Depression and pregnancy: know the signs to get the help you need

Postpartum depression (PPD) is a form of depression that occurs after childbirth. Celebrities such as Gwyneth Paltrow, Serena Williams, and Adele have spoken candidly about feeling sad, helpless, and even zombie-like after giving birth.

But for some people, serious bouts of depression and related symptoms can begin before delivery of a baby, in what is known as prenatal depression. This is why guidelines from the United States Preventive Services Task Force (USPSTF) make it clear that healthcare providers (HCPs) should be screening for depression both during pregnancy and in the postpartum period. (Prenatal depression and postpartum depression fall under the term perinatal depression, which describes depression that occurs during pregnancy or after childbirth.)

“Fewer than 20 percent of people with perinatal depression self-report their symptoms,” says Sz-Min Harley, MD, an OBGYN in Aurora, Colorado. “So this routine screening helps to catch the people who may fall through the cracks [whose symptoms could be missed but who may benefit from treatment].”

Here’s what you need to know about pregnancy and depression.

Maternity and mental health

As many as 1 in 8 people who are pregnant may experience postpartum depression. Even those who don’t fit the criteria for clinical depression may feel symptoms of depression. It’s estimated that up to 85 percent of people who have given birth will experience some type of negative mood in the postpartum period.

Experts believe pregnancy-related mental health issues are connected to the rapid shifts in hormones that occur during and after pregnancy. Estrogen and progesterone levels can change quickly, leading to potentially severe mood changes.

And while anyone can experience depression during this time, Dr. Harley points out that people with a history of psychiatric disorders—including previous postpartum depression, major depression, bipolar disorder, anxiety, or schizophrenia—are at higher risk.

Recognizing the signs of depression

The arrival of a baby can bring about changes in your lifestyle, relationships, and sleep patterns. Some people experience a range of emotions—from relief and joy to sadness and anxiety—during pregnancy and after childbirth. Many health professionals think of maternal mental health on a continuum, from “baby blues,” to postpartum depression, to a more severe condition known as postpartum psychosis.

Baby blues

The baby blues typically occur in the first few days up to a month after childbirth. Signs may include feeling angry at your partner, crying for no reason, bouts of anxiety, worrying about being able to care for the newborn, and generally feeling sad, empty, and tired. The baby blues can come and go, but usually get better within a couple of weeks.

Postpartum depression

According to Harley, it can be difficult to tell the difference between the baby blues and postpartum depression. Generally speaking, if symptoms don’t go away within a few weeks or if they get worse, it may indicate postpartum depression. Speak to your HCP if you’re experiencing the following:

• Feelings of anger
• Withdrawal from friends, family, and your baby
• Feeling numb or disconnected from your baby
• Fear that you could hurt your baby
• Worrying about your ability to take care of your baby
• Feelings of apathy about being a parent
• Persistent difficulties with recalling details or making decisions
• Overeating or loss of appetite
• Aches and pains that don’t go away
• Thoughts of hurting yourself or suicide

Postpartum psychosis

Postpartum psychosis is much less common than baby blues or postpartum depression. It affects only 1 or 2 out of every 1,000 people who give birth. It can arrive dramatically and quickly, often within the first 72 hours of giving birth and up to six weeks after birth. Symptoms may be similar to episodes of bipolar disorder and they tend to escalate within the first two weeks. Although the condition is rare, it’s important to be aware of the signs, which include:

• Restlessness, insomnia, and irritability soon after giving birth
• Manic episodes of high energy and rapid, muddled thinking that interfere with your ability to sleep, followed by periods of total exhaustion
• Hallucinations or delusions (seeing and hearing things that aren’t there)
• Feelings of suspicion or paranoia (which may include thinking that someone is trying to harm your baby)
• Confusion
• Changes in appetite
• Loss of touch with reality
• Disorganized and erratic thoughts or behaviors
• Noticeable change in functioning
• Suicidal or homicidal ideation

If you’re concerned about any of these symptoms or their potential impact on your child, it’s important to speak to your HCP or a mental health professional right away. That way you can be screened and provided with the necessary level of care, says Harley. If you are having thoughts of suicide or harming your baby, call, text, or chat the Suicide and Crisis Lifeline at 988. If you feel that you or your baby is in immediate danger, call 911 right away.

“You should seek professional help if you’re having persistent or extreme anxiety or guilt, insomnia, feelings of hopelessness, loss of pleasure in doing fun activities more days than not, or any thoughts at all of hurting yourself or your baby,” Harley says.

How depression affects bonding with your child

“Parents with untreated depression have a harder time bonding with their children,” says Harley. “They also perform less self-care and have a more difficult time meeting the needs of their newborn. They have a lower threshold for stress, which increases their risk of harming the child.” In extreme cases, it can also lead to suicide.

Get the help you need

Everyone has a different journey during pregnancy and beyond and your emotions are valid no matter what they are. Depression isn’t a weakness and it can get better. There is no shame in seeking help and doing what you need to do to feel healthy, both mentally and physically, so you can care for yourself and your child. Here are important steps you can take:

Practice self-care

It takes time to heal physically after giving birth and to adjust to your new schedules and routines. It may be a while before you start feeling like yourself again. Be sure to take care of yourself by nourishing your body with a healthy diet and getting outside for fresh air and exercise.

Reach out

Talk to close friends and family about how you’re feeling or express those feelings in a journal.

Ask for help

Particularly in the first few months of parenthood, call on friends or family to watch the baby for an hour or to do your grocery shopping when you’re overwhelmed. It can make a huge difference and give you a much-needed break.

Seek treatment

If your symptoms are putting you or your baby at risk or affecting your ability to care for yourself and your child, talk to your HCP or a mental health professional immediately about treatment for postpartum depression and postpartum psychosis. Treatment for postpartum depression may include talk therapy or medications, including certain types of antidepressants called selective serotonin reuptake inhibitors (SSRIs).

Another medication an HCP might suggest is brexanolone, which is given by intravenous (IV) infusion directly into a vein over the course of 60 hours (or 2.5 days). You must receive this medicine at a special treatment center where you can be observed by an HCP for any side effects that may crop up. Zuranolone, the first oral medication approved to treat PPD, may be another option.

If you are in distress, call, text, or chat the 988 Suicide & Crisis Lifeline for round-the-clock support.