Perinatal Depression

Catherine Monk, PhD, with patient

At this time, the Women's Mental Health initiative is only accepting patients referred by providers in the Department of Obstetrics and Gynecology at NewYork-Presbyterian/Columbia University Irving Medical Center.

What is perinatal depression?

The word “perinatal” refers to the time before and after the birth of a child. Perinatal depression is a mood disorder that can impact people during and after pregnancy. Perinatal depression includes both prenatal depression, which occurs during pregnancy, and postpartum depression, which occurs after the baby is born.

Prenatal depression often is believed to be less common than postpartum depression, yet prenatal depression is just as common as postnatal depression, about 10-15% experience it during pregnancy and during the postpartum period. Prenatal depression can be difficult to recognize, as many of the symptoms of depression like fatigue, changes in appetite or sleeping habits, and mood swings can be common during pregnancy. However, prenatal depression can be differentiated from these common symptoms, for example by feelings of guilt and worthlessness that someone may have, and by an ongoing down mood that last for at least two weeks.

Postpartum depression is often confused with what is called the “baby blues,” a relatively minor and short-term condition. In the immediate postpartum period, many people who have been pregnant get the “baby blues” and feel sad or empty for a few days. This is a normal response to the many changes the body experiences during pregnancy and after giving birth, and to the huge psychological transition of now being a parent of a baby who is with you. For many people, these feelings resolve in less than a week.

When these feelings of sadness, hopelessness, tiredness, or emptiness continue for two weeks, a person may be experiencing postpartum depression. Like prenatal depression, postpartum depression is a medical condition that can cause a serious interruption in day-to-day-life, and make it difficult or impossible to care for or connect with the new baby, or even to care for oneself.

What causes perinatal depression?

During pregnancy and after giving birth, the body and mind go through many changes. Perinatal depression may be the consequence of many different factors:

  • Hormonal changes experienced during pregnancy and after giving birth. Pregnant people have extremely high levels of estrogen and progesterone, and within 24 hours after childbirth, these hormones drop back to pre-pregnancy levels. Levels of thyroid hormones may also drop after giving birth. These changes in hormones can affect the mood of the person who has given birth.
  • History of depression: People who have a history of depression are at higher risk for experiencing perinatal depression. People who have previously experienced perinatal depression during or after one pregnancy may have it again if they have another baby.
  • Lack of sleep: Poor sleep during pregnancy and after giving birth also is a risk factor for depression  
  • Adjusting to the demands of caring for a new baby, or anticipating doing so, as well as the many changes in one’s life in relationships, in balancing work demands, can lead to added stress and function as a risk for depression
  • Other emotional factors: Many new parents say they struggle with a variety of difficult or painful emotions after giving birth, like feeling overwhelmed, having doubts about their abilities as a parent, feeling stressed by changes in routine, and even grief over the loss of who they were and their life prior to having the baby.

What are the symptoms of perinatal depression?

Perinatal depression can manifest in very different ways from one person to another. Some of the symptoms of perinatal depression can include, but are not limited to:

  • Feeling depressed regularly
  • Sense of worthlessness, guilt, or hopelessness
  • Feeling panicked or scared a lot of the time
  • Having severe mood swings
  • Loss of interest in everyday activities or activities that used to be enjoyable
  • Fatigue or loss of energy
  • Changes in diet, like eating much more or much less than is normal for that person
  • Changes in sleep patterns, like having trouble sleeping or sleeping too much
  • Having trouble bonding with the baby
  • Thinking about self-harming or hurting the baby
  • Thinking about suicide or wishing to escape

How is perinatal depression diagnosed?

Anyone who believes that they may be experiencing perinatal depression should contact their Ob/Gyn, primary care provider, or mental health care provider as soon as possible. In diagnosing perinatal depression, a health care provider will want to hear about the patient’s thoughts, feelings, experiences, and the overall state of their mental health. This will help the provider distinguish between a short-term case of “baby blues” and perinatal depression.

During an evaluation for perinatal depression, a health care provider may do a depression screening, including filling out a questionnaire.

How is perinatal depression treated?

Common treatment options for postpartum depression include:

  • Individual counseling or therapy
  • Support groups for patients struggling with postpartum depression
  • Medicine, including antidepressants and hormone treatments.

Importantly, with treatment, the majority of people with perinatal depression recover and feel back to themselves.