Psychiatric Care for Postpartum Depression and Perinatal Mental Health

Perinatal mood and anxiety disorders can begin during pregnancy or in the year after birth. They can include depression (called postpartum depression after birth), anxiety, intrusive thoughts, panic or trouble sleeping even when the baby sleeps. They are common, and they are not a sign of weakness or of being a bad parent. Partners and adoptive parents can be affected too. Postpartum psychosis, with confusion, seeing or hearing things, or strange beliefs, is rare and is an emergency: call 911 or go to the nearest emergency room.

How our physicians help

Our physicians take time to understand your history, your pregnancy or postpartum course, and your goals for care. Treatment can combine psychotherapy and medication management, with careful attention to pregnancy and breastfeeding. We coordinate with obstetric and pediatric providers when helpful.

Signs to watch for

Every new parent feels tired and overwhelmed. These signs suggest something more:

• Feeling sad, empty or numb most days for more than two weeks
• Feeling distant from your baby, or going through the motions
• Constant worry about your baby's health, with repeated checking
• Anger or irritability that feels unlike you
• Believing your family would be better off without you. If you feel this way, please do not wait: call or text 988 (the Suicide & Crisis Lifeline) or call 911. We are not an emergency service.
• Nightmares, flashbacks or avoidance after a difficult birth or pregnancy loss

What your physician will ask about

We ask about past depression or anxiety, any illness after an earlier birth, family history, and who can help at home. Thyroid changes after birth and anemia can look like a mood disorder, so we may ask your obstetric team for lab results.

A personal or family history of bipolar disorder raises the chance of postpartum psychosis and changes which treatments make sense, so please tell us early.

Treatment during pregnancy and after birth

Every option has trade-offs. Therapy takes time and energy that can feel scarce with a newborn, and medications usually take weeks to help. Options include:

• Interpersonal therapy focuses on role changes, relationships and support, all of which shift with a new baby.
• Cognitive behavioral therapy (CBT) gives you tools to catch and change the thoughts behind worry and guilt.
• Antidepressants, especially SSRIs, are the most common medication choice.
• A sleep plan that protects one longer stretch of rest, with help from someone you trust, can make a real difference.

When to call, and when it is an emergency

Call us if symptoms last more than two weeks, make it hard to look after yourself or your baby, or frighten you. Unwanted, scary thoughts are a reason to call.

Postpartum psychosis is different. It is rare and it is an emergency. Signs include confusion, seeing or hearing things, strange beliefs, going without sleep and not feeling tired, or thoughts of harming yourself or your baby that feel right or that you want to act on. Call 911 or go to the nearest emergency room. With prompt treatment, many people improve.

For thoughts of suicide, call or text 988 (the Suicide & Crisis Lifeline) or call 911. We are not an emergency service.

How loved ones can help

You may notice changes first. New parents often hide how hard things are, out of guilt or fear of being judged. Ask how they are really doing, and take a night feeding so they can sleep.

A person with postpartum psychosis may not realize anything is wrong. If you see the signs, call 911 or go to the nearest emergency room, stay with them, and have another adult look after the baby until help arrives.

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