risk for cognitive, emotional, verbal and development deficits and impaired social skills over the long-term.

Untreated peripartum depression can also cause postpartum psychosis, a rare but severe form of major depression, or the recurrence of a primary psychotic disorder, such as schizophrenia. Symptoms of postpartum psychosis are similar to bipolar disorder and include:

• Feeling restless

• Being especially irritable

• Auditory or visual hallucinations

• Delusional beliefs related to the baby (like that others are trying to hurt the baby)

• Erratic and unusual behavior

• Rapidly changing moods

Postpartum psychosis is rare and estimated to occur in only one to two out of 1,000 women after childbirth. However, if these symptoms occur it is vital that you seek medical help immediately.

Any woman can have peripartum depression. If you are experiencing depressive symptoms or have been in a severely depressed mood for more than two weeks, you should seek advice from a healthcare professional.

Your provider may also ask you about your mood. In early 2016, the U.S. Preventive Services Task Force updated its recommendation for depression screening in adults to include screening for depression in pregnant and postpartum women. It’s important to answer any screening questions fully and honestly so you can get any support you need.

If you’re experiencing any of the symptoms of perinatal depression and have talked to a healthcare provider for a diagnosis, there are several treatment options.

Therapy

Counseling and therapy are often the first recommendations for treating peripartum depression. Working with a therapist, expectant or new mothers can work to better understand the peripartum diagnosis and develop strategies to decrease the severity of symptoms.

Different types of therapy exist, but two in particular have been studied to treat peripartum depression:

• Cognitive-behavioral therapy (CBT): Cognitive behavior therapy emphasizes the link between thoughts and feelings. You work to identify and reframe negative thinking patterns and build positive thought patterns instead. 

• Interpersonal therapy: This type of therapy focuses on treating interpersonal issues that may contribute to the development of depression, with the goal of improving your relationships with other people. Interpersonal therapy was shown to be successful in treating peripartum depression in a randomized, controlled trial.

Another type of therapy known as electroconvulsive therapy can be used in extreme cases to treat postpartum or peripartum depression. However, there is very limited research behind using electroconvulsive therapy as a treatment option.

You can learn more about your mental health and find a therapist who is right for you with online consultations.

Medication

Since peripartum onset depression is a kind of depression, medications typically used for depression are another treatment option.

Antidepressant medications often help decrease the severity of depression symptoms by increasing levels of serotonin, norepinephrine and dopamine in the brain.

Some antidepressants that may be prescribed to pregnant women include:

• Selective serotonin reuptake inhibitors (SSRIs) like sertraline, citalopram (Celexa®), escitalopram (Lexapro®) and fluoxetine (Prozac®)

• Serotonin-norepinephrine reuptake inhibitors (SNRIs)

• Bupropion (Wellbutrin)

• Tricyclic antidepressants (TCAs)

However, there is limited research on the risks versus the benefits of antidepressant use during pregnancy, as well as use in women who breastfeed.

A healthcare provider can help decide if antidepressants are the right treatment option if you are pregnant or a new mother and experiencing perinatal depression symptoms.

Acupuncture

Early research has shown that alternative treatments such as acupuncture can help manage depression symptoms in pregnant women.

For most women, expecting a new baby can bring a lot of emotions, from joy to sadness to anxiety. But for women with peripartum depression, it can be a distressing and difficult time.

Different from the oft-experienced “baby blues” (which typically last around a few weeks), peripartum onset depression is a kind of depression that lasts for more than two weeks.

Perinatal depression encompasses depression developed during pregnancy and depression that can occur after delivery, otherwise known as postpartum depression.

Many of the symptoms of peripartum depression are similar to the symptoms of postpartum depression, including irritability, fatigue, loss of interest in activities and a severely depressed mood.

Several safe and effective treatment methods are available to manage this condition, with psychotherapy and medication at the forefront. If you are experiencing peripartum depression symptoms, you should speak with a healthcare professional for a plan of treatment.