Depression and Anxiety During Pregnancy and After Birth

You imagined pregnancy would be a time of joy and excitement—so why do you feel so anxious, sad, or overwhelmed? If you're struggling with difficult emotions during pregnancy or after having your baby, you're not alone, and you're not failing at parenthood. Perinatal mood and anxiety disorders affect up to 1 in 5 women, making them among the most common complications of pregnancy and childbirth. AAP

This guide will help you understand what's happening, recognize the signs, and find the support you deserve. Because getting help isn't a sign of weakness—it's one of the strongest things you can do for yourself and your baby.

Understanding Perinatal Mood Disorders AAP

"Perinatal" refers to the time during pregnancy through the first year after birth. Mood and anxiety disorders during this period are medical conditions—not character flaws or signs that you're not cut out for parenthood.

Common perinatal mood and anxiety disorders include:

• Prenatal depression: Persistent sadness, hopelessness, or loss of interest during pregnancy
• Prenatal anxiety: Excessive worry, panic attacks, or intrusive thoughts while pregnant
• Postpartum depression: Depression that develops after birth, sometimes weeks or months later
• Postpartum anxiety: Overwhelming worry about your baby's health and safety
• Postpartum OCD: Intrusive, unwanted thoughts (often about harm coming to your baby)
• Postpartum PTSD: Can occur after a traumatic birth experience
• Postpartum psychosis: A rare but serious emergency requiring immediate care

These conditions are caused by a combination of hormonal changes, sleep deprivation, life stress, and genetic factors. ACOG They can happen to anyone—regardless of age, income, or whether this is your first baby or fourth.

Baby Blues vs. Something More Serious

Almost 80% of new mothers experience the "baby blues"—mood swings, crying spells, anxiety, and difficulty sleeping in the first two weeks after birth. AAP This is normal and typically resolves on its own.

Baby blues typically include:

• Mood swings and tearfulness
• Feeling overwhelmed
• Irritability
• Anxiety about caring for your baby
• Trouble sleeping (beyond what's expected with a newborn)
• Usually resolve within 2 weeks

Postpartum depression is different:

• Symptoms last longer than 2 weeks
• Feelings are more intense and persistent
• May include thoughts of harming yourself or your baby
• Interferes with your ability to function or care for your baby
• Doesn't go away on its own without treatment

If your symptoms last beyond two weeks or are severe at any point, please reach out for help. AAP

Recognizing the Signs in Yourself

Depression and anxiety don't always look the way you'd expect. You might not feel "sad"—you might feel numb, irritable, or just empty. You might be going through the motions but feel disconnected from your baby or your life.

Signs of perinatal depression:

• Persistent sadness, emptiness, or hopelessness
• Loss of interest in things you used to enjoy
• Withdrawing from family and friends
• Difficulty bonding with your baby
• Feeling like a bad mother or that your baby would be better off without you
• Changes in appetite—eating much more or much less
• Sleeping too much or inability to sleep even when baby sleeps
• Overwhelming fatigue or loss of energy
• Difficulty concentrating or making decisions
• Thoughts of death or suicide

Signs of perinatal anxiety:

• Constant worry that something bad will happen
• Racing thoughts you can't turn off
• Feeling on edge, restless, or keyed up
• Physical symptoms: racing heart, shortness of breath, dizziness
• Difficulty sleeping because of worry
• Avoiding certain activities, places, or people
• Intrusive, unwanted thoughts (especially about harm to your baby)
• Needing constant reassurance

Signs in partners and fathers:
Perinatal mood disorders don't just affect the person who gave birth. Partners and fathers can also experience depression and anxiety during this transition. AAP Symptoms may look different—more irritability, anger, or withdrawal—but are just as valid and treatable.

What Causes These Conditions?

There's no single cause, but several factors increase risk: ACOG

Biological factors:

• Dramatic hormone shifts during pregnancy and after birth
• Thyroid changes (should be checked if you're experiencing symptoms)
• Sleep deprivation
• Physical recovery from birth

History and circumstances:

• Previous depression or anxiety (at any time in your life)
• Family history of mood disorders
• Difficult pregnancy or birth complications
• Baby health problems or NICU stay
• Lack of social support
• Financial stress
• Unplanned pregnancy
• History of trauma or abuse

Life stressors:

• Major life changes beyond the new baby
• Relationship difficulties
• Work stress or returning to work
• Moving or lack of stable housing

Having risk factors doesn't mean you'll definitely experience perinatal mood disorders, and many people develop them without obvious risk factors. This is not your fault.

When to Get Help Immediately

Some symptoms require immediate attention. Please seek emergency help if you experience: ACOG

• Thoughts of harming yourself or your baby
• Hearing or seeing things that aren't there
• Paranoid thoughts or feeling like people are out to get you
• Confusion or disorientation
• Inability to sleep for days
• Manic behavior (racing thoughts, not needing sleep, risky decisions)
• Thoughts of suicide

In an emergency:

• Call 988 (Suicide and Crisis Lifeline)
• Go to your nearest emergency room
• Call your doctor or midwife immediately
• Don't leave yourself or your baby alone

Postpartum psychosis is rare (affecting 1-2 per 1,000 births) but is a medical emergency. It usually appears within the first two weeks after birth and requires immediate treatment. ACOG

Getting Help and Treatment AAP

The good news: perinatal mood and anxiety disorders are highly treatable. Most people feel significantly better with appropriate care.

Talk to your healthcare provider:
Your OB, midwife, or primary care doctor can screen you, rule out physical causes (like thyroid problems), and connect you with treatment. You can also talk to your baby's pediatrician—they see new parents struggling and can help.

Treatment options include:

• Therapy: Talk therapy, especially cognitive behavioral therapy (CBT) and interpersonal therapy, is very effective. You can do therapy in person, online, or even through apps.

• Medication: Antidepressants are safe to use during pregnancy and breastfeeding. AAP The benefits of treating depression typically outweigh any small risks. Your doctor can help you weigh options.

• Support groups: Connecting with other parents who understand can be incredibly healing. Organizations like Postpartum Support International offer free support groups.

• Lifestyle support: While not a replacement for treatment, these help: regular sleep (when possible), physical activity, healthy eating, reducing isolation, and accepting help.

Finding a therapist:

• Ask your OB or pediatrician for referrals
• Contact your insurance company for covered providers
• Look for therapists specializing in perinatal mental health
• Postpartum Support International has a provider directory

Supporting a Partner Who's Struggling

If your partner is experiencing depression or anxiety, you play a crucial role in their recovery:

• Believe them: Don't minimize their feelings or tell them to "snap out of it"
• Encourage professional help: Offer to help make the appointment, provide childcare, or go with them
• Provide practical support: Take on extra baby care and household tasks
• Be patient: Recovery takes time
• Take care of yourself too: You can't pour from an empty cup

Watch for warning signs and don't hesitate to seek emergency help if you're concerned about their safety or your baby's safety.

What Other Parents Ask

Q: Will taking medication during pregnancy or breastfeeding hurt my baby?
A: Many antidepressants are considered safe during pregnancy and breastfeeding. The risks of untreated depression—including preterm birth, low birth weight, and bonding difficulties—often outweigh the small risks of medication. Your doctor can help you choose the safest option. ACOG

Q: I'm having scary thoughts about my baby. Does this mean I'm dangerous?
A: Intrusive thoughts are a common symptom of postpartum anxiety and OCD. Having a thought doesn't mean you'll act on it. These thoughts are distressing *because* you don't want to harm your baby. Still, please talk to a healthcare provider—treatment can make these thoughts go away. AAP

Q: My baby is several months old. Is it too late to be postpartum depression?
A: Postpartum depression can begin anytime in the first year after birth, and sometimes later. It's never too late to get help.

Q: Will this affect my baby?
A: Untreated perinatal mood disorders can affect bonding and your baby's development. But here's the important part: getting treatment protects both of you. With support, you can have a healthy relationship with your baby. AAP

The Bottom Line

Struggling with your mental health during pregnancy or after having a baby doesn't mean you're a bad parent. It means you have a medical condition that deserves treatment—just like gestational diabetes or preeclampsia.

You don't have to white-knuckle through this. Effective help is available, and most people feel significantly better with treatment. The strongest thing you can do for your baby is to take care of yourself.

If you're not sure where to start, just tell someone—your partner, your doctor, your baby's pediatrician, a friend. Let Clara help you think through your next steps. You deserve support.