Pregnancy and having a baby can bring major changes to your body, relationships, routines, and sense of identity. While some emotional ups and downs are expected, mental health symptoms that are persistent, intense, or interfering with everyday life may be signs that something more is going on.
Mental health conditions that occur during pregnancy or after childbirth are often referred to as perinatal mental health conditions. Depression may be the most familiar, but it isn’t the only one. Anxiety disorders, obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), bipolar disorder, and other conditions can also emerge or become more difficult to manage during this period.
Here are eight mental health conditions that can affect people during pregnancy and after birth, along with signs that it may be time to seek support.
1. Perinatal Depression
Perinatal depression refers to depression that occurs during pregnancy or following childbirth. When depression develops during pregnancy, it may be called prenatal or antenatal depression. Depression occurring after birth is commonly known as postpartum depression (PPD).
Symptoms can look different from person to person but may include:
- Persistent sadness, emptiness, or hopelessness
- Loss of interest in activities you normally enjoy
- Feelings of guilt, worthlessness, or inadequacy
- Difficulty concentrating or making decisions
- Changes in sleep or appetite beyond those associated with pregnancy or caring for a newborn
- Difficulty feeling connected to the baby
- Withdrawing from friends, family, or a partner
- Thoughts of death, self-harm, or suicide
Postpartum depression is different from the โbaby blues,โ which can cause temporary tearfulness, irritability, worry, and mood changes shortly after delivery. Baby blues generally improve within a couple of weeks. Symptoms that are severe, persist longer, or interfere with daily functioning may indicate postpartum depression or another mental health condition.
2. Perinatal Anxiety
Some worry during pregnancy and early parenthood is understandable. There are suddenly many new things to think about, from prenatal appointments and delivery to feeding, sleep, and your baby’s health.
Perinatal anxiety goes beyond occasional worry. Anxiety may become difficult to control, occupy significant amounts of time, or make it harder to function normally.
Signs may include:
- Constant or excessive worry
- Feeling unable to relax
- Racing thoughts
- Irritability or restlessness
- Muscle tension
- Difficulty sleeping even when there is an opportunity to rest
- Repeatedly seeking reassurance
- Persistent fears that something bad will happen to you or your baby
Some people experience anxiety for the first time during pregnancy or postpartum, while others notice that an existing anxiety disorder becomes more difficult to manage.
3. Perinatal OCD
Obsessive-compulsive disorder involves obsessions, which are intrusive and unwanted thoughts, images, or urges, and compulsions, which are repetitive behaviors or mental rituals performed in an attempt to reduce distress.
Pregnancy and the postpartum period can sometimes be associated with the onset or worsening of OCD symptoms.
With perinatal OCD, intrusive thoughts may focus heavily on the pregnancy or baby. Someone might experience unwanted thoughts about accidentally harming the baby, contamination, illness, or something terrible happening. Compulsions might involve repeatedly checking on the baby, excessive cleaning, avoiding certain activities, or constantly seeking reassurance.
These thoughts can be extremely frightening. Importantly, intrusive thoughts associated with OCD are typically unwanted and distressing. Experiencing an intrusive thought is not the same as wanting to act on it.
Treatment can help people understand these symptoms and reduce the cycle of obsessions, anxiety, and compulsive behavior.
4. Panic Disorder
A panic attack is a sudden episode of intense fear accompanied by physical and emotional symptoms. It may involve a racing heart, shortness of breath, dizziness, shaking, sweating, chest discomfort, nausea, or a feeling that something terrible is about to happen.
Having an isolated panic attack does not necessarily mean someone has panic disorder. Panic disorder involves recurrent, unexpected panic attacks along with persistent concern about experiencing additional attacks or changes in behavior intended to avoid them.
Pregnancy can make panic symptoms particularly confusing because some normal physical changes, such as changes in heart rate or breathing, can resemble sensations associated with anxiety.
Panic disorder can also continue or emerge after childbirth. When fear of another attack begins affecting sleep, travel, medical appointments, caregiving, or other parts of daily life, professional support may be helpful.
5. Birth-Related PTSD
Post-traumatic stress disorder is often associated with experiences such as violence, accidents, or military combat, but traumatic experiences involving pregnancy and childbirth can also contribute to PTSD.
Birth-related PTSD may develop after experiences such as:
- A frightening or traumatic delivery
- Emergency medical interventions
- Severe pregnancy or childbirth complications
- Feeling that your life or your baby’s life was in danger
- Pregnancy or infant loss
- A difficult NICU experience
- Feeling powerless, unheard, or unsafe during medical care
Symptoms can include intrusive memories or nightmares, avoiding reminders of the experience, feeling constantly on alert, emotional numbness, difficulty sleeping, or intense distress when reminded of what happened.
People can also enter pregnancy with PTSD related to earlier experiences. Pregnancy, medical examinations, childbirth, or changes in the body may trigger symptoms associated with previous trauma.
6. Bipolar Disorder
Bipolar disorder causes episodes of significant changes in mood, energy, activity, and functioning. These can include depressive episodes as well as periods of mania or hypomania.
Pregnancy and the postpartum period can present particular challenges for people with bipolar disorder. Changes in sleep, hormones, stress, and psychiatric medications may all affect mood stability.
Recognizing bipolar disorder is also important because a depressive episode after childbirth may initially resemble postpartum depression. A history of unusually elevated or irritable mood, decreased need for sleep, racing thoughts, increased activity, impulsive behavior, or previous manic or hypomanic episodes can help clinicians distinguish between conditions.
People with bipolar disorder who are pregnant, planning a pregnancy, or have recently given birth should work closely with qualified medical and mental health professionals when making decisions about treatment or medication. Psychiatric medications should not be abruptly stopped because of pregnancy without medical guidance.
7. Eating Disorders During Pregnancy and Postpartum
Pregnancy changes the body rapidly, and the postpartum period can bring additional changes in weight, appetite, body image, and daily routines. For someone with a current or previous eating disorder, these experiences may be particularly challenging.
Conditions such as anorexia nervosa, bulimia nervosa, binge-eating disorder, and other specified feeding or eating disorders can occur during the perinatal period.
Warning signs may include:
- Intense distress about pregnancy-related weight gain
- Restricting food intake
- Binge eating
- Purging or compensatory behaviors
- Excessive or compulsive exercise
- Persistent preoccupation with weight, food, or body shape
- Avoiding prenatal care because of concerns about being weighed
- Significant anxiety about postpartum weight loss
Eating disorders can affect both physical and mental health during pregnancy, making coordinated medical, nutritional, and behavioral health care especially important.
8. Postpartum Psychosis
Postpartum psychosis is rare, but it is one of the most serious mental health conditions associated with childbirth. Symptoms generally develop rapidly and can include:
- Hallucinations
- Delusions or beliefs that are disconnected from reality
- Severe confusion or disorientation
- Paranoia
- Extreme agitation
- Dramatic changes in mood
- Manic symptoms
- Unusual or highly disorganized behavior
Postpartum psychosis is different from postpartum depression and postpartum OCD. Someone experiencing psychosis may have difficulty recognizing that their thoughts or perceptions are not based in reality.
Postpartum psychosis is a psychiatric emergency. A person showing signs of psychosis after childbirth needs immediate medical evaluation. If there is an immediate risk of harm to the parent or baby, call 911 or go to the nearest emergency department.
When Should You Seek Help for Perinatal Mental Health Symptoms?
You don’t have to determine exactly which condition you have before asking for help. A healthcare professional can evaluate your symptoms, medical history, medications, sleep, physical health, and other factors to determine what may be contributing to how you feel.
Consider reaching out to an OB-GYN, primary care provider, psychiatrist, therapist, or other qualified healthcare professional if emotional or behavioral changes:
- Persist or become progressively worse
- Make it difficult to complete everyday activities
- Interfere with sleep beyond what pregnancy or infant care would normally cause
- Affect your relationships or ability to care for yourself
- Cause significant fear, distress, or isolation
- Include intrusive thoughts or behaviors that are difficult to control
Thoughts of suicide, harming yourself or someone else, hallucinations, delusions, severe confusion, or other symptoms suggesting a psychiatric emergency require immediate help. In the United States, you can call or text 988 to reach the Suicide & Crisis Lifeline. Call 911 for an immediate emergency.
Treating Mental Health Conditions During and After Pregnancy
Perinatal mental health conditions are treatable. The appropriate approach depends on the condition, symptom severity, medical history, pregnancy or postpartum status, and individual needs.
Treatment may include psychotherapy, psychiatric care, medication, support groups, lifestyle interventions, or a combination of approaches. When medication is being considered during pregnancy or breastfeeding, healthcare professionals can help weigh potential risks and benefits and determine an appropriate treatment plan.
Getting support early can prevent symptoms from becoming more disruptive and help parents protect their own well-being while adjusting to pregnancy or life with a new baby.
Pregnancy and parenthood don’t require you to feel happy all the time. If anxiety, depression, intrusive thoughts, trauma symptoms, or major changes in mood are making this period harder to navigate, talking with a professional can be an important first step.
Frequently Asked Questions
What is perinatal mental health?
Perinatal mental health refers to mental and emotional well-being during pregnancy and the period following childbirth. Perinatal mental health conditions can include depression, anxiety disorders, OCD, PTSD, bipolar disorder, and other psychiatric conditions.
What is the most common mental health condition during pregnancy?
Depression and anxiety are among the most common mental health concerns experienced during pregnancy. They can occur independently or at the same time.
Can pregnancy cause anxiety or depression?
Mental health conditions usually don’t have a single cause. Hormonal and physical changes, sleep disruption, stress, previous mental health conditions, trauma, social circumstances, pregnancy complications, and other factors may contribute to depression or anxiety during pregnancy and postpartum.
Can you develop postpartum depression if you weren’t depressed during pregnancy?
Yes. Someone can experience depression for the first time after giving birth even if they did not experience depression during pregnancy. Conversely, depression that begins during pregnancy can continue after delivery.
Are intrusive thoughts after having a baby normal?
Unwanted intrusive thoughts can occur during the postpartum period and don’t necessarily mean someone intends to act on them. However, frequent or highly distressing intrusive thoughts, particularly when accompanied by compulsive behaviors or significant anxiety, may be associated with postpartum OCD or another mental health condition and are worth discussing with a professional.
What’s the difference between postpartum OCD and postpartum psychosis?
A major distinction involves a person’s relationship to their thoughts and perceptions. With postpartum OCD, intrusive thoughts are generally unwanted and distressing, and the person typically recognizes that they do not reflect what they want to happen. Postpartum psychosis involves a loss of contact with reality that may include hallucinations, delusions, severe confusion, or disorganized behavior. Postpartum psychosis requires immediate medical attention.
