Perinatal depression

Includes antenatal and postnatal depression and anxiety

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 about perinatal depression or anxiety

  1. Perinatal means anything to do with pregnancy, birth and the first years of a baby's life.
  2. 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.
  3. About 10% of fathers may also develop perinatal depression and or anxiety.
  4. 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.
  5. 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.

Learn more about treatments for perinatal depression 

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.

See more Tips to cope Little Shadows, NZ 

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.

Find affordable/free counselling Mothers Helpers NZ
Low-cost counselling (Wellington region) Little Shadows NZ
Parent’s groups Mothers Helpers NZ
Support and services for mothers at-risk of or have developed postnatal depression Mothers Helpers NZ
Holistic recovery programme: perinatal depression and anxiety recovery and prevention course Mothers Helpers NZ
Support for Dads Mothers Helpers NZ
The Journal Free personalised online programme to help you to stay positive, create lifestyle changes and learn steps for problem-solving.
Support and education for women with experience of depression ThroughBlue, NZ
Perinatal Anxiety and Depression Aotearoa (PADA)

Learn more

Postnatal depression depression.org.nz
It’s time to talk about anxiety and depression in new dads The Spinoff, NZ, 2020

References

  1. 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.
  2. Depression in the antenatal and postnatal periods BPAC, NZ, Nov 2010
  3. Perinatal anxiety and depression The Royal New Zealand College of Obstetricians and Gynaecologists, 2015
  4. What is postnatal depression?  depression.org.nz
  5. Postnatal depression Perinatal Anxiety and Depression Aotearoa (PADA)
  6. Postnatal depression and perinatal mental health Mind UK, 2016
  7. Langan RC, Goodbred AJ. Identification and management of peripartum depression Am Fam Physician. 2016 May 15;93(10):852-858.
  8. Understanding postnatal depression Mind, UK, 2013

Reviewed by

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