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What You Should Know About Perinatal Depression

The Mighty logo The Mighty 2/26/2021 Silvia Pittman
a person sitting on a bench: A pregnant woman wearing a black dress sits in the corner of an empty gray room © The Mighty A pregnant woman wearing a black dress sits in the corner of an empty gray room

Kandice Anderson, a blogger and boutique owner, said she first experienced depression after the birth of her eldest child. When she got pregnant with her second, she was surprised to see those telltale signs of depression begin to surface again. She said she felt “the same feelings of overwhelming sadness [and] thoughts of inadequacy.” Anderson isn’t alone.

Pregnancy and motherhood are often portrayed as a blissful experience when you’re expected to be your happiest and “glowing.” But for some, creating a new life — before, during and after a baby’s birth — also marks the onset of depressive symptoms. If this sounds familiar, you may be experiencing perinatal depression.

What Is Perinatal Depression?

Perinatal depression refers to clinical depression that starts at any point beginning with your pregnancy until after giving birth. Most people are more familiar with depression that happens postpartum, but it’s important to understand that in many cases symptoms start before giving birth.

According to Kristina Deligiannidis, MD, director of women’s behavioral health at Zucker Hillside Hospital/Northwell Health, the specific timing of perinatal depression post-birth varies. The World Health Organization (WHO), however, defines perinatal depression as occurring up to a year postpartum, or after giving birth.

Perinatal depression affects up to 10% of expectant moms and 13% of those who just had a baby worldwide. Signs of perinatal depression are similar to other types of clinical depression and can include persistent sadness and “empty” mood, aches and pains unrelated to pregnancy, trouble forming an emotional bond with the baby, or thoughts of hurting oneself or the baby.

Dr. Deligiannidis explained one additional sign that seems to separate depression associated with maternity from other major depressive episodes: Perinatal depression has a tendency to manifest with more anxiety, insomnia as well as more irritability.

What Causes Perinatal Depression?

But why do some women experience perinatal depression while others don’t? Deligiannidis said based on available research, there tends to be a strong genetic factor, more so than general depression. When you take a closer look, there are many additional factors that may predispose someone to perinatal depression.

“We see it as all these risk factors from the environment — social support, family history, medical history, nutritional sleep, hormones,” said Deligiannidis. “When you have enough of these risks, then it takes you over the edge to develop clinical depression.”

One common school of thought when it comes to perinatal depression is that it’s triggered by the sudden drop in pregnancy hormones like progesterone and estrogen. The Feinstein Institutes in New York was recently awarded a $4 million grant to study perinatal depression. That will include research to determine whether shifting hormones are truly a determining factor.


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“We’re trying to tease out, what’s the role of progesterone and estrogen and these other steroids?” explained Deligiannidis, adding:

Why is it that some women develop [perinatal depression] in pregnancy when the hormones are high, versus some women develop it after they deliver? Because if the mechanisms are different, our treatments should be different as well.

She added that further research could also help differentiate symptoms that could be pointing to a different condition like anxiety or insomnia and further improve the efficacy of treatment.

How Is Perinatal Depression Treated?

Women who think they might be dealing with perinatal depression (or other mental health concerns) should always reach out for help, even if you’re unsure. Deligiannidis explained some women think what they’re going through is just related to normal mood swings and changes from pregnancy.

“They find reasons to explain their symptoms outside of depression, and so that leads them not to report symptoms to clinicians,” Deligiannidis said. Doctors have now begun screening women for depression during pregnancy in addition to the postpartum period as scientists gain a better understanding of perinatal depression.

The treatment options for those diagnosed with perinatal depression are similar to the options you have with any depressive disorder. This may include evidence-backed psychotherapy, antidepressant medications or a combination of these depending on the severity of your symptoms.

Are Antidepressants Safe During Pregnancy?

For those worried about antidepressant use during pregnancy or while breast feeding, the risk appears to be low. Antidepressants overall have been well-studied, even more so than other medications prescribed during pregnancy like antibiotics. Based on everything we know, “in most cases, the benefits outweigh the risks for mom and baby,” Deligiannidis said.

In 2019, the Food and Drug Administration (FDA) approved the first drug, brexanolone (brand name Zulresso), specifically for postpartum depression. Administered through IV treatment at a health care center, brexanolone works differently than the other common antidepressants already on the market. This may provide some people an additional medication treatment to try.

What’s Next in Perinatal Depression Treatment?

Additional research for perinatal depression treatment options is ongoing, including a clinical trial Deligiannidis is conducting using chronotherapy to regulate sleep. Chronotherapy incorporates bright light therapy plus what Deligiannidis described as a personalized sleep prescription for those experiencing perinatal depression.

After collecting data about your sleep rhythms, doctors can determine the ideal time for you to wake up and go to sleep. By sticking with this bedtime routine and supplementing with bright light therapy to regulate your sleep-wake pattern, Deligiannidis said it may help reduce insomnia and lift depression symptoms.

If you’re experiencing symptoms of depression during or after your pregnancy, know you’re not alone and help is available. “We want women to come forward and seek treatment,” Deligiannidis said. The first step? Talk to your doctor and/or OB/GYN.

If you’re interested in learning more about Deligiannidis’ research and to find out if you qualify to participate, you can contact her team via email.

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