Perinatal depression, or major depressive disorder with perinatal onset, is depression that begins in the period from conception to after pregnancy. Treatment options can help reduce symptoms.

Perinatal depression refers to depression that occurs during and after pregnancy. Symptoms can range in severity.

Discussions tend to focus on postpartum depression, or depression that occurs after childbirth. This can make it easy to overlook the combination of biological and emotional factors that can lead to anxiety and depression in pregnant people.

The prevalence of postpartum depression is 17% among pregnant people. About 20% to 40% of pregnant people develop prenatal depression, according to a 2021 review of literature.

The same review notes that 7.4% of pregnant people may experience depression during the first trimester, and 12% to 12.8% may experience depression during the second and third trimesters.

Keep reading to learn more about the symptoms and treatment options for perinatal depression.

Symptoms of prenatal depression

Many pregnancies can include symptoms associated with depression. For instance, with both conditions, you’re likely to be tired, have some insomnia, experience emotional changes, and gain weight. Because of this, pregnancy can easily hide symptoms of depression.

To help you recognize symptoms of depression during pregnancy, it’s worth talking with a doctor. Symptoms can include:

frequent crying or weepiness
trouble sleeping (when not caused by frequent urination)
fatigue or low energy
changes in appetite
loss of enjoyment in once pleasurable activities
increased anxiety
trouble feeling connected to your developing baby (called poor fetal attachment)

If you had depression before pregnancy, your symptoms may be more significant during it than they were before. People with a history of depression may be more likely to experience a recurrence during pregnancy.

Symptoms of the “baby blues”

During pregnancy, your levels of estrogen and progesterone rise dramatically. They’re needed to help your uterus expand and to sustain the placenta. These hormones are also associated with mood.

Within 48 hours of your baby’s arrival, the levels of both hormones plummet drastically. Many researchers believe this postpartum hormonal crash causes what is known as the “baby blues.”

For about 1 or 2 weeks after you give birth, you may have symptoms of the baby blues. In many parents, symptoms go away after that. Until then, you may feel especially:

irritable
anxious
frustrated
overwhelmed
likely to have rapid mood changes (elation one moment, weeping the next)
exhausted
sleepy, like you want to sleep all the time (hypersomnia)
unable to sleep (insomnia)

Symptoms of postpartum depression

The same plunge of estrogen and progesterone after delivering a baby may make some people more susceptible to postpartum, or postnatal, depression.

Postpartum depression affects 1 in 9 women who give birth. But there’s little research on how perinatal and postpartum depression affects transgender and gender nonconforming parents who give birth.

One difference between the baby blues and postpartum depression is the duration. Symptoms of postpartum depression last for more than 2 weeks after giving birth. They can include:

feeling overwhelmed
intense anxiety
weeping or crying all the time
irritability or anger
feeling sad all the time
extremely tiredness and lack of energy
having feelings of worthlessness, hopelessness, or guilt
wanting to sleep or eat more or less than you usually do
being unable to concentrate or forgetful
intense worry about your baby
being uninterested in your newborn or doing things you used to enjoy
experiencing headaches

Symptoms of postpartum psychosis

Some people may experience a more severe form of postpartum depression called postpartum psychosis. It’s an extremely rare condition that may affect between around 1 to 2 in 1,000 people assigned female at birth.

Common symptoms of postpartum psychosis can include:

either auditory or visual hallucinations
delusions, which is believing something that isn’t true
suicidal thoughts
thoughts about harming your baby

Postpartum psychosis is an extremely serious condition. It requires immediate emergency care. A mother may be hospitalized for her own safety as well as her baby’s.

Treatment

Treatment for perinatal depression can help you feel better. Treatment options can vary based on your needs and symptoms. Some medications may not be safe for people who are pregnant or breastfeeding.

If you notice symptoms of depression during or after your pregnancy, talk with a doctor about all of your treatment options. You and a doctor can work together to make an informed decision about a treatment that’s best for you and your baby.

Talk therapy

Talk therapy has proven to be effective for perinatal depression. Options can include cognitive behavioral therapy and interpersonal therapy.

Medications

Antidepressant drugs are a common treatment for perinatal depression. Doctors typically prescribe selective serotonin reuptake inhibitors (SSRIs). You and a doctor may talk about taking an antidepressant while you’re pregnant, after your child’s born, or both.

Talk with a doctor about any risks that concern you. Some parents may opt for other treatments instead of antidepressants.

Note that prolonged depression may be more harmful to a parent and their child than the side effects of any treatment or medication. Early assessment and care can have real benefits.

Alternative therapies

A few alternative treatments, including massage and acupuncture, may also help parents with perinatal depression when used alongside medical treatment. These therapies may help reduce symptoms. For acupuncture, a specialist inserts small needles at specific parts of the body.

If you’re experiencing perinatal depression, consider seeking medical care, since alternative therapies alone may not reduce your symptoms.

Lifestyle changes may also help reduce symptoms, in addition to prescribed treatment. These can include:

eating a wide variety of nutritious food
getting regular exercise
practicing meditation
getting 7 to 8 hours of sleep each night
spending time engaging in supportive relationships
managing stress

Frequently asked questions

The following includes frequently asked questions about perinatal depression.

What is perinatal distress?

Perinatal distress is a general term used to refer to any depression, anxiety, or other emotional difficulties a parent encounters from conception through the first year of their child’s life. Perinatal depression and postpartum depression are both forms of perinatal distress.

What is major depression with perinatal onset?

Pregnancy-related depression can be complex. Some guidelines suggest that postpartum depression can be more accurately described by a diagnosis of major depressive disorder. The term “perinatal onset” refers to when symptoms begin, a window that lasts from conception until 4 weeks after delivery.

What are the effects of perinatal depression on the infant?

The stress of perinatal depression, particularly if it isn’t treated correctly, may influence the development of a baby’s developing brain. This may result in developmental delays and other challenges.

Being open with a doctor about any emotional challenges that arise during pregnancy is an important way to lower any risks for your infant.

Takeaway

Perinatal depression includes depression that begins during and in the weeks after pregnancy. Hormone changes during this time may contribute to depression.

Treatment can help reduce symptoms or make them go away completely. It can involve talk therapy, medication, and other therapies.

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Dubovicky M, et al. (2020). Risks of using SSRI / SNRI antidepressants during pregnancy and lactation. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6096863/
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