Perinatal Mental Health:
Signs, Symptoms and Treatment
Perinatal Mental Health (PMH) conditions are the number one complication of childbearing.
Below you will find a list of Perinatal Mental Health conditions that can occur during the perinatal period (including pregnancy, post-loss, and postpartum) and affect not only the pregnant person but also other family members, including dads and partners.
Perinatal Mental Health Conditions
Learn more about Perinatal Mental Health (PMH) conditions, including prevalence, symptoms, risk factors, and potential treatment options.
Perinatal Depression
(Pregnancy, Post-loss and Postpartum)
Perinatal depression, including postpartum depression, occurs more often than most people realize. Studies show that 1 in 5 women and 1 in 10 men may experience depression and anxiety during the perinatal period. However, the numbers are likely higher and increase for high-stress parenting groups.
It is important to know the signs and symptoms of Perinatal Depression. Perinatal Depression is treatable, and help is available. You do not need a diagnosis to reach out for help.
Symptoms
Symptoms can start anytime during the perinatal period and they may differ for each person. They might include the following:
- Feelings of anger, irritability and/or rage
- Lack of interest in the baby
- Disturbances of sleep and appetite
- Crying and sadness
- Feelings of guilt, shame or hopelessness
- Loss of interest, joy or pleasure in things you used to enjoy
- Possible thoughts of harming the baby or yourself
Risk Factors
Research shows that the items listed below may put you at a higher risk for perinatal depression. It is important to discuss your risk factors with your medical provider so that you can plan ahead for the care you may need.
- A personal or family history of mental health conditions, like depression, anxiety, perinatal depression, bipolar, or OCD.
- Premenstrual dysphoric disorder (PMDD or PMS)
- Inadequate support in caring for the baby
- Financial stress
- History of Abuse
- Marital stress
- Unplanned Pregnancy
- Unwanted Pregnancy
- Complications in pregnancy, birth or lactation.
- A major recent life event including: loss, moving or relocation, and job loss
- Pregnancy and/or infant loss
- Parents of multiples
- Having an infant(s) in the Neonatal Intensive Care (NICU)
- Fertility Challenges
- Thyroid imbalance
- Any form of diabetes (type 1, type 2 or gestational)
In addition, belonging to a high-stress parenting group may also be a risk factor. These groups might include:
- Queer and Trans Families
- Military Families
- Teen Parents
- Parent(s) of Multiples
- Single Parents
- Parents of Color
- Near Miss Survivor
- Those who experience a pregnancy and/or infant loss
Treatment Options
Perinatal depression is treatable, and there are many options to consider when looking for the correct treatment option. You should consult your doctor or therapist, to find the right plan for you. Some may include:
- Social Support & Practical Help: including activities like prioritizing sleep, time for self, reading, podcasts, meditation, asking for help & support groups.
- Mental Health Counseling: Evidence-based therapy types may include CBT (Cognitive Behavioral Therapy) & IPT (Interpersonal Psychotherapy), but others may be an option. The PSI HelpLine, or the PSI Provider Directory, can help you find a qualified perinatal-trained mental health specialist.
- Medical Evaluation and Treatment: Medication may be an option, and you must consult a doctor to see what will work for you. Antidepressants are the most commonly used to treat depression. Medication Resources for lactation and pregnancy are listed here.
- Intensive Treatment Facilities are available and are listed here.
You are not alone. PSI is here to help.
Perinatal Anxiety
(Pregnancy, Post-loss, and Postpartum)
Research shows that 1 in 5 women and 1 in 10 men may experience depression or anxiety during the perinatal period. You may experience perinatal anxiety independently, but it is often combined with perinatal depression. High-stress parenting groups experience perinatal anxiety at a higher rate.
Perinatal anxiety is treatable, and help is available. You do not need a diagnosis to reach out for help.
Symptoms
The symptoms of anxiety during the perinatal period might include:
- Constant worry
- Feeling that something bad might happen
- Racing thoughts
- Disturbances of sleep and appetite
- Inability to sit still
- Physical symptoms could include dizziness, hot flashes diarrhea and nausea
- Feelings of anger, irritability and/or rage
- Nervousness/on edge/anxious, trouble relaxing
Panic Disorder
Many people with anxiety, may also experience panic or anxiety attacks.
This is a form of anxiety with which the sufferer feels very nervous and has recurring panic attacks. During a panic attack, they may experience shortness of breath, chest pain, claustrophobia, dizziness, heart palpitations, and numbness and tingling in the extremities. Panic attacks seem to go in waves, but it is important to know that they will pass and will not hurt you. It may be helpful to know that panic attacks subside after 5-7 minutes.
Risk Factors
Risk factors for perinatal anxiety and panic include a personal or family history of anxiety, previous perinatal depression or anxiety, or thyroid imbalance.
- Lack of partner support
- Lack of social support
- History of abuse
- Teen Parents
- Unplanned pregnancy
- Unwanted pregnancy
- Adverse life events
- High-levels of stress
- Pregnancy complications currently or in the past
- Pregnancy and/or infant loss
- Financial Challenges
- Thyroid imbalance
- Single parent
- Negative or low self-esteem and self-efficacy
- Relationship challenges
In addition, belonging to a high-stress parenting group may also be a risk factor. High-stress parenting groups include:
- Queer and Trans Families
- Military Families
- Teen Parents
- Parent(s) of Multiples
- Single Parents
- Parents of Color
- Near Miss Survivor
- Those who experience a pregnancy and/or infant loss
Treatment Options
Perinatal anxiety is treatable, and there are many options to consider when looking for the correct treatment option. You should consult your doctor or therapist, to find the right plan for you. Some may include:
- Social Support & Practical Help: including activities like prioritizing sleep, time for self, reading, podcasts, mindfulness, relaxation, asking for help & support groups.
- Mental Health Counseling: Evidence-based therapy types may include CBT (Cognitive Behavioral Therapy) & IPT, but others may be an option. Mental Health Counseling: Evidence-based therapy CBT (Cognitive Behavioral Therapy), ERP (Exposure & Response Prevention), and DBT (Dialectical Behavioral Therapy). The PSI HelpLine, or the PSI Provider Directory, can help you find a qualified perinatal-trained mental health specialist.
- Medical Evaluation and Treatment: Medication may be an option, and you need to consult a doctor to see what will work for you. Antidepressants, and possibly anti-anxiety medications, are the most commonly used to treat anxiety. Medication Resources for lactation and pregnancy are listed here.
- Intensive Treatment Facilities are available and are listed here.
You are not alone. PSI is here to help.
Perinatal Obsessive Compulsive Disorder (OCD)
(Pregnancy, Post-loss and Postpartum)
Perinatal OCD is characterized by repetitive, unwanted, intrusive thoughts (obsessions) and irrational, excessive urges to do certain actions (compulsions). These obsessions and compulsions often center around the health and safety of the pregnancy and/or baby.
Some people find these Obsessions and Compulsions worries can get in the way of your everyday functioning (brushing your teeth, driving a car, leaving your house).
Repetitive, intrusive images and thoughts are very frightening and can feel like they come “out of the blue.” Research has shown that these images are anxious in nature, not a break from reality. It is likely that the parent experiencing symptoms may take steps to avoid triggers and what they fear could harm the baby.
Perinatal OCD is treatable, and help is available. You do not need a diagnosis to reach out for help.
Learn more about postpartum harm thoughts. View or download the informative infographic here.
Symptoms
Symptoms of Perinatal Obsessive-Compulsive symptoms can include:
- Obsessions, also called intrusive thoughts, which are persistent, repetitive thoughts or mental images that are often related to the baby. These thoughts are very upsetting.
- Compulsions, where you may do certain things over and over again to reduce your fears and obsessions. This may include things like needing to clean constantly, checking things many times, counting, or reordering things and/or avoiding triggers.
- A sense of horror about these thoughts
- Fear of being left alone with the infant
- Hypervigilance in protecting the infant
Risk Factors
Risk factors for perinatal OCD include a personal or family history of anxiety or OCD. Rates of perinatal OCD are higher among people who had OCD prior to giving birth.
- History of mental health disorders and/or family history of mental health disorders
- Thyroid imbalance
- Premenstrual dysphoric disorder (PMDD or PMS)
- History of Abuse
- Inadequate support in caring for the baby
- Financial stress
- Marital stress
- Complications in pregnancy, birth, or lactation.
- Unplanned Pregnancy
- Unwanted Pregnancy
- A major recent life event including: loss, moving or relocation, and job loss
- Pregnancy and/or infant loss
- Parents of multiples
- Having an infant(s) in the Neonatal Intensive Care (NICU)
- Fertility Challenges
- Thyroid imbalance
Treatment Options
Perinatal OCD is treatable, and there are many options to consider when looking for the correct treatment option. You should consult your doctor or therapist, to find the right plan for you. Some treatment options may include:
- Social Support & Practical Help: including activities like prioritizing sleep, time for self, reading, podcasts, mindfulness, relaxation, asking for help & support groups.
- Mental Health Counseling: Evidence-based therapy CBT (Cognitive Behavioral Therapy), ERP (Exposure & Response Prevention), and DBT (Dialectical Behavioral Therapy). The PSI HelpLine, or the PSI Provider Directory, can help you find a qualified perinatal-trained mental health specialist.
- Medical Evaluation and Treatment: Medication may be an option, and you need to consult a doctor to see what will work for you. Anti-depressant medications are the most commonly used to treat OCD. Medication Resources for lactation and pregnancy are listed here.
- Intensive Treatment Facilities are available and are listed here.
You are not alone. PSI is here to help.
Perinatal Post-Traumatic Stress Disorder (PTSD)
(Pregnancy, Post-loss and Postpartum)
Perinatal PTSD is caused by a traumatic or disappointing experience during pregnancy, delivery or postpartum. These traumas could include pregnancy complications, prolapsed cord, unplanned C-sections, use of vacuum extractor or forceps to deliver the baby, baby going to NICU, feelings of powerlessness and/or lack of support and reassurance during the delivery, severe physical complication or injury related to pregnancy or childbirth.
Perinatal PTSD is treatable, and help is available. You do not need a diagnosis to reach out for help.
Symptoms
Symptoms of perinatal PTSD might include:
- Flashback of a past traumatic event (which in this case may have been the childbirth itself)
- Nightmares
- Avoidance of reminders associated with the event, including thoughts, feelings, people, places and details of the event
- Persistent increased arousal (irritability, difficulty sleeping, hypervigilance, exaggerated startle response)
- Anxiety and panic attacks
- Feeling a sense of unreality and detachment
- Avoidance of aftercare following a birth trauma
Risk Factors
- Childhood sexual abuse or any previous sexual trauma
- Living through or experiencing a traumatic event
- Prior mental health disorder
- Feelings of powerlessness and/or lack of support and reassurance during the delivery
- Having an infant(s) in the Neonatal Intensive Care (NICU)
- Pregnancy and/or infant loss
- Traumatic or disappointing birth experience
Treatment Options
Perinatal PTSD is treatable, and there are many options to consider when looking for the correct treatment option. You should consult your doctor or therapist, to find the right plan for you. Some treatment options, or combination of options, may include:
- Social Support & Practical Help: including activities like prioritizing sleep, time for self, reading, podcasts, mindfulness, relaxation, asking for help & support groups.
- Mental Health Counseling: Evidence-based therapy types may include CBT (Cognitive Behavioral Therapy) & EMDR (Eye Movement Desensitization and Reprocessing), IPT (Interpersonal Psychotherapy). A possible emerging therapy may include Brainspotting. Mental Health Counseling: Evidence-based therapy CBT (Cognitive Behavioral Therapy), ERP (Exposure & Response Prevention), and DBT (Dialectical Behavioral Therapy). The PSI HelpLine, or the PSI Provider Directory, can help you find a qualified perinatal-trained mental health specialist.
- Medical Evaluation and Treatment: Medication may be an option, and you need to consult a doctor to see what will work for you. Antidepressants, and possibly anti-anxiety and sleeping medications are the most commonly used to treat PTSD. Medication Resources for lactation and pregnancy are listed here.
- Intensive Treatment Facilities are available and are listed here.
You are not alone. PSI is here to help.
Bipolar Mood Disorders
Bipolar Mood Disorders include Bipolar I and Bipolar 2
(Learn More about Bipolar 1 and 2 here)
Research shows that 50% of women with bipolar disorder are first diagnosed in the postpartum period.
There are two phases of a bipolar mood disorder: the lows and the highs. The low time is clinically called depression, and the high is called mania or hypomania.
Perinatal Bipolar Disorder is treatable, and help is available. You do not need a diagnosis to reach out for help.
Symptoms
Bipolar disorder can look like a severe depression or anxiety and can include symptoms such as:
- Periods of severely depressed mood and irritability
- Elevated mood, higher energy than normal.
- Rapid speech
- Little need for sleep
- Racing thoughts
- Trouble concentrating
- Overconfidence
- Impulsiveness
- Poor judgment
- Distractability
- Grandiose thoughts
- Inflated sense of self-importance
- In the most severe cases, delusions and/or hallucinations
- Childbirth may be a specific trigger for a manic episode, which could then be followed up by the onset of depression.
Risk Factors
Risk Factors for Bipolar Mood Disorder are family or personal history of bipolar mood disorder (also called manic-depression).
- History of depression, anxiety, and/or PTSD
- Substance use has been found to increase risk for bipolar depression
Treatment Options
Postpartum Bipolar is treatable, and there are many options to consider when looking for the correct treatment option. You should consult your doctor or therapist, to find the right plan for you. Some treatment options, or combination of options, may include:
- Social Support & Practical Help: including activities like prioritizing sleep, time for self, reading, podcasts, mindfulness, relaxation, asking for help & support groups.
- Mental Health Counseling: Evidence-based therapy types may include DBT (Dialectical Behavioral Therapy) & CBT (Cognitive Behavioral Therapy). The PSI HelpLine can help you find a qualified perinatal-trained mental health specialist.
- Medical Evaluation and Treatment: Medication may be an option, and you need to consult a doctor to see what will work for you. Medication Resources for lactation and pregnancy are listed here.
- Intensive Treatment Facilities are available and are listed here.
You are not alone. PSI is here to help.
Perinatal/Postpartum Psychosis
(Pregnancy, Post-loss, and Postpartum)
Perinatal Psychosis, or Postpartum Psychosis (PPP), is a serious PMH disorder that usually has an onset in the first 2-weeks (but it can be experienced up to a year postpartum). Perinatal Psychosis occurs in approximately 1 to 2 out of every 1,000 deliveries. Review the information below to learn more about PPP and you can find information on support and resources here.
An active case of Perinatal Psychosis is considered an emergency, and you should reach out to one of the numbers listed under Treatment below. It is important to stay with the perinatal individual and the child to ensure everyone’s safety.
Perinatal Psychosis is treatable, and help is available. You do not need a diagnosis to reach out for help.
Symptoms
Symptoms of perinatal psychosis can include:
- Delusions or strange beliefs
- Hallucinations (seeing or hearing things that aren’t there)
- Feeling very agitated
- Hyperactivity or having more energy than usual
- Severe depression or lack of emotion
- Decreased need for or inability to sleep
- Paranoia and suspiciousness
- Rapid mood swings
- Difficulty communicating at times
Immediate treatment for a person going through psychosis is imperative. Individuals experiencing PP are at higher risk of harming themselves or others (including their infant); however, it should be noted that the vast majority do not. This is because the individual experiencing psychosis is experiencing a break from reality. In their psychotic state, the delusions and beliefs make sense to them; delusions feel very real and are often religious. Immediate treatment for someone going through psychosis is imperative.
It is also important to know that many survivors of perinatal psychosis never experienced delusions containing violent commands. Delusions take many forms, and not all of them are destructive. The majority of individuals who experience perinatal psychosis do not harm themselves or anyone else. However, there is always the risk of danger because psychosis includes delusional thinking and irrational judgment, and this is why this illness must be quickly assessed, treated, and carefully monitored by a trained healthcare or perinatal mental health professional.
Perinatal psychosis is temporary and treatable with professional help, but it is an emergency, and it is essential that you receive immediate help. If you feel you or someone you know may be suffering from this illness, know that it is not your fault and you are not to blame. It is important to stay with the perinatal individual and the child to ensure everyone’s safety. Call your doctor or an emergency crisis hotline right away so that you can get the help you need.
Risk Factors
The most significant risk factor for perinatal/pospartum psychosis is a personal or family history of bipolar disorder, or a previous psychotic episode. It may also include prolonged lack of sleep (for instance going days without any sleep)
Treatment Options
The majority of individuals who experience perinatal psychosis do not harm themselves or anyone else. However, there is always the risk of danger because psychosis includes delusional thinking and irrational judgment. It is important to stay with the perinatal individual and the child to ensure everyone’s safety. Call your doctor or an emergency crisis hotline right away so that you can get the help you need.
- Call or text the National Maternal Mental Health Hotline 833-852–6262. Hotline Counselors are available to discuss and explore next steps for you and your loved one. Available 24/7, in the United States only.
- Intensive Treatment Facilities are available and are listed here.
After in-patient psychiatric treatment:
After emergency treatment, those individuals who have experienced Perinatal Psychosis should be followed by a doctor and therapist to continue treatment, including medication and ongoing therapy. PSI hosts peer support groups for perinatal psychosis survivors and those affected. Additional resources are available here.
You are not alone. PSI is here to help.