Perinatal

Depression
Perinatal depression is depression that 

occurs during or after pregnancy. The 

symptoms can range from mild to 

severe. In rare cases, the symptoms are 

severe enough that the health of the 

mother and baby may be at risk. 

Perinatal depression can be treated. 

This brochure describes the signs and 

symptoms of perinatal depression and 

how you or a loved one can get help.

Overview

What is perinatal depression?

Perinatal depression is a mood disorder that 

can affect women during pregnancy and 

after childbirth. The word “perinatal” refers 

to the time before and after the birth of a 

child. Perinatal depression includes depression 

that begins during pregnancy (called prenatal 

depression) and depression that begins after 

the baby is born (called postpartum 

depression). Mothers with perinatal 

depression experience feelings of extreme 

sadness, anxiety, and fatigue that may make 

it difficult for them to carry out daily tasks, 

including caring for themselves or others.

What causes perinatal depression?

Perinatal depression is a real medical illness 

and can affect any mother—regardless of 

age, race, income, culture, or education. 

Women are not to blame or at fault for having 

perinatal depression: it is not brought on by 

anything a mother has or has not done. 

Perinatal depression does not have a single 

cause. Research suggests that perinatal 

depression is caused by a combination of 

genetic and environmental factors. Life 

stress (for example, demands at work or 

experiences of past trauma), the physical 

and emotional demands of childbearing and 

How is postpartum 

depression different from 

the “baby blues”?

The “baby blues” is a term 

used to describe mild mood 

changes and feelings of worry, 

unhappiness, and exhaustion 

that many women sometimes 

experience in the first 2 weeks 

after having a baby. Babies 

require around-the-clock care, 

so it’s normal for mothers to feel 

tired or overwhelmed sometimes. 

If mood changes and feelings 

of anxiety or unhappiness are 

severe, or if they last longer than 

2 weeks, a woman may have 

postpartum depression. Women 

with postpartum depression 

generally will not feel better 

unless they receive treatment.

Postpartum Psychosis

Postpartum psychosis (PP) is a 

severe mental illness that occurs 

after childbirth. PP is a medical 

emergency, and it is important 

to seek help immediately by 

calling 911 or going to the nearest 

emergency room. Women who 

have PP can have delusions 

(thoughts or beliefs that are not 

true), hallucinations (seeing, 

hearing, or smelling things 

that are not there), mania (a 

high, elated mood that often 

seems out of touch with reality), 

paranoia, and confusion. Women 

who have PP also may be at risk 

for harming themselves or their 

child and should receive help as 

soon as possible. Recovery is 

possible with professional help. 
caring for a new baby, and changes in hormones that occur during and after 

pregnancy can contribute to the development of perinatal depression. In 

addition, women are at greater risk for developing perinatal depression if they 

have a personal or family history of depression or bipolar disorder or if they 

have experienced perinatal depression with a previous pregnancy. 

Signs and Symptoms

Some women may experience a few symptoms of perinatal depression; others 

may experience several symptoms. Some of the more common symptoms of 

perinatal depression include:

⊲ Persistent sad, anxious, or “empty” mood

⊲ Irritability

⊲ Feelings of guilt, worthlessness, hopelessness, or helplessness

⊲ Loss of interest or pleasure in hobbies and activities

⊲ Fatigue or abnormal decrease in energy 

⊲ Feeling restless or having trouble sitting still

⊲ Difficulty concentrating, remembering, or making decisions

⊲ Difficulty sleeping (even when the baby is sleeping), awakening early in the 

morning, or oversleeping

⊲ Abnormal appetite, weight changes, or both

⊲ Aches or pains, headaches, cramps, or digestive problems that do not have 

a clear physical cause or do not ease even with treatment

⊲ Trouble bonding or forming an emotional attachment with the new baby

⊲ Persistent doubts about the ability to care for the new baby

⊲ Thoughts about death, suicide, or harming oneself or the baby 

Only a health care provider can help a woman determine whether the 

symptoms she is feeling are due to perinatal depression or something else. It is 

important for women who experience any of these symptoms to see a health 

care provider.

If You Know Someone in Crisis:

⊲ Dial 911 in an emergency.

⊲ Call the toll-free National Suicide Prevention Lifeline at 1-800-273-TALK 

(8255), 24 hours a day, 7 days a week. All calls are confidential. To use 

the Lifeline Chat, visit https://suicidepreventionlifeline.org.

⊲ Contact the Crisis Text Line 24 hours a day, 7 days a week, by 

texting HELLO to 741741.
Treatment

Treatment for perinatal depression is important for the health of both the mother 

and the baby, as perinatal depression can have serious health effects on both. 

With proper treatment, most women feel better and their symptoms improve. 

Treatment for perinatal depression often includes therapy, medications, or a 

combination of the two. If these treatments do not reduce symptoms, brain 

stimulation therapies, such as electroconvulsive therapy, may be an option to 

explore. Learn more about these therapies by visiting the National Institute of 

Mental Health’s (NIMH) Brain Stimulation Therapies webpage at www.nimh.nih.

gov/braintherapies. A health care provider can help women choose the best 

treatment based on their symptoms.

Psychotherapy

Several types of psychotherapy (sometimes called “talk therapy” or 

“counseling”) can help women with perinatal depression. Two examples of 

evidence-based approaches that have been used to treat perinatal depression 

include cognitive behavioral therapy and interpersonal therapy. 

Cognitive Behavioral Therapy (CBT)

CBT is a type of psychotherapy that can help people with depression and 

anxiety. It teaches people different ways of thinking, behaving, and reacting to 

situations. People learn to challenge and change unhelpful patterns of thinking 

and behavior as a way of improving their depressive and anxious feelings and 

emotions. CBT can be conducted individually or with a group of people who 

have similar concerns. 

Interpersonal Therapy (IPT)

IPT is an evidence-based therapy that has been used to treat depression, 

including perinatal depression. It is based on the idea that interpersonal and life 

events impact mood and vice versa. The goal of IPT is to help people to improve 

their communication skills within relationships, to develop social support networks, 

and to develop realistic expectations that allow them to deal with crises or other 

issues that may be contributing to their depression.

For information on how to identify a mental health professional and questions to 

ask when considering therapy, visit the NIMH Psychotherapies webpage at

www.nimh.nih.gov/psychotherapies.

Medication

Women with perinatal depression are most commonly treated with antidepressants, 

which are medications used to treat depression. They may help improve the way 

the brain uses certain chemicals that control mood or stress. Women who are 

pregnant or breastfeeding should notify their health care provider before starting 

antidepressants so their health care provider can work to minimize the baby’s 
exposure to the medication during pregnancy or breastfeeding. The risk of 

birth defects and other problems for babies of mothers who take antidepressants 

during pregnancy is very low; however, women should work with their health 

care provider to weigh the risks and benefits of treatment and to find the best 

solution for their situation. Women may need to try several different 

medications before finding the one that improves their symptoms and has 

manageable side effects. 

Antidepressants take time—usually 6 to 8 weeks—to work, and symptoms such 

as sleep, appetite, and concentration problems often improve before mood lifts. 

It is important to give medication a chance before deciding whether or not it works. 

Do not stop taking antidepressants without the help of a health care provider. 

Sometimes people taking antidepressants feel better and then stop taking the 

medication on their own, and the depression returns. Stopping medications 

abruptly can cause withdrawal symptoms. When a woman and her health care 

provider have decided it is time to stop the medication, the health care 

provider will help her to decrease the dose slowly and safely. To find the latest 

information about antidepressants, talk to a health care provider and visit this 

U.S. Food and Drug Administration (FDA) webpage on the use of medications 

during and after pregnancy: www.fda.gov/pregnancy.

Please Note: In some cases, children, teenagers, and young adults under 

the age of 25 may experience an increase in suicidal thoughts or behavior 

when taking antidepressants, especially in the first few weeks after starting 

or when the dose is changed. Patients of all ages taking antidepressants 

should be watched closely, especially during the first few weeks of treatment.

If suicidal behaviors are observed, notify a health care provider right away. 

If you or a loved one is in crisis, call 911 for emergency services or contact 

the National Suicide Prevention Lifeline (Lifeline) at 1-800-273-TALK (8255). 

To learn more about the Lifeline, visit https://suicidepreventionlifeline.org. 

After the birth of a child, many women experience a drop in certain hormones, 

which can lead to feelings of depression. FDA has approved one medication, 

called brexanolone, specifically to treat severe postpartum depression. 

Administered in a hospital, this drug works to relieve depression by restoring 

the levels of these hormones. To learn more, visit www.fda.gov/news-events/

press-announcements/fda-approves-first-treatment-post-partum-depression.

Researchers continue to study treatment options for perinatal depression. A 

health care provider can explain the different treatment options and help 

women choose the treatment that is right for them.
How can family and friends help?

It is important to understand that depression is a medical condition that 

impacts the mother, the child, and the family. Spouses, partners, family 

members, and friends may be the first to recognize symptoms of perinatal 

depression in a new mother. Treatment is central to recovery. Family members 

can encourage the mother to talk with a health care provider, offer emotional 

support, and assist with daily tasks such as caring for the baby or the home.

Support or advocacy groups can offer a good source of support and information. 

One example of this type of group is Postpartum Support International 

(www.postpartum.net); others can be found through online searches.

Learn More About Perinatal Depression

Federal Resources 

⊲ Moms’ Mental Health Matters

(Eunice Kennedy Shriver National Institute of Child Health and Human 

Development, National Child & Maternal Health Education Program)

www.nichd.nih.gov/MaternalMentalHealth

⊲ Postpartum Depression

(Office on Women’s Health, U.S. Department of Health and Human 

Services)

www.womenshealth.gov/mental-health/mental-health-conditions/

postpartum-depression

⊲ Medicine and Pregnancy

(U.S. Food and Drug Administration)

www.fda.gov/pregnancy

⊲ Postpartum Depression

(MedlinePlus, National Library of Medicine)

https://medlineplus.gov/postpartumdepression.html

⊲ “Baby Blues”—or Postpartum Depression? video

(NIMH)

www.youtube.com/watch?v=6kaCdrvNGZw

⊲ NIMH research studies on postpartum depression

www.nimh.nih.gov/labs-at-nimh/join-a-study/adults/adults-postpartumdepression.shtml
Participating in Clinical Research

Clinical trials are research studies that look at new ways to prevent, detect, or 

treat diseases and conditions. Although individuals may benefit from being part 

of a clinical trial, participants should be aware that the primary purpose of a 

clinical trial is to gain new scientific knowledge so that others may be better 

helped in the future.

Researchers at NIMH and around the country conduct many studies with 

patients and healthy volunteers. Talk to your health care provider about clinical 

trials, their benefits and risks, and whether one is right for you.

For more information, visit www.nimh.nih.gov/clinicaltrials.

Finding Help

Behavioral Health Treatment Services Locator 

The Substance Abuse and Mental Health Services Administration (SAMHSA) 

provides this online resource for locating mental health treatment facilities and 

programs. Find a facility in your state at https://findtreatment.samhsa.gov. For 

additional resources, visit www.nimh.nih.gov/findhelp.

Talking to Your Health Care Provider About Your Mental Health 

Communicating well with a health care provider can improve your care and help 

you both make good choices about your health. Find tips to help prepare for 

and get the most out of your visit at www.nimh.nih.gov/talkingtips. For 

additional resources, including questions to ask a provider, visit the Agency for 

Healthcare Research and Quality website at www.ahrq.gov/questions.
Reprints

This publication is in the public domain and may be reproduced or copied 

without permission from NIMH. We encourage you to reproduce and use NIMH 

publications in your efforts to improve public health. If you do use our materials, 

we request that you cite the National Institute of Mental Health. To learn more 

about using NIMH publications, please refer to www.nimh.nih.gov/reprints.

For More Information

NIMH website 

www.nimh.nih.gov

MedlinePlus (National Library of Medicine)

https://medlineplus.gov

https://medlineplus.gov/spanish (en español) 

ClinicalTrials.gov

www.clinicaltrials.gov

https://salud.nih.gov/investigacion-clinica (en español)

National Institute of Mental Health

Office of Science Policy, Planning, and Communications

6001 Executive Boulevard

Room 6200, MSC 9663

Bethesda, MD 20892-9663

Toll-free: 1-866-615-6464

Email: nimhinfo@nih.gov

Website: www.nimh.nih.gov

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

National Institutes of Health 

NIH Publication No. 20-MH-8116