Women's mental health

Perinatal depression is depression during pregnancy or after a baby is born. Anxiety often comes with it. It can start during pregnancy or at any point in the first year after birth.

Many new parents have the "baby blues" in the first days after birth: worry, tearfulness and exhaustion that usually ease within a week or two without treatment. When those feelings are stronger or last longer than 2 weeks, it may be postpartum depression, which usually doesn't get better on its own.

Common signs, in plain language

• Sadness, anxiety or an "empty" feeling most of the day
• Irritability, guilt or feeling like a failure
• Trouble sleeping even when the baby is asleep
• Low energy, and trouble concentrating or making decisions
• Trouble bonding with the baby, or constant doubts about caring for them
• Thoughts of harming yourself or the baby

These signs are a general guide, not a checklist for diagnosis. It isn't caused by anything you did or didn't do. If you're in crisis or thinking about harming yourself, call or text 988 (Suicide & Crisis Lifeline), any time, day or night. In an emergency, call 911 or go to the nearest emergency room. The National Maternal Mental Health Hotline also offers free, confidential support for pregnant and new parents, 24 hours a day: call or text 1-833-852-6262.

PMDD (premenstrual dysphoric disorder) is like PMS, but much more severe. Mood symptoms start in the week or two before your period and usually ease within a few days after it starts. It affects up to 5% of women of childbearing age, and many also have anxiety or depression.

• Lasting irritability or anger that affects the people around you
• Sadness, despair, tension or anxiety, sometimes panic attacks
• Mood swings, crying often, or feeling out of control
• Losing interest in usual activities, low energy, trouble focusing or sleeping
• Physical symptoms, such as bloating, breast tenderness or headaches

Depression that gets worse in the second half of your cycle can look like PMDD, and it may need a change in treatment instead. A symptom calendar helps show the pattern.

Perimenopause often brings irregular periods, hot flashes, poor sleep and mood swings. Some people also notice brain fog, which often improves after menopause.

Stronger irritability, anxiety, sadness or loss of enjoyment can be signs of depression, especially if they don't lift. Night sweats and mood changes can disrupt sleep, so we look at sleep too. Hormone therapy for hot flashes is a conversation for your gynecologist or primary care provider, since we don't provide primary medical care.

A careful evaluation looks at what you're feeling and when it happens:

• How your mood lines up with pregnancy, the months after birth, your menstrual cycle or the menopause transition
• A symptom calendar or diary over your cycle, if PMDD is a question
• Your past history of depression, anxiety or bipolar disorder, including during an earlier pregnancy, and your family history
• Sleep, stress, support at home, and your health and medications
• Whether you're pregnant, planning a pregnancy or breastfeeding

Physical causes, such as thyroid problems, can affect mood, so we may ask you to check in with your primary care provider or gynecologist. This is all part of a comprehensive psychiatric evaluation. Your first evaluation is up to 90 minutes in length. Some people need more time, some less, and we take the time you need. Follow-up visits are typically 20 to 30 minutes, and extended follow-ups are available.

Medication, when appropriate. For PMDD, SSRI antidepressants are usually the first medication option, taken every day or only in the second half of your cycle. For depression in pregnancy, after birth or in perimenopause, antidepressants are a common, effective treatment; see our depression page for more. It can take several weeks to feel the full effect.

Pregnancy and breastfeeding. Untreated depression affects both parent and baby. Decisions about medication weigh the risks of treatment against the risks of untreated illness, and we make them together, with clear information. Please don't stop a medication on your own; some can cause withdrawal symptoms or a return of symptoms if stopped suddenly.

Time to talk in every visit. Depending on your clinician, visits may include supportive therapy, psychoeducation, CBT-informed strategies and sleep hygiene. Cognitive behavioral therapy (CBT) and interpersonal therapy are well-studied talk therapies for perinatal depression, and CBT is also used for PMDD. We don't offer standalone weekly therapy, but we're happy to help you find a therapist and, with your permission, we'll coordinate with them.

Regular follow-ups. We check in regularly and adjust carefully. If you've had depression with an earlier pregnancy, planning ahead with your provider before or early in a pregnancy can help.