Knowledge is Power: What to know about Perinatal Mental Health

By Katie Sardone, PhD

You’ve probably heard a variety of things about “postpartum depression” through the media, some true, some maybe not true. Maybe you’ve had friends or family members who have experienced it, maybe they called it postpartum anxiety or the baby blues or maybe they aren’t sure what to label it at all. There has historically been some confusion in the general public about what postpartum depression is and how to treat it (…cut to the Tom Cruise/Brook Shields Spat in 2005 or the depiction of PPD on shows like Private Practice and Susanna). Regardless of the public myths and fears about postpartum depression, in the scientific literature, there is clarity, data and consistency in the professional community as to what constitutes postpartum depression and how to treat it. 

Throughout the information provided by our group, Behavioral Health Dallas (BHD), we’ll refer to “perinatal” depression, which means depression in the pregnancy and postpartum periods. It’s important to education yourself about the signs and symptoms of depression and anxiety during pregnancy so that you know when to seek help. It is not in fact necessary to diagnose yourself, no google scholaring required, only to be aware so you and your partner can monitor your well-being and be quick to seek medical and mental health support when needed.

Know Thyself (aka know your risk factors)

Let’s start with what to know about yourself from the get-go. Several factors can put a woman at risk for perinatal depression before she’s even pregnant including previous episodes of depression (in the perinatal period or otherwise), if their mother or family member has experienced perinatal or general depression, or if they have recently discontinued medication for depression or another mental health disorder. If you have struggled with depression, anxiety or another mental health condition in the past, it’s best to proactively let your medical provider know and set up an appointment with a mental health provider specialized in perinatal mental health so that you can stop the problem before it starts. Other risk factors for the development of perinatal mood disorders include if the pregnancy was not intended, limited family or social support, previous traumatic experiences, significant life stressors (think financial, moving, family member illness etcetera), previous infertility and/or losses, and pregnancy complications such as bedrest.  

Most importantly, if you’re already feeling down and/or anxious, pregnancy and the postpartum period may exacerbate those feelings as opposed to making them better. About half of women with postpartum depression developed symptoms during pregnancy. So, bottom line, if you’re feeling symptoms now, GO GET HELP NOW! The longer you wait, the more severe symptoms become and the harder they are to treat. 

Depression in Pregnancy

If you are feeling down, anxious or irritable during pregnancy, you are not alone. 15-20% of women experience depression or anxiety during pregnancy or the postpartum period (Postpartum Support International, 2021). This is a significantly higher rate than in the general population. Pregnancy and postpartum periods are high risk times for mental health concerns. You might recognize symptoms of anxiety or depression if you’re experiencing some of the following: 

• Feeling sad, down, apathetic, irritable, worried, or anxious

• Preoccupation with pregnancy or infant well-being

• Experiencing difficulty sleeping and excessive fatigue

• Changes in appetite or eating behaviors

• Feelings of guilt, hopelessness or helplessness

• Reduced interest in things that you used to enjoy

• Withdrawal form social interactions 

• Difficulty paying attention and getting things done 

You might notice that some of these symptoms could be related to pregnancy itself, or a variety of other circumstances in your life. This is part of why it is important to speak with a specialized mental health provider who can evaluate the symptoms and let you know if what you’re experiencing really is postpartum depression or if it’s something else.  

The Baby Blues and Beyond

Once  you deliver baby, you may very well experience something called the “Baby Blues.” Depending on which study you read, 50-70% of women experience the baby blues, which is a transient period of time occurring between 0-14 days postpartum. Symptoms may include intermittent depression, tearfulness, anxiety/fears, irritability and distractibility. These symptoms should not interfere with your functioning on a day-to-day basis, if these symptoms are severe enough to impact your functioning, then you might be experiencing postpartum depression and need to contact a mental health provider. 

The baby blues should resolve after about two weeks. If it does not, then you might be experiencing postpartum depression. About 1 in 7 women experience postpartum depression (ACOG, 2016). Postpartum depression is often an anxious and agitated depression. Women often describe feeling very irritable, sad, anxious, worried about themselves or the baby and may experience scary or disturbing thoughts. Women may feel overly worried, angry, apathetic or disconnected from the baby. It may be difficult for the mother herself to recognize these symptoms due to sleep deprivation and difficulty adjusting; therefore, it’s important to education your partner or another trusted individual on these symptoms and ask them to monitor you as well. You may also ask your medical provider to screen for depression at a postpartum follow up appointment. 

Treatment Options

Perinatal Depression is real and is considered one of the most common complications of pregnancy. It’s not your fault. You didn’t cause it, but you do have the power to change it. Getting better starts with a phone call to your ob-gyn or midwife and a referral to a qualified mental health professional.  Therapy with someone specialized in perinatal mental health and medication can help. There are even specific types of therapy which are evidence-based to treat perinatal depression. Be quick to seek support, this is not a wait and see kind of thing. Postpartum depression often gets worse before it gets better, but Postpartum depression IS treatable, with help you can get better.