Perinatal Depression
Major depressive disorder during pregnancy and postpartum period
This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.
This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Psikiyatri department. Book Appointment →
What is Perinatal Depression?
Perinatal depression includes major depressive disorder occurring during pregnancy (antenatal/prenatal depression) or postpartum period (postpartum depression, PPD), with PPD typically beginning within 4-6 weeks after delivery but defined to occur within the first year. Prevalence is 7-13% during pregnancy and 10-15% in postpartum period, with higher rates in adolescent mothers (24-30%), low-income women, and those with prior depression history. Perinatal depression is distinct from postpartum blues (transient, mild, lasting 2 weeks) and postpartum psychosis (severe, rare, occurring 1-2 per 1000 births).
Pathogenesis involves complex interaction of biological factors (hormonal fluctuations including estrogen, progesterone, cortisol changes; thyroid dysfunction; inflammatory cytokines; genetic predisposition with familial transmission), psychosocial factors (relationship problems, intimate partner violence, social isolation, lack of support, financial stress, unintended pregnancy), psychological factors (history of depression or anxiety, previous postpartum depression, perfectionism, low self-esteem), and obstetric factors (pregnancy complications, traumatic birth, neonatal complications, breastfeeding difficulties, sleep deprivation).
Clinical features include persistent sadness, anhedonia, fatigue, sleep disturbance disproportionate to infant care demands, appetite changes, feelings of guilt and worthlessness (especially as a mother), difficulty bonding with baby, intrusive thoughts about harm to baby (rare to act on), suicidal ideation, irritability, and anxiety. Suicide is leading cause of maternal death in first postpartum year. Universal screening with Edinburgh Postnatal Depression Scale (EPDS) at antenatal and postpartum visits is recommended. Treatment includes psychotherapy (CBT, interpersonal therapy as first-line), antidepressants when needed (sertraline, escitalopram preferred during pregnancy and breastfeeding), brexanolone (allopregnanolone analog approved 2019 for severe PPD), zuranolone (oral, approved 2023), social support, lactation consultation, and treatment of comorbid anxiety. Untreated perinatal depression has significant consequences for mother, infant attachment, child development, and family functioning.
Symptoms
Risk Factors
When to See a Doctor?
If you experience any of the following symptoms, seek medical attention promptly:
- Persistent sadness during pregnancy or postpartum
- Difficulty bonding with baby
- Sleep problems beyond newborn-related sleep deprivation
- Tearfulness lasting beyond two weeks postpartum
- Suicidal thoughts (immediate evaluation)
- Thoughts of harm to baby
- Significant anxiety affecting daily functioning
- Inability to care for self or baby
- Family member concerns
- Significant relationship problems
- Substance use during pregnancy or postpartum
- Severe postpartum mood disorder symptoms
- Prior history of perinatal depression
- Postpartum psychosis symptoms (emergency)
Treatment Methods
Which Department to Visit?
You can visit our Psikiyatri department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.
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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.