Depression and Pregnancy: Know the Signs to Get the Help You Need

Screening for prenatal and postpartum depression helps protect parent and baby.

a young white pregnant women sits in a dimly lit room near a window, placing her hands on her belly

Updated on February 6, 2024.

There’s been a lot of media coverage of postpartum depression (PPD), a form of depression that occurs after having a baby. 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 the baby is even born, 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 umbrella 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.”

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 the blues. 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.

Seeing the signs of depression

The arrival of a baby brings about big changes in your lifestyle, relationships, and sleep patterns. It can all feel overwhelming. Some people experience a range of emotions—from relief and joy to sadness and anxiety—during pregnancy and after delivery. 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’ve 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 arrives 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 the baby bond

“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. They say it takes a village to raise a child. That is never more true than 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. You can also call the Suicide and Crisis Lifeline at 988 for round-the-clock support if you are in distress.

Article sources open article sources

Centers for Disease Control and Prevention. Depression During and After Pregnancy. Last Reviewed: May 1, 2023.
March of Dimes. Postpartum depression. Last reviewed: March, 2019.
Massachusetts General Hospital Center for Women’s Mental Health. New Study at CWMH: Genetics of Postpartum Psychosis – Massachusetts General Hospital Postpartum Psychosis Project (MGHP3). October 10, 2018.
Massachusetts General Hospital Center for Women’s Mental Health. Postpartum Psychiatric Disorders. Accessed May 24, 2021.
Mayo Clinic. Depression (major depressive disorder). February 3, 2018.
Raza SK, Raza S. Postpartum Psychosis. [Updated 2023 Jun 26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-.
U.S. Preventative Services Task Force. Perinatal Depression: Preventive Interventions. February 12, 2019.

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