Perinatal depression refers to depression that occurs during or around pregnancy; postpartum depression refers to depression that occurs following pregnancy. It involves low mood, tearfulness, difficulty getting motivated for things or enjoying things, and can often involve sleep and appetite disturbances. Postpartum, this can look like difficulty sleeping even when the baby is sleeping, or difficulty finding motivation to shower or care for yourself.

Postpartum Depression is among the most common complications of pregnancy in the United States. While incidence varies in different groups of women, up to 1 in 5 women will develop symptoms of postpartum depression.

“Baby Blues” describes brief, time limited symptoms of low mood or weepiness that do not impair functioning and resolve within two weeks of pregnancy. Symptoms are consistent with Postpartum Depression when they persist beyond two weeks, are more severe, and/or impair mom’s ability to function or bond with her baby.

Postpartum depression for many women starts rapidly after delivery, though it can have onset any time within the first year postpartum. Many women start to see symptoms during the third trimester of pregnancy.

Postpartum depression can have a number of contributing factors, including the marked hormonal shifts associated with pregnancy and delivery. Prior studies have re-created postpartum depression in moms with a history of postpartum depression simply by giving women escalating doses of hormones and then abruptly withdrawing them- no baby required! Sleep deprivation, changes in relationships/social support, and financial concerns also frequently play an important role.

Depression during pregnancy is not a benign condition; untreated perinatal depression is associated with a higher risk of a number of pregnancy complications, particularly when there are concerns about mom’s ability to keep herself safe. Depression in pregnancy also often impacts mom’s ability to take good care of herself, including by eating well, sleeping well, and exercising regularly. Postpartum Depression is associated with a higher risk of negative neurodevelopmental outcomes in the baby, which are often related to difficulty bonding with the baby and difficulty engaging with the baby when mothers are very depressed.

Medications used to treat depression during pregnancy are some of the best studied and most commonly used medications during pregnancy, and we have years of reproductive safety data to support their use. Trained reproductive psychiatrists always consider what we call a “risk-risk analysis,” weighing what we know about potential risks of any medication mom takes during pregnancy against the risks of leaving her illness untreated.

Yes! We generally consider medications to be safe for breastfeeding when the baby’s adjusted dose by weight is less than 10% of mom’s dose, called the “Relative Infant Dose” or “R.I.D.” Many medications we use to treat postpartum depression fall within this category. We will always discuss you and your baby’s specific risk factors for treatment.

With good treatment we can often get moms relief from symptoms within a few weeks. Without treatment, women with histories of trauma or Posttraumatic Stress Disorder are at particularly high risk for symptoms that persist for a year or more.