Perinatal depression or anxiety is moderate to severe depression or anxiety experienced during pregnancy or within the first year or so after childbirth. It is more common than most people realise. With treatment and support, you can make a full recovery.
Key points
Perinatal means anything to do with pregnancy, birth and the first years of a baby's life.
Perinatal depression or anxiety can happen any time during pregnancy or up to a year after pēpi (baby) is born. It can also occur after a miscarriage.
About 10% of fathers may also develop perinatal depression and or anxiety.
If you are experiencing signs of perinatal depression or anxiety, seek help as early as possible. The earlier treatment is started, the sooner you will start to feel better.
Perinatal depression or anxiety is usually treated with a combination of practical support and advice, talk therapy and support groups. If necessary, antidepressants may be helpful.
What is perinatal depression or anxiety?
Most parents experience a degree of worry with ups and downs in their mood when expecting a baby or coping with a newborn. Postnatal or maternity 'blues' are very common and involve a brief period of the mother feeling down and tearful in the week after her baby is born. This feeling passes after a few days.
However, some women develop a more pronounced anxiety or depressed mood that affects their daily life and functioning. This is known as perinatal depression or perinatal anxiety. These are much more serious conditions, and you can become seriously depressed or anxious. This can start during pregnancy but is more common in the months following childbirth.
Postnatal psychosis (sometimes called postpartum psychosis) is rare and involves symptoms of psychosis (being out of touch with reality) associated with significant changes in mood – either a depressed or an extremely high mood. It usually begins in the first 2 weeks after your child is born. Read more about postnatal psychosis (Mental Health Foundation, NZ).
What causes perinatal depression or anxiety?
About 10 to 15% of women will develop anxiety or depression in the months after the birth of a baby. It may also start during pregnancy, and, if untreated, continue and perhaps get worse after the baby is born.
Perinatal depression or anxiety is likely to be associated with several factors, such as your previous history of anxiety and depression and factors in your environment, such as how much other stress there is in your life and how much support you have.
What increases my risk of perinatal depression or anxiety?
In terms of life stress, pregnancy, childbirth and parenting all rate highly, with many adjustments to be made and stressful situations to be coped with. It’s not surprising then that those with the following extra factors in their life are at risk of developing perinatal depression or anxiety.
The hormonal changes your body goes through may also play a small role in the development of perinatal anxiety and depression.
General risk factors include:
past history of anxiety, depression or other mental health problems
relationship difficulties, especially with the father of the baby or with your own mother
having little social support
life stresses or difficulties such as money or housing problems.
Risk factors related to pregnancy and birth include:
previous loss, including infertility, IVF, miscarriage, termination, stillbirth or death of baby
birth complications, such as Caesarean delivery
the birth not going as planned (eg, birth in hospital or with intervention when a home or natural birth was hoped for)
birth of a brain-damaged, disabled or ill baby.
Risk factors after birth include:
persisting postnatal blues
having a baby in neonatal intensive care (NICU)
relationship difficulties
competing demands (from other children, your partner, family, etc)
sleep problems
underlying medical problems (like diabetes, high blood pressure, etc)
a baby that is fussy, has problems feeding or has colic or reflux
isolation and lack of social connections.
Getting help early can reduce how severe your symptoms get and improve your chances of a faster recovery.
What are the symptoms of perinatal depression or anxiety?
The symptoms of perinatal depression are the same as for depression and they can develop during pregnancy or in the post-natal period. This can be from shortly after pēpi is born to up to around about 1 year later.
The symptoms of depression include those related to:
your feelings (mood)
your body (physical)
your thoughts and beliefs (cognitive).
Many women will also have anxiety symptoms. For a diagnosis to be made, mood symptoms and some or all of the other signs must have been present for at least 2 weeks.
Read more about the symptoms of perinatal depression If you have some of these symptoms, talk to your doctor, midwife or Well Child Tamariki Ora provider.
How is perinatal depression or anxiety diagnosed?
If you are concerned and think you (or someone you care about) may have perinatal depression or anxiety, talk to your midwife, doctor, Plunket nurse or Well Child Tamariki Ora provider.
Wondering if you have depression or anxiety?
The following online self-tests give an indication of your mood and whether you would be advised to seek help:
Note: These are screening tests only and the results do not provide a diagnosis.
There is no medical test that can diagnose depression. To make a diagnosis, your health professional needs a full understanding of the difficulties you are experiencing. They will ask whether you are experiencing any of the signs of depression listed above. You may find it helpful for your family/whānau or close friend to be involved in this discussion.
If you are experiencing signs of perinatal depression or postnatal psychosis, seek help as early as possible. These conditions can both be effectively treated, and you are likely to recover.
You may fear that your baby will be taken away if you admit to feeling depressed, anxious or having distressing thoughts, for example, about harming yourself or the baby. But fear of asking for help may be part of the problem, and you may need encouragement and support in getting it. The earlier treatment is started, the better your chances of recovery.
"I don’t think I’m depressed or anxious, but I’m struggling – what can I do?"
Many parents are surprised by how difficult they find adjusting to their new roles as parents or to the birth of another child. It’s common for mums (and dads) to feel overwhelmed and out of their depth.
If you’re finding parenting hard and need extra support, talk to your midwife, doctor or Well Child Tamariki Ora provider. There are many services available that can make all the difference when you’re struggling. The sooner you talk to someone and get some extra supports put in place – be it a parenting group, a meal train or an online forum – the sooner you’ll start to feel better.
See also our self-care and support sections below.
What is the treatment for perinatal depression or anxiety?
Perinatal depression or anxiety are not only distressing conditions, they can also be disabling, so the earlier you get help the better. If perinatal depression or anxiety is acknowledged and addressed, it is likely to pass sooner and be less severe than if you get no help. It is then also less likely to affect the relationship between you and your baby.
There are many health professionals who are familiar with these issues and who can provide you with support in several different ways. These may include your GP, midwife, counsellor or complementary practitioner.
Research suggests that the treatment most women prefer for perinatal depression or anxiety is a combination of practical support and advice, talk therapies and support groups. If necessary, antidepressants may be helpful.
Self-care – how can I look after myself if I have perinatal depression or anxiety?
If you have depression or anxiety, it can be hard to do the very things you need to do to take care of yourself. Your motivation tends to bottom out, leaving you stuck in a whirlpool of negative thoughts about yourself, your baby and your world.
You might feel quite overwhelmed with a loss of self-confidence and a sense that you are unable to do or change anything. Your thoughts may be full of "have to" and "should" but at the same time you may feel unable to do the things that will help you feel better.
As much as you can, try to put these feelings and thoughts to the side and choose to act. By choosing every day to do one small thing for yourself, you will slowly start to feel better.
From the following ideas find what works best for you when you feel down or anxious. You may find it helpful to develop a list of things that help you and keep it pinned to the fridge.
Track your mood. You may find there are times of the day when you feel better and can get more done. Likewise, you may find triggers or activities you find more draining. Discuss these findings with your doctor or health providers.
Keep active. Physical activity is very helpful for everyone and an excellent way to help manage anxiety and low mood, reduce stress hormones etc.
Establish good sleep routines. While interrupted sleep is normal once you have a baby, there are things you can do to foster good sleep routines. Try to develop a good bedtime routine which gives you time to unwind before bed and keeps bedtime and wake times relatively regular.
Structured problem-solving. Some people are naturally good problem solvers. Most of us are not when we are tired, stressed or depressed. This is an evidence-based approach and easy to learn. View our structured problem-solving factsheet for 6 easy steps.
Plan activities. Plan some specific 'you time' activities a week ahead. Having something to look forward to, someone to catch up with, or some relaxation time while someone cares for baby are all great activities to improve balance and wellbeing. Planning ahead and writing it down also helps with getting the day to day activities done. Set yourself small goals each day you can achieve and feel good about.
Develop a good support system. This is so important. Reach out to friends and family, accept their offers of help and build your support network. Join a local mothers' group, playgroup or coffee group. Ask your Plunket Nurse or contact Parent's Centre for groups near you, or join Mothers Helpers private Facebook group – NZ PND Support and Social Group. Spend time with people who make you feel good and are emotionally supportive.
WRAP: Wellness recovery action plan. This is another proven strategy anyone can set up and benefit from. Write a list of things that help you when you're having a bad day or feeling down eg, ring a friend, take the baby for a walk, play some music, dance, do something creative, put some nice clothes on and do your hair, journaling, join a class and learn something new.
Find ways to give and help others. There is always someone worse off and better off than yourself. Look for little ways to help brighten someone else's day and in doing so it often brightens yours.
How long will perinatal depression or anxiety last?
The length of time women are affected by perinatal depression or anxiety varies. Without treatment, it may continue for 6 months or more. With treatment, 70–80% of women will recover much sooner. Most women make a complete recovery.
Roughly 20–30% of women will improve but still have some symptoms of depression persisting for months or even years later. For a minority (5–10%) there is no improvement, with symptoms continuing for 2 or more years.
Early access to treatment increases the chance of full recovery. Some women have a single episode and remain well following the birth of future children. However, some will have postnatal depression or anxiety following any future births, particularly if you still have the same risk factors in your life. Others will go on to have other episodes of depression outside of the specific perinatal period.
What about fathers?
Only mothers can formally be diagnosed with perinatal depression or anxiety. However, research suggests that between about 10% of men experience depression during the first year after the birth of a child.
Some new fathers appear to be more vulnerable to depression than others. Being young, unemployed and/or poor when the child is born increases the risk of depression after becoming a dad. It may be that young fathers are more at risk because being young might mean that it is less likely that the child was planned. A young dad might therefore not feel ready to take on the new responsibilities that come with fatherhood.
If the new mother is depressed, this might make the role as a father more stressful, which in turn can add to the risk of experiencing depression. Other possible causes include increased responsibility, the expense of having children and the change in lifestyle that it brings, the changed relationship with your partner, as well as lack of sleep and the increased workload at home. Few services exist for men, although awareness and understanding of this problem is improving slowly. Talk to your doctor if you are a new dad and feel anxious or depressed.
What support is available for perinatal depression or anxiety?
Sometimes people can’t tell you’re not okay from the outside. Talking with a trusted friend or family member, combined with professional counselling and other resources, provides broad support.
If you need to talk to someone immediately – call or text 1737 to reach a trained counsellor.
Cox J, Holden J, Sagovsky R. (1987) Detection of postnatal depression: development of the 10-item Edinburgh postnatal depression scale. Brit J Psychiatry 150: 782-86.
Dr Mark Huthwaite is a senior lecturer in psychiatry in the Department of Psychological Medicine and the Associate Dean of Student Affairs at the University of Otago, Wellington. He is also a perinatal psychiatrist in CCDHB’s Regional Specialist Maternal Mental Health Service and is a committee member of the RANZCP’s Special Interest Group in Perinatal and Infant Psychiatry. Mark is a founding member of the World Maternal Mental Health Day Committee. He has published research on sleep in pregnancy, the use of psychotropic medication in pregnancy and the use of hyponsedative medication.
Credits: Health Navigator Editorial Team . Reviewed By: Dr Mark Huthwaite, perinatal psychiatrist, Regional Specialist Maternal Mental Health Service, Wellington
Last reviewed: 24 Jan 2020
What are the symptoms of perinatal depression or anxiety?
The signs or symptoms of perinatal depression are similar to those for depression. Symptoms can vary from person to person and over time. Not everyone with depression will complain of sadness or a persistent low mood. They may have other signs of depression such as sleep problems. Others will complain of vague physical symptoms.
The symptoms of depression include those related to :
your feelings (mood)
your body (physical)
your thoughts and beliefs (cognitive).
Some women also have anxiety symptoms. For a diagnosis of depression to be made, mood symptoms and some or all of the other signs must have been present for at least 2 weeks.
Mood symptoms of perinatal depression
Persistent low, sad or depressed mood. People have different ways of describing this, especially if you are from non-European cultures. Some women describe feeling sad, empty, having no feelings, or may complain of pain which is hard to locate. Others may cry for no apparent reason. Some may feel sad or low in mood all of the time, while others have periods where their mood is more normal but the periods of feeling good do not last more than a day or two.
Loss of interest and pleasure in usual activities. This is a reduced ability to enjoy things which you would usually find pleasurable, and can be quite distressing. It includes loss of interest in sex, although this often lessens for a period after childbirth as a result of hormonal changes.
Irritable mood. This may be the main mood change for some. You may feel angry, short-tempered and irritable. If it continues, it can make dealing with the frustrations of caring for a baby very difficult, and may also be very damaging to other relationships.
Physical symptoms of perinatal depression
Change in sleeping patterns. The most common change is reduced sleep, with difficulty getting to sleep, disturbed sleep, and/or waking early and being unable to return to sleep. For a few women, sleep is increased. Most people with depression wake feeling unrefreshed from their sleep. While it is usual for mothers to have their sleep interrupted by a waking baby, women with perinatal depression often find they cannot sleep even when the baby is settled. For example, you may lie awake worrying about the next feed or the next day.
Change in appetite, often not feeling like eating and, as a result, losing weight. Some women will have increased appetite, often without taking any pleasure in eating. This is often seen in those who also sleep more.
Decreased energy, tiredness and fatigue may be so severe that even the smallest task seems too difficult to complete, causing great difficulty in caring for the baby. Women with postnatal depression need a lot of assistance with caring for the baby and any other children.
Physical slowing or agitation often comes with severe depression. The person may sit in one place for periods and move, respond and talk very slowly; or they may be unable to sit still, pace and wring their hands. The same person may experience alternating slowing and agitation.
Bodily symptoms such as generalised aches and pains, headaches and generally feeling unwell.
Cognitive symptoms of perinatal depression
Thoughts of worthlessness or guilt involve loss of self-confidence and excessive guilt about past minor wrongs. As a result of feeling bad about themselves, women may withdraw from doing things and from contact with others. They may also feel they are a bad mother.
Thoughts of hopelessness and death and feeling there is no hope in life. The woman may wish she were dead or have thoughts of suicide. While many women with postnatal depression have thoughts of harming themselves (and sometimes their baby), often it is not that they want to die or hurt the baby, but rather they want the situation to change.
Difficulty thinking clearly. Some women may have difficulty in concentrating. They may not feel able to read the paper or watch television. They may also have great difficulty making even simple everyday decisions.
Anxiety symptoms of various kinds are also very common as part of depression (80 to 90% of people with depression) but as the depression resolves, these symptoms stop. They may include:
Excessive worry or fear, with associated physical symptoms such as muscle tension, pounding heart or dry mouth. The focus of worry will often be the baby.
Panic symptoms or even panic attacks, with sudden episodes of extreme anxiety and panic and physical symptoms of fear. Again, the focus is often to do with the baby,
Phobias. Specific fears about situations, fear of open spaces, confined spaces, heights, objects, animals or creatures such as spiders.
Excessive concern about physical health. The woman may worry she is physically ill in some way, or that her baby is ill or has something terribly wrong with him/her.
Symptoms of perinatal anxiety
These include:
anxiety or fear that interrupts thoughts and interferes with daily tasks
panic symptoms or attacks – outbursts of extreme fear and panic that are overwhelming and feel difficult to bring under control
anxiety and worries that keep coming into your mind and are difficult to stop or control
constantly feeling irritable, restless or on edge
having tense muscles, a tight chest and heart palpitations
finding it difficult to relax and/or taking a long time to fall asleep at night
anxiety or fear that stops you going out with your baby
anxiety or fear that leads you to check on your baby constantly.
If you have some of these symptoms, talk to your doctor, midwife or Well Child Tamariki Ora provider.
Self-tests
The Edinburgh Postnatal Depression Scale (EPDS)
This is one of the most well-known screening tools for perinatal depression or anxiety. It consists of a set of 10 screening questions that can help assess symptoms that are common in women with depression and anxiety during pregnancy and in the first year after having a baby (Questions 3, 4 and 5 address anxiety specifically). This is not intended to provide a diagnosis – only trained health professionals should do this.
What are the treatment options for perinatal depression and anxiety?
Counselling & talking therapies
There are a range of talking treatments that have been shown to work for all types of depression and anxiety. Cognitive behaviour therapy is one of the most well known. Talking therapies are provided through face-to-face, phone, group or online programmes.
Often you can refer yourself to a private counsellor or psychologist. For funded services, ask your health provider what the options are in your region and for a referral.
Learning about perinatal depression and anxiety can you understand what you are experience and can be a huge help in your recovery. Your doctor or other health professional will be able to give you information about perinatal depression or anxiety, suggest ways to cope with it and discuss any complications which could occur. There are also online courses you can take or ask your midwife or doctor about courses or groups in your area.
Sometimes medication is helpful or needed. Talk about the pros and cons with your doctor and together find one that works for you and has the least side effects for your baby.
Once you start taking antidepressant medication, keep taking it every day. It takes several weeks to work and most side effects are mild and go away with time. If you have any concerns about possible side effects, talk with your pharmacist or doctor right away.
The term complementary therapy is generally used to indicate therapies and treatments that differ from conventional Western medicine and that may be used to complement and support it.
Certain complementary therapies may enhance your life and help you to maintain wellbeing. In general, mindfulness, hypnotherapy, yoga, exercise, relaxation, massage, mirimiri and aromatherapy have all been shown to have some effect in alleviating mental distress. When considering taking any supplement, herbal or medicinal preparation talk to your doctor to make sure it is safe and will not harm your health, eg, by interacting with any other medications you are taking.
Note: The resource below is from overseas so some details may be different. Make sure you know the emergency numbers for New Zealand. Ring 111 for emergencies, or freephone Healthline on 0800 611 116.
Emily Writes shares a group post on The Spinoff that outlines the many ways perinatal anxiety, depression and psychosis have affected New Zealand parents. We hope that anyone who sees themselves or their loved ones in these stories will seek help.
To find a maternal mental health service within your area, use the location filter under the map (mobile view) or at the bottom of the search results (computer view).
Source: HealthPoint services directory used with permission.
Information for healthcare providers on depression- perinatal
The content on this page will be of most use to clinicians, such as nurses, doctors, pharmacists, specialists and other healthcare providers.
Management
This information on perinatal mental health is from Auckland Regional HealthPathways, accessed July 2019:
Patients who are potentially vulnerable to an exacerbation, recurrence or new onset of mental illness require ongoing and careful assessment throughout the perinatal period.
Patients experiencing, or vulnerable to, mental distress are best cared for through an integrated approach including (some or all of) lead maternity carer (LMC), general practitioner, antenatal clinic, and mental health services, during and after pregnancy.
Mild to moderate anxiety or depression
If mild anxiety or depression, consider supportive counselling, brief intervention therapy, and support groups. Medication is not the preferred first treatment option.
Goodfellow Gem: Exercise is effective for treating post-partum depression
This evidence comes from a review of exercise for post-partum depression from 12 studies. It was found that exercise interventions during and after pregnancy had a large effect size which translated to 41% of participants improving (numbers needed to treat of 2.5). The types of exercise ranged from stretching and breathing exercises, a walking programme, cardiovascular exercises, mixed cardiovascular and strength exercises, Pilates, yoga and home-based programmes.
Session frequency varied from 1–5 days per week and intensity levels included low, moderate or moderate to high. Physical activity interventions were individualised in 3 studies. Kelly McGonigal from Stanford suggests that for stress in general, exercise done with others gets an additional benefit from the social connection.
Further attention is required to providing appropriate primary health care for Pacific women of child-bearing age in NZ. Better screening processes and a greater understanding of effective antenatal support for Pacific women is recommended to respond to the multiple risk factors for antenatal depression among Pacific women.
Depression during or after pregnancy, known as perinatal depression, is widespread in New Zealand; and the consequences are significant. Postnatal depression is the most common postpartum mental disorder, and recent findings suggest antenatal depression is even more common. Suicide is the leading indirect cause of perinatal death in New Zealand (Perinatal and Maternal Mortality Review Committee (PMMRC) report, 2017).
Early identification and treatment of perinatal depression is intuitive and important. It leads to better outcomes for women and their children and whānau, and is more cost-effective than picking up the pieces later on.
This report focuses on the role of mobile health (mHealth) technology, such as mobile phones, tablets and applications (‘apps’), to better detect perinatal depression and to deliver prevention interventions, follow-up, treatment and support.
Pregnancy and the postnatal year represent a critical time in the health and development of families, and a time when psychologists can play an important role in the primary health care team. This paper discusses some key issues of interest in perinatal mental health care, encouraging clinicians and researchers to broaden the focus beyond postnatal depression to perinatal emotional disorders, and to become informed and involved in promoting recognition of, and appropriate treatment for, parents who are struggling with psychological distress
The purpose of this report is to add to current knowledge around postnatal depression (PND) in New Zealand by providing an indication of PND prevalence as well as an overview of the social and life experiences, as well as help-seeking knowledge and attitudes, of women who might be experiencing PND. To this end, the current report uses data from the New Mothers’ Mental Health Survey (NMMHS), a cross-sectional survey conducted between July and September 2015.
Continuing professional development
Become a PND Recovery Course Facilitator
Mothers Helper’s PND Recovery Course training is now available to all qualified counsellors, social workers, psychologists and mental health nurses interested in becoming a facilitator. Learn more
Goodfellow Seminars
Perinatal mood and anxiety disorders – Dr Mark Huthwaite
(Goodfellow Unit Webinar, 2019)
Regional HealthPathways NZ
Access to the following regional pathways is localised for each region and access is limited to health providers. If you do not know the login details, contact your DHB or PHO for more information:
