What Is Perinatal Depression?

Perinatal depression is often described as depression that occurs during pregnancy or the first year after childbirth. Contributing factors include hormonal shifts, increased stress, physical and environmental changes, as well as other factors.

Pregnancy is often described as a beautiful time of life. However, that's just not true for everyone. Sometimes, the inability to meet the unrealistic expectations of a totally joyous pregnancy can even contribute to symptoms of depression.

Definition of Perinatal Depression

The current Diagnostic and Statistic Manual of Mental Disorders (DSM-5) defines perinatal depression as a major depressive episode that occurs during pregnancy or in the four weeks following delivery.

Depression during pregnancy is described as prenatal depression and depression in the year after giving birth is described as postnatal depression or postpartum depression. Perinatal depression encompasses both pre and postnatal depression.

Perinatal depression is not uncommon. Historically, pregnancy was considered to be protective against mood disorders. However, recent research shows that this is false.

Symptoms

There are many symptoms of perinatal depression, but not everyone will experience exactly the same effects.

Symptoms of perinatal depression can include:

• Irritability
• Feeling sad, empty, hopeless, guilty, or worthless
• Significant fatigue or increase in tiredness
• Difficulty with concentration, memory, or decision-making
• Changes in sleep pattern
• Loss of interest in activities you previously enjoyed
• Trouble bonding with baby, or lack of interest in baby
• Persistent doubts about caregiving abilities

It is normal to have feelings of anxiety, doubt, or fatigue when experiencing the huge changes of pregnancy or caring for a newborn.

"Baby blues," a milder form of depression, affects 50 to 80% of women in the first few days after delivery. If your symptoms persist for a few weeks or impair your daily functioning, it could be more serious—and you should talk to your healthcare provider.

Identifying

It can be difficult to identify perinatal depression because some of the symptoms of depression can overlap with the effects of a normal pregnancy. Overlapping symptoms include fatigue, weight gain, or altered sleeping pattern.

Screening and specific assessment for perinatal depression symptoms can help identify the condition.

The American College of Obstetricians and Gynecologists (ACOG) advises that obstetric care providers screen people who are pregnant for perinatal depression at least once during pregnancy, using a standardized and validated tool.

• The Edinburgh Postnatal Depression Scale (EPDS) is the most common screening tool used during the perinatal period. It includes questions about how the person felt during the previous seven days.
• ACOG also advises physicians to perform a full assessment of mood and emotional wellbeing during the comprehensive postpartum visit. This can identify perinatal depression, along with milder forms of depression (the "baby blues") and more severe issues, including postpartum psychosis.

Causes

Nearly 20% of women experience perinatal depressive symptoms. Pregnancy involves physical changes that can be uncomfortable, such as fatigue and nausea.

The prospect of caring for a newborn, as well as the financial or environmental stressors that accompany this responsibility, can be overwhelming. All of these factors can contribute to perinatal depression.

In addition to physical changes and life stressors, some research indicates that perinatal depression is caused by hormonal shifts—particularly the interplay between estrogen, progesterone, and the hypothalamic–pituitary–adrenal axis.

Genetics and epigenetics are also believed to contribute to perinatal depression. There is also a theory that increased inflammation during and after pregnancy can cause perinatal depression, but more research is needed to determine the impact of inflammation on this condition.

Treatment

There are a variety of treatment options for perinatal depression. Most people do feel better with treatment, and it is important to seek treatment for the health of both the parent and baby.

Psychotherapy

Psychotherapy can be very effective at treating various types of mild to moderate depression, including perinatal depression. In particular, cognitive-behavioral therapy (CBT) and interpersonal psychotherapy (IPT) have been studied as methods of perinatal depression treatment.

• CBT involves becoming aware of your thought patterns and positively changing your behavior. It is used to treat depression and anxiety and can be done individually or in groups.
• IPT approaches depression treatment through acknowledgment of the impact of changes in social roles, life events, and relationships on one's mood.

Medication

Antidepressant medication, such as selective serotonin reuptake inhibitors (SSRIs) and selective serotonin-norepinephrine reuptake inhibitors (SNRIs), can be prescribed during pregnancy. In fact, about 13% of women take an antidepressant during pregnancy.

These medications take about six to eight weeks to have their full effect and can help balance chemicals in the brain and improve depressive symptoms. They are often used in conjunction with psychotherapy and lifestyle changes.

Coping

It's important that you know that you are far from alone if pregnancy is not the happiest time of your life. Your body, hormones, social roles, and much more are in flux—so it is natural for your mental health to be impacted.

If you are experiencing perinatal depression, there are several things you can do to cope.

These include:

• Reach out for help from your support network.
• Join a support group for expecting or new parents.
• Schedule time to rest.
• Eat regular, frequent, and healthy meals.
• Exercise regularly, including pre or postnatal yoga, or aquatic exercise.
• Explore complementary therapies, including S-Adenosyl-methionine (SAMe) supplements, light therapy, massage, and acupuncture, but always in conversation with your healthcare provider.

A Word From Verywell

Depression before or after giving birth is a difficult thing to go through, but you are not alone in this experience. This can be a stressful time, but remember that it is important to care for yourself, as well as your baby.

Perinatal depression is treatable through medication, psychotherapy, complementary therapies, and lifestyle changes. If your depressive symptoms are getting in the way of your daily life, or you've lost interest in activities you used to love, speak to your healthcare provider about diagnosis and treatment.