Pregnancy can stir up a host of emotions ranging from excitement to worry. But for some women, they may find themselves struggling with perinatal depression — a mood disorder that can start during pregnancy or the first 12 months after giving birth.
This isn’t the same thing as the “baby blues” — a term used to describe “the worry, sadness and tiredness many women experience after having a baby,” notes the Centers for Disease Control and Prevention. "Baby blues takes place in the first two weeks postpartum and is considered normal and resolves with time," Dr. Karen Horst, assistant professor of obstetrics and gynecology at Baylor College of Medicine and staff psychiatrist at Texas Children’s Hospital, tells Yahoo Life. "The key to distinguishing baby blues from postpartum depression is the fluctuation, not just timing. Baby blues symptoms should come and go. By contrast, postpartum depression feels like a setting change in mood state and is more consistent."
The condition is getting some attention after Britney Spears revealed on Monday in an Instagram post that she is pregnant. In the post, Spears shared that she has experienced perinatal depression in the past: “It’s hard because when I was pregnant I had perinatal depression. ... I have to say it is absolutely horrible.”
Spears wrote that “women didn’t talk about it back then,” and noted how women talk more openly about perinatal depression now. She said that she’s grateful “we don’t have to keep that pain a reserved proper secret” anymore.
What is perinatal depression?
Perinatal depression is a mood disorder that can happen during a woman’s pregnancy (prenatal depression) or up to a year after giving birth (postpartum depression).
Depression is one of the most common serious complications of pregnancy, according to a 2021 study published in the Journal of Women’s Health. Perinatal depression affects up to 20% of women in the U.S., according to a 2020 study in the Cleveland Clinical Journal of Medicine.
What are the signs to watch out for?
Experts say there are certain symptoms to be aware of when it comes to perinatal depression, which tend to last more than 14 days and affect a woman’s quality of life.
“The symptoms are similar to those seen outside of pregnancy, and may include feeling ‘down’ or depressed, losing interest in things that used to make one happy, changes in weight, appetite or sleep, feeling tired or guilty, increased fidgeting and cognitive deficits,” Dr. Danielle Panelli, an instructor of obstetrics and gynecology at Stanford Children’s Health, tells Yahoo Life. “Thoughts of suicide, even if passive without a plan, are strong signs of depression.”
In the perinatal period, “a sense of detachment from the infant or lack of bonding may also be a sign,” says Panelli. Horst adds other symptoms include "excessive worry about the baby, crying/tearfulness, flat affect" — meaning a blank expression and decreased speech — and "excessive guilt or expressions of feeling inadequate." A diagnosis of depression is usually made when several of these symptoms occur together and last at least two consecutive weeks.
They can also be easily overlooked. “Some of these symptoms, such as fatigue or sadness related to weight changes, can be perceived as normal by many people, especially in the third trimester and postpartum,” says Panelli, “which is why awareness of the signs of perinatal depression is so important.”
What causes perinatal depression?
Several factors can contribute to perinatal depression. “These include fluctuations in hormone levels, increased fatigue from sleep disruption, feelings of anxiety or stress surrounding pregnancy, childbirth or becoming a parent and situational factors such as changes in employment, moving or alterations in social support systems,” explains Panelli.
She adds: “Often multiple factors play a role in the onset of perinatal depression, and often many of these factors are beyond a person’s control.”
Who is more likely to have it?
People with a history of mental health conditions such as depression, anxiety or post-traumatic stress disorder are more vulnerable to developing perinatal depression, according to Panelli.
Other factors associated with perinatal depression include “preexisting diabetes, high blood pressure, family history of mental health conditions or perinatal depression and socioeconomic factors such as being a young parent or single marital status,” she says.
If you experienced perinatal depression in a past pregnancy, are you more likely to have it again?
Yes, says Panelli. People with a history of perinatal depression in a past pregnancy — like Spears — are at “increased risk of recurrence of depression in a subsequent pregnancy,” she says. “This is especially true if the prior depressive episode was triggered by an event that occurred in pregnancy, such as a traumatic birth experience.”
However, Panelli points out that, “with early awareness and screening for this history, management strategies can be implemented during the perinatal period to try and prevent recurrence.”
How is perinatal depression treated?
The good news is that perinatal depression can be treated, typically with medication and/or psychotherapy for moderate to severe symptoms. “The first step towards treatment is acknowledging symptoms,” says Panelli. “Treatment usually depends on severity, but options generally include psychotherapy and antidepressant medications such as serotonin re-uptake inhibitors,” noting that it is “up to the patient and their provider to determine what the specific treatment choice should be.” That includes weighing the risks and benefits of taking an antidepressant with their health care provider.
In either case, Panelli points out that “it can take weeks for people to see improvements in their symptoms.” For example, antidepressants usually take six to eight weeks to work, according to the National Institute of Mental Health — “so close follow-up is important during this period.”
For mild to moderate symptoms, Horst says that mental health support, which comes in many forms, can help. That includes "validation of the mom's feelings, that they are real and not her fault by a medical professional, spouse, extended family member or friend," says Horst, as well as identifying social supports that the mom can use for "reassurance, education [and] a break from childcare in order to sleep or take care of herself."
Therapists who have experience working with patients in the peripartum period can also help, says Horst, noting that Postpartum Support International has a referral network, along with utilizing other professional support options for new moms, including a lactation consultant, postpartum support groups and neighborhood parent groups.
If you or someone you know is having suicidal thoughts, call 911 or the National Suicide Prevention Lifeline at 1-800-273-8255 or text HOME to the Crisis Text Line at 741741.
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