Perinatal Mental Health: Recognizing Signs of Postpartum Depression and Anxiety and When to Seek Help
For first-time expecting mothers, pregnancy and the postpartum period can bring wild emotions—joy, excitement, but also stress and uncertainty (and maybe a little fear or self-doubt if I’m being honest?).
Preparing for the physical changes of pregnancy is necessary, but so is preparing for the mental and emotional changes that can happen. Expecting parents (both mom and dad) can be caught off-guard by the mental health challenges that arise.
Perinatal mental health refers to mental health conditions, including depression, anxiety, and psychosis, that arise during pregnancy and up to one year postpartum, that significantly impact the well-being of both the mother and child.
Even though we know that perinatal mental health is essential to maternal and infant well-being, perinatal mental health is often misunderstood or overlooked, leading to dangerous delays in care.
You may also hear about PMAD, which stands for perinatal mood and anxiety disorders; we’re talking about the same thing.
Recognizing the early signs of depression and anxiety symptoms during pregnancy and postpartum is an essential safeguard for both mother and baby.
Now, we’ll dive into helping you understand perinatal mental health, how to recognize postpartum anxiety and depression, and when it’s time to seek help.
What Is Perinatal Mental Health and Why Does It Matter?
Perinatal mental health refers to the emotional and psychological well-being of women during pregnancy (antenatal) and up to one year after childbirth (postnatal).
These conditions range from mild, such as the "baby blues," to more severe disorders like depression and/or anxiety during pregnancy and postpartum, and even postpartum psychosis.
When left untreated, these mental health challenges can affect your well-being, relationships, and ability to care for your baby, and they may even become life-threatening. Recognizing them and seeking help is essential.
Perinatal Depression
Perinatal depression goes beyond the typical “baby blues,” which usually resolve within two weeks after childbirth and don’t typically require any interventions.
Perinatal depression persists, interferes with daily life, and often requires treatment. Symptoms of perinatal depression are often the same as symptoms of any depressive disorder; it’s the timing (occurring in pregnancy or postpartum) that matters.
Symptoms of perinatal depression include:
Persistent feelings of sadness, anxiety, or an "empty" mood most of the day, nearly every day, for at least two weeks
Feelings of hopelessness or pessimism
Irritability, frustration, or restlessness
Guilt, worthlessness, or helplessness
Loss of interest or pleasure in activities or hobbies previously enjoyed
Fatigue or an unusual decrease in energy
Restlessness or difficulty sitting still
Trouble concentrating, remembering things, or making decisions
Difficulty sleeping (even when the baby is asleep), waking up early, or oversleeping
Significant changes in appetite or unplanned weight fluctuations
Physical aches, pains, headaches, cramps, or digestive issues without an obvious physical cause that don’t improve with treatment
Difficulty bonding or forming an emotional connection with the baby
Persistent doubts about one’s ability to care for the baby
Thoughts of death, self-harm, harming the baby, or suicide attempts
Perinatal depression negatively impacts mothers' quality of life, relationships, birth outcomes, and breastfeeding. It can also affect children's long-term cognitive and emotional development.
Recognizing the signs and symptoms, and seeking help, can absolutely change the trajectory of your life, and your baby’s.
Perinatal Anxiety
Anxiety during pregnancy and postpartum can manifest as generalized anxiety, panic disorder, obsessive-compulsive disorder (OCD), or post-traumatic stress disorder (PTSD).
Studies indicate that more than 15% of women experience anxiety during pregnancy, and around 17% experience it during the postpartum period. These rates are notably higher than those for postpartum depression, which affects about 4-5% of women.
However, other studies report a higher incidence of PMAD, including both depression and anxiety.
Symptoms of perinatal anxiety include:
Excessive worry, especially about the baby’s health and well-being
Restlessness or irritability
Difficulty concentrating or focusing
Physical symptoms such as a racing heart, dizziness, or nausea
Panic attacks, including shortness of breath, chest pain, or overwhelming fear
Difficulty sleeping, even when the baby is sleeping
Intrusive, unwanted thoughts (common in obsessive-compulsive disorder)
Repetitive behaviors or compulsions (common in obsessive-compulsive disorder)
Flashbacks or heightened anxiety related to past trauma (common in post-traumatic stress disorder)
Avoidance of certain situations or activities due to anxiety
Postpartum Psychosis
While rare, postpartum psychosis is a severe mental health condition; it’s considered a psychiatric emergency that requires immediate medical attention.
Symptoms include:
Confusion and disorganized thoughts
Paranoia and delusions
Hallucinations (visual or auditory)
Sleep disturbances and appetite changes
Risk of suicide or filicide (killing your child)`
Recognizing postpartum mental health issues early, especially for postpartum psychosis, is critical as symptoms of mental illness can escalate quickly and may involve risks to both the mother and baby.
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Risk Factors for Perinatal Mental Illness
Risk factors for perinatal depression, which are also often attributed to other perinatal mood and anxiety disorders, include:
Lower Education Level
Poor Economic Status
History of Mental Illness
Domestic Violence
Perinatal Smoking or Drinking
Multiparity (multiple pregnancies)
Obstetric factors including complications and/or high-risk pregnancy
Psychological factors including a history of mental illness, PTSD, or past sexual abuse
Biological factors including hormone changes, glucose metabolism disorder in pregnancy, increased inflammatory markers
Lifestyle factors including poor nutrition (e.g., low intake of vitamin B6, zinc, selenium, and seafood), sleep deprivation and poor sleep quality, and low physical activity or exercise
Risk factors for postpartum psychosis also include a history of bipolar disorder, previous postpartum psychosis, family history of psychosis or bipolar disorder, and discontinuation of psychiatric medications during pregnancy. Lack of sleep and rapid hormonal changes after the baby’s birth can also be contributing factors.
These factors significantly increase the risk of PMADs and suggest the need for early screening and interventions.
How Perinatal Mental Health Affects You and Your Baby
Untreated perinatal mental illness can deeply affect a mother’s relationship with herself, her health, and her baby and the baby’s development.
Persistent depression or anxiety can make it harder for the mother to be emotionally present, responsive, or sensitive to her baby’s needs. This can disrupt the bonding process, potentially affecting the child’s emotional well-being.
Sadly, untreated perinatal mental illness is one way mental health issues can echo through generations. Too often, new moms put their wellness on the backburner, thinking it’s best for the baby. But if you or a new parent you know is struggling, getting help isn’t selfish; it’s essential.
Risks of Untreated Perinatal Mental Illness for the Mama
There are several documented health risks associated with postpartum depression (PPD) for mothers:
Chronic Depression and Recurrence of Major Depression: if left untreated, PPD can lead to a chronic depressive disorder. Additionally, mothers who experience PPD are at a higher risk for future episodes of major depression or bipolar disorder.
Suicide Risk: PPD is linked to an increased risk of suicide, which is a leading cause of mortality among postpartum individuals.
Strain on Family Relationships: PPD can lead to marital conflict, lack of partner support, and increased risk of family disruption due to strained relationships.
Increased Risk of Developing Other Psychiatric Conditions: women with a prior episode of PPD have a heightened risk of developing other mental health disorders including anxiety and psychosis in future postpartum periods.
Impaired Parenting and Bonding: PPD may affect a mother’s ability to bond with her child, resulting in long-term issues in parenting and relationship building with her child, which can also impact the child’s development and behavior.
Risks of Untreated Perinatal Mental Illness for the Baby
If your mental illness is suffering, your baby is affected too. Risks for your baby include:
Attachment Challenges: babies of moms who struggle with PPD may struggle to form secure attachments, which is foundational for emotional and social development.
Emotional and Behavioral Problems: babies of mothers with perinatal mental illness are more likely to develop emotional and behavioral problems and may have trouble regulating emotions, and may show more emotions like frustration and anxiety.
Long-Term Mental Health: research indicates these babies may have higher risks of anxiety or depression later in life.
Stress Sensitivity: prenatal stress and maternal depression can increase the baby’s stress sensitivity, affecting their emotional regulation.
Risks for the Mother-Baby Relationship
Perinatal mental health disorders can deeply impact bonding, care, and the baby’s development.
Depressed mothers may engage less in nurturing behaviors, respond slowly to their baby’s cues, or display more negative emotions, which can weaken bonding and make the baby feel insecure. This lack of responsiveness can lead to insecure attachment patterns, potentially impacting the child’s relationships later in life.
Mothers with depression may also skip safety practices (for example, car seats and working smoke detectors), reduce engagement in positive activities, and feel less confident in parenting.
Their babies might miss regular check-ups, face higher risks of emergency visits, and experience more screen time with fewer interactive moments.
Depression can also increase the risk of maltreatment, as mothers may rely on discipline over nurturing, sometimes leading to abusive behavior. These effects underscore the importance of early intervention to support both mother and child.
Breaking the Cycle: Recognizing and Seeking Treatment for Perinatal Mental Health Conditions
If you’ve felt a struggle with your mental health lately, I want you to take a deep breath and know that recognizing it is the first step. It doesn’t mean you’ve done anything wrong; it just means that it’s time to seek professional help as well as reaching out to loved ones for support.
Early intervention in perinatal mental health issues is key, but too often they do go missed.
Your perinatal mental health is foundational to your well-being and your baby’s development. Untreated postpartum depression and anxiety can make daily tasks like feeding or bonding with your baby feel overwhelming, and make self-care feel like a cruel, unattainable joke. It can also have lasting effects on your relationship with your baby.
If symptoms begin in pregnancy or within one year of birth and persist beyond two weeks, or you feel overwhelmed, have difficulty functioning, or struggle with intrusive thoughts or impulses of harming yourself or your baby, it’s time to reach out to a healthcare provider.
Practical Steps to Support Perinatal Mental Health
Taking care of your mental health during pregnancy and postpartum requires proactive efforts.
Here are a few self-care strategies that can support your perinatal mental health:
Journaling: writing down thoughts and emotions helps you process feelings. Or, find at least one person to talk with honestly.
Mindfulness: deep breathing, sipping water slowly, or simply holding your baby can reset a frazzled nervous system.
Physical Activity: gentle movement like walking or yoga can boost your mood and reduce stress. Anything beyond light exercise should be cleared by your doctor.
Sleep: whenever you can, just do it. And never shake off an offer to help so you can nap. It’s not selfish. It’s essential.
Support Network: build a network of supportive family, friends, or other new mothers. Write down names, numbers, and times they’re available to help. This network is essential for maintaining your mental health after childbirth.
For more guidance on creating your Postpartum Support Team, check out my book POST: The Essential Guide to Creating Your Postpartum Self-Care Plan in Pregnancy.
Create Your Medical Support Team: this includes your OB-GYN, midwife, primary care provider, any specialists, mental health professionals, doula, acupuncturist, chiropractor, etc. Anyone overseeing your medical care needs to be on that list.
Again, my book walks you through the creation of your Postpartum Self-Care Plan in detail, which includes research-backed steps to enhance mental, emotional, and physical wellness in pregnancy and postpartum.
Take Breaks: there’s no such thing as Supermom, and you are under no obligation to try. Instead, acknowledge when you need a minute, whether it’s to shower, nap, Netflix, hang with your partner or friends, or whatever else, take those moments without guilt.
Set Realistic Expectations: give yourself permission to rest, ask for help, and accept that perfection isn’t necessary.
Medications are an Option
If you have any symptoms of depression in pregnancy or postpartum, speak to your doctor right away. They can discuss options with you that are appropriate in pregnancy and lactation as necessary.
In August 2023 a new medication called zuranolone was approved by the FDA for the treatment of postpartum depression.
A study published in JAMA Psychiatry explored the effects of zuranolone, a neuroactive steroid that influences GABA receptors, on postpartum depression (PPD).
In this phase 3, double-blind trial with 151 participants, women who took zuranolone (30 mg daily for two weeks) experienced significant reductions in depression symptoms compared to those taking a placebo.
The improvements were noticeable by day 3, continued through day 15, and lasted through day 45. The treatment was generally well tolerated, indicating zuranolone could be a fast-acting, effective option for treating PPD.
There is no room for medication stigma, or self-care stigma, in perinatal mental health. You and your baby are too precious to spend any more time struggling. If you find yourself living with symptoms of perinatal depression, anxiety, or postpartum psychosis, reach out to your medical provider immediately.
Where to Find Support for Perinatal Mental Health
If you’re experiencing postpartum anxiety and depression, know that there are many resources available for support for perinatal mental health. Start with your doctor, and seek out other support as well:
Healthcare Providers: speak to your obstetrician, midwife, or primary care physician about your concerns. They can help with screenings and referrals.
Therapists and Counselors: look for professionals who specialize in perinatal mental health. Cognitive-behavioral therapy (CBT) or interpersonal therapy (IPT) can be particularly effective.
Support Groups: online and in-person support groups offer the chance to connect with other mothers facing similar challenges.
Postpartum Hotlines: hotlines like Postpartum Support International (PSI) provide immediate assistance and connect you with local resources.
Friends, Family, Your Partner: ask the people in your life for support. They would love to help you, and just need to know how.
Key Takeaways: Supporting Perinatal Mental Health
What’s the most effective step to improving your mental health after childbirth?
Building a strong support system of trusted people, and your medical providers, early on can significantly reduce the severity of postpartum depression symptoms and postpartum anxiety.
The second most effective step? Diet is a powerful way to promote mental and emotional wellness in general, and research backs that up for pregnant and postpartum people too.
The Mediterranean diet is a great diet to provide ample nutrients as well as enough healthy fat, carbohydrates and protein to manage healing from childbirth, returning to your new normal, and bearing the storm of pregnancy and postpartum recovery.
Recognizing the signs of postpartum depression symptoms and postpartum anxiety early on is essential for ensuring a healthier postpartum experience. Seeking support for perinatal mental health is not a sign of weakness, but rather a powerful step toward recovery and well-being for both mother and baby.
If you’re looking for more guidance, POST: The Essential Guide to Creating Your Postpartum Self-Care Plan in Pregnancy offers actionable steps for supporting your mental health before and after childbirth.
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