How Perinatal Depression Is Diagnosed
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Medically reviewed by Steven Gans, MD
Perinatal depression, or major depressive disorder (MDD) with peripartum onset, is depression that occurs during or after pregnancy. It is also known as antepartum depression (when it occurs during pregnancy) or postpartum depression (when it occurs after birth).
People with perinatal depression can experience extreme sadness, anxiety, and fatigue, which may make it challenging to carry out daily tasks, including caring for themselves and others.
Related:What Is Perinatal Depression?
The symptoms of perinatal depression can be severe enough to cause risks to the health of the person who is pregnant and the fetus.
Atipati Netiniyom / EyeEm / Getty Images
It is recommended that all pregnant people are screened for perinatal depression at least once during their pregnancy. If a person needs further evaluation, they will be referred to a mental health practitioner who can make a diagnosis of perinatal depression using the specific criteria described in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5).
According to the American College of Obstetricians and Gynecologists, perinatal depression affects one in seven pregnant people, making it one of the most common medical complications of pregnancy and the postpartum period.
Professional Screenings
Many organizations, including the United States Preventive Services Task Force (USPSTF), the American College of Obstetricians and Gynecologists (ACOG), the American Psychiatric Association (APA), and the American Academy of Pediatrics (AAP), recommend that all pregnant people are screened for perinatal depression during the perinatal period.
Close monitoring, evaluation, and assessment is specifically recommended for pregnant people who have:
Current depression or anxiety
A history of perinatal mood disorders
Risk factors for perinatal mood disorders
Suicidal thoughts
Screening tools can help identify people at risk for perinatal depression who are in need of a more thorough diagnostic assessment. After screening is complete, a person can be referred to a mental health professional for further assessment and treatment.
Related:What Is Antepartum Depression?
Major Depressive Episode
The DSM-5 provides the diagnostic criteria for major depressive disorder, which can occur with the specifier “with peripartum onset.”
A diagnosis of a major depression episode (MDE) requires that at least five of the following symptoms have been present daily for at least two weeks. At least one of the symptoms must be “depressed mood” or “loss of interest or pleasure in almost all activities.”
The criteria for MDE are:
Depressed mood
Loss of interest or pleasure in almost all activities
Significant unintentional weight loss or gain and/or a decrease or increase in appetite
Difficulty sleeping (sleeping too much or too little)
Psychomotor changes (increase or decrease in physical movements, such as pacing or a slowing down of speech)
Tiredness, fatigue, or low energy
A sense of worthlessness or excessive, inappropriate, or delusional guilt
Impaired ability to think, concentrate, or make decisions
Recurrent thoughts of death (not just fear of dying), suicidal ideation, or suicide attempts
Related:How Is Depression Diagnosed?
Three additional important criteria must be met:
The symptoms must cause a person significant distress or impairment in social, occupational, or other important areas of functioning.
The symptoms must not be better explained by schizophrenia spectrum or other psychotic disorders.
The symptoms must not be caused by the direct physiological effects of substance use or a medical condition.
Edinburgh Postnatal Depression Scale (EPDS)
A common screening tool for perinatal depression is the Edinburgh Postnatal Depression Scale, which was developed in 1987. The 10-question form can be completed in a couple of minutes—in the waiting room, online, or with a clinician in an office setting.
The EPDS does not focus on the symptoms—such as changes in appetite or sleep—which are more common among perinatal people who are not experiencing depression. Instead, it asks people to report how they have been feeling over the previous seven days.
When using the EPDS, a person might be asked to think about how they have been feeling lately and rate how much they agree with a statement such as “I have felt happy.”
They could respond with:
Yes, all of the time
Yes, most of the time
No, not very often
No, not at all
Onset
According to the DSM-5, the symptoms of MDD with peripartum onset can begin at any time during pregnancy or within four weeks of delivery.
Many professional organizations, including ACOG, further specify that the symptoms of perinatal depression can occur up to 12 months after delivery.
Differential Diagnosis
Before making a diagnosis of perinatal depression, a clinician needs to be certain that a person’s symptoms are not being caused by a different mental health condition or by a medical condition.
According to the DSM-5, a diagnosis of perinatal depression requires that the symptoms are not better explained by schizophrenia spectrum or other psychotic disorders—conditions that have many symptoms that overlap with perinatal depression.
Clinicians also need to rule out medical conditions that could better explain a person’s symptoms, including the normal changes that take place after a person gives birth.
During pregnancy, levels of the hormones estrogen and progesterone rise. In the day or so after delivery, the levels abruptly drop back to normal. For some people, these major shifts can produce symptoms that are also common in perinatal depression.
Changes in thyroid hormone levels—which decrease after childbirth—have also been linked to symptoms that are common among people with depression.
Labs and Tests
When ruling out other possible causes of a person’s symptoms, a clinician may run tests to check levels of hormones and/or thyroid function. They may also run other tests if they suspect a specific health condition or complication of pregnancy could explain a person’s symptoms.
Self/At-Home Testing
Untreated perinatal depression affects the health of the person who is pregnant, as well as the fetus. Depression puts a pregnant person at increased risk of delivering prematurely and of giving birth to a low birth weight baby. Perinatal depression may also contribute to sleeping and feeding problems after birth.
The symptoms of perinatal depression can go unnoticed because experiencing changes in sleep, appetite, and libido are often regarded as typical after the birth of a baby.
Studies have shown that many people are reluctant to report changes in their mood during their pregnancy. Family members may not realize that the symptoms a person is having are signs of a mental health condition that needs treatment.
There are several signs of perinatal depression that you should know. The sooner the condition is recognized and diagnosed, the sooner a person can get treated.
Signs that might indicate a person is experiencing 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 an abnormal decrease in energy
Feeling restless or having trouble sitting still
Difficulty concentrating, remembering, or making decisions
Difficulty sleeping 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 get better with treatment
Persistent doubts about the ability to care for your baby
Thoughts about death, suicide, or harming yourself
Most people with perinatal depression will experience several of these symptoms, which can range from mild to severe. Not everyone will experience the same symptoms.
Most people will experience feelings of weepiness and rapid changes in their mood related to the rapidly changing hormones in the body post-pregnancy. This experience is often called the “baby blues,” and it’s different from perinatal depression.
While telling the two apart can be tricky, the “baby blues” are usually brief and do not last longer than 10 days. The symptoms of perinatal depression last for more than 14 days and are more severe.
A Word From Verywell
Perinatal depression is a common disorder, but one that might not be recognized early because people are reluctant to talk about the changes in their mood after pregnancy, do not know the signs of depression, or think that they just have a mild case of the “baby blues.”
If you or a loved one who has recently given birth have symptoms of depression that do not get better shortly after delivery, it’s important to talk to your healthcare provider. They can screen you for perinatal depression and refer you to a qualified mental health professional for further assessment.
Untreated perinatal depression can have a negative effect on people who are or have recently been pregnant, as well as their infants. However, when it’s recognized and diagnosed, it is treatable.
