Peripartum / Postpartum Depression

🧠1. Overview

Peripartum / Postpartum Depression is a depressive condition that occurs during pregnancy or in the postpartum period. In the DSM-5-TR diagnostic manual, it is classified as a Major Depressive Episode “with peripartum onset” — meaning a depressive episode that begins during pregnancy or within 4 weeks after delivery. However, in real life, most clinicians and researchers use the terms “Perinatal Depression” or “Postpartum Depression” to include the entire period from the beginning of pregnancy up to 12 months after childbirth, because symptoms often appear much later than the time frame stated in the DSM.

Biologically, this period is one of the most intense transitions for the body and brain in a woman’s life. Sex hormones (estrogen, progesterone, oxytocin) fluctuate dramatically. The body is recovering from pregnancy, blood loss, sleep deprivation, breastfeeding, and 24-hour infant care — while at the same time, the brain has to “reorganize” emotional networks and the maternal bonding network to fit this new life role. All of these changes are like resetting the entire nervous system.

What is frightening is that postpartum depression does not always start with obvious sadness. It often begins with chronic exhaustion, getting used to having no energy, crying for no clear reason, self-blame, and the thought “I’m not good enough for my baby.” As these symptoms gradually accumulate and overlap with sleep deprivation, physical pain, and loneliness, they can develop into a full depressive state without the mother even realizing it.

Worldwide, this condition is found in approximately 10–20% of mothers, but the real number may be higher, because many are never screened or think they are just having “postpartum mood swings,” which is very different from reality. Postpartum Depression is not just “baby blues” that resolves on its own within two weeks, but a clinical depressive disorder that truly affects the brain and its neurochemistry.

Baby blues is a temporary mood disturbance that occurs around 2–3 days after childbirth due to hormonal changes and fatigue, and usually improves within 10–14 days. Mothers may cry easily and feel more sensitive, but still have enough energy to care for their baby and still feel bonded with their child. In contrast, Postpartum Depression is more intense, more clearly defined, and more prolonged. There is pervasive low mood, feelings of worthlessness, loss of pleasure in previously enjoyed activities, thoughts of self-harm, or even fear of harming the baby unintentionally.

There may also be social withdrawal, insomnia even when the baby is asleep, poor concentration, loss of appetite, or in some cases overeating as a way to cope with stress. Many mothers report that they “feel like a robot” — waking up to breastfeed because they have to, not because they want to. The sense of bonding with the baby temporarily disappears, which further fuels guilt and deeper sadness.

The impact of this condition does not stop with the mother. It also affects the child’s emotional development. For example, the baby may become more sensitive to stress, sleep poorly, cry more than usual, or in the long term be more prone to anxiety. Research also shows that partners of mothers with postpartum depression have an increased risk of developing depression themselves due to shared stress and sleep deprivation.

Therefore, Postpartum Depression is not just “a mother’s problem,” but an issue for the entire family and support system around her. Understanding and recognizing symptoms early are key, because the earlier the treatment begins, the better the outcomes for both mother and child. Psychotherapy, social support, and in some cases antidepressant medication can all help the brain recover and return to balance.

In summary, “Peripartum / Postpartum Depression” is a depressive condition arising from a combination of hormones, brain changes, stress, and social expectations. It does not mean that the mother is “weak,” but that her body and mind are crying out for care — and that care should begin with understanding, not judgment.

🧩 2. Core Symptoms — Main Symptoms Commonly Seen 

Peripartum / Postpartum Depression is not merely about “feeling sad.” It represents a systemic change in the brain, emotions, and body that affects every dimension of life — from formerly bright thoughts turning dim, to deep feelings of worthlessness in the maternal role.
These symptoms often appear gradually, bit by bit, and when they accumulate, they form a “full depressive state” that is hard to ignore.

2.1 Mood Cluster

Mood is the central core of this condition.

• Patients often feel “sad for no clear reason,” and may cry at any time, even while holding or breastfeeding their baby.
• The pleasure once gained from small things — listening to music, drinking coffee, chatting with a loved one — disappears without them realizing it.
• They feel an inner emptiness, as if nothing is left inside emotionally.
• Feelings of guilt take over, such as “I’m a bad mother,” or “My baby would be better off if they weren’t born because of me.”
• In some cases, sadness transforms into anger or irritability (irritable depression), especially when dealing with the baby’s crying or exhaustion from sleepless nights.
• These emotions are not stable, but fluctuate intensely like waves, oscillating between “sad–numb–angry–hurt” throughout the day.

2.2 Cognition Cluster

Cognitive processes and self-perception clearly change:

• Shortened attention span, difficulty thinking, a sense that the “brain is foggy” even when trying hard to focus.
• Inability to make decisions about simple things such as what to eat or whether to take a shower.
• Persistent self-critical thoughts and a sense of worthlessness, as if they have failed in every area of life.
• In some cases, intrusive thoughts occur — unwanted, disturbing thoughts such as mental images of the baby dying or of unintentionally harming the baby, even though the mother does not want to do this and feels terrified by the thought.
• Cognitive distortions may arise, such as believing everyone around them despises them, or believing the child will hate them in the future.
• These thought patterns create a sense of helplessness and make the future seem hopeless.
• Suicidal ideation may appear in a subtle form, such as “I wish I could just fall asleep and never wake up,” or “I wish I could disappear from this world” — these are warning signs that require urgent attention.

2.3 Behavior Cluster

External behavior clearly reflects the internal changes:

• Many begin to withdraw from social contact, not wanting to talk to anyone or answer calls or messages.
• They avoid activities they once enjoyed, such as watching movies, cooking, or even going out for a walk.
• There is a tendency to neglect self-care — not showering, not getting dressed, not eating regularly.
• Daily activities are carried out in “automatic mode,” such as getting up to breastfeed because they have to, not because they want to.
• In some cases, compulsive checking behavior appears, such as repeatedly checking if the baby is still breathing. This reflects depression mixed with anxiety (an anxious–depressive type).
• Chronic fatigue makes facial expressions flat and dull; the smile disappears.

2.4 Somatic / Physical Symptom Cluster

The body reflects the depressive state through various symptoms that are often misinterpreted as “just being tired from childcare”:

• Insomnia even when the baby is asleep — the brain remains hyperaroused with worry.
• Or, in some people, excessive sleep, yet they still wake up feeling unrefreshed.
• Loss of appetite and rapid weight loss, or in some cases overeating as emotional comfort.
• Chronic fatigue, as if life energy has been drained away.
• Headaches, back pain, generalized muscle aches without a clear physical cause.
• These physical symptoms result from alterations in neurotransmitter systems such as serotonin and cortisol, which are linked to both mood and physical energy.

2.5 Mother–Infant Relationship / Maternal Role Cluster

One of the most heartbreaking symptoms is the “sense of alienation from the baby”:

• Some mothers feel indifferent when they look at their baby, as if they are looking at a random child rather than their own.
• When the baby cries, they may feel irritated or want to escape, followed by intense guilt.
• Breastfeeding can become a time filled with tears because they feel “unbonded.”
• These feelings do not come from a lack of love for the baby, but from disruption in the limbic system — the brain region associated with bonding — caused by the depressive state.
• Some mothers feel afraid of their own baby, worried they might accidentally harm them, and thus avoid the baby as a way to protect themselves from that fear.
• The relationship with the partner may also be shaken: feeling misunderstood, emotionally distant, or lonely despite having someone physically present.

2.6 Other Common Associated Symptoms

• High anxiety (postpartum anxiety).
• Flashbacks of the birth experience (if labor was difficult or traumatic).
• Feeling insecure about their body after childbirth.
• Loss of sexual interest.
• Fear of “going crazy.”

Summary:

Postpartum Depression is not just “feeling sad.” It is the collapse of emotional, cognitive, and relational systems all at once.
The critical point is that these symptoms must persist for more than 2 weeks and significantly interfere with daily functioning to meet medical diagnostic criteria.

🧾 3. Diagnostic Criteria — Expanded Version

This condition is categorized under Major Depressive Disorder (MDD) with the specifier “with peripartum onset.”
All criteria are based on DSM-5-TR and the guidelines of APA, ACOG, and WHO, which help standardize diagnosis and distinguish it from other similar conditions.

3.1 Core of the Diagnosis: Major Depressive Episode

Basic conditions:

• At least 5 out of 9 symptoms must be present for ≥ 2 consecutive weeks.
• At least one of these must be:
  1️⃣ Depressed mood most of the day, or
  2️⃣ Markedly diminished interest/pleasure in almost all activities.

Symptom list according to DSM-5-TR:

• Depressed mood nearly every day.
• Markedly diminished interest or pleasure.
• Significant weight loss or gain, or decreased/increased appetite.
• Insomnia or hypersomnia.
• Psychomotor agitation or retardation.
• Fatigue or loss of energy.
• Feelings of worthlessness or excessive/inappropriate guilt.
• Poor concentration, slowed thinking, or difficulty making decisions.
• Recurrent thoughts of death, suicidal ideation, or suicide plan/attempt.

Additional conditions:

• Symptoms must cause clinically significant distress or impairment in work, caregiving, or relationships.
• They must not be better explained by a medical condition (e.g., hypothyroidism) or the direct effects of a substance or medication.
• There must be no history of manic or hypomanic episodes that would warrant a diagnosis of Bipolar Disorder instead.

3.2 Specifier “with peripartum onset”

• Means that the depressive episode begins during pregnancy or within 4 weeks after delivery.
• However, most research and guidelines from ACOG/WHO extend this time frame up to 12 months postpartum to reflect clinical reality.
• DSM uses the term “Peripartum onset” to include depression that occurs both during pregnancy (antenatal) and after childbirth (postpartum).

3.3 Differential Diagnosis

Clinicians must carefully distinguish this condition from others that look similar:

• Baby Blues: Mild symptoms that resolve within 2 weeks.
• Postpartum Psychosis: Presence of delusions or hallucinations — a psychiatric emergency.
• Bipolar Depression: If there is a history of mania/hypomania, the diagnosis should be reconsidered.
• Thyroid Disorder / Iron Deficiency / Vitamin D Deficiency: Laboratory tests are needed to rule out these physical causes.

3.4 Use of Screening Tools

To aid in diagnosis, clinicians or clinical psychologists often use standardized instruments such as:

• Edinburgh Postnatal Depression Scale (EPDS) → specifically designed to screen women postpartum.
• PHQ-9 → used to assess the severity level of depressive symptoms.

Scores above cutoffs indicate that more in-depth assessment by a professional is warranted.

3.5 Severity Levels

Level	Characteristics	Example
Mild	Depressive symptoms are present, but functioning is only partially impaired.	Feels sad and fatigued but can still care for the baby.
Moderate	Work performance and caregiving capacity are clearly reduced.	Cannot manage household or self-care normally; needs help.
Severe (with/without psychotic features)	Suicidal thoughts or plans, or delusions/hallucinations present.	Requires urgent psychiatric treatment.

3.6 Assessing Context and Co-occurring Risks

• History of previous pregnancies (those who have had postpartum depression before are at high risk of recurrence).
• Current family, financial, or health-related stressors.
• Comorbid conditions such as Anxiety, PTSD, OCD, Chronic Pain.
• Childcare environment, e.g., lack of support from partner or family.

Summary:

Diagnosing Peripartum / Postpartum Depression is not just about checking for sadness. It requires a holistic assessment of mind, brain, body, and postpartum life context.
It is “a brain disorder expressed through the feelings of the heart” — and the sooner it is understood, the greater the chances of recovery for the mother and her relationship with her child. 💛

4. Subtypes or Specifiers — Subcategories

In clinical practice, both standard DSM-5 specifiers and timing/mechanism-based groupings are used to guide treatment planning.

4.1 DSM-based Specifiers (Key Examples)

With anxious distress

• Prominent anxiety symptoms are present (constantly worrying about the baby, fearing the baby will die, fearing being a bad mother, etc.).
• If left untreated, there is an increased risk of suicide attempts.

With mixed features

• Some manic/hypomanic-like symptoms appear alongside depression, such as pressured speech or unusually high energy, while depressive symptoms remain.
• This suggests a possible underlying Bipolar Spectrum condition.

With psychotic features

• Delusions or hallucinations occur along with the depressive episode.
• If the content involves the baby, such as voices commanding the mother to harm the baby or beliefs that the baby is a demon, this constitutes an emergency requiring immediate medical attention.

Severity: Mild / Moderate / Severe

• Mild: The mother can still more or less care for herself and the baby, although it is difficult.
• Moderate: Daily functioning and caregiving capacity are clearly impaired.
• Severe: The mother cannot care for herself or the baby, and may have suicidal or infanticidal thoughts.

4.2 Timing-based Subtypes (Common Clinical Concepts)

Antenatal / Pregnancy-Onset Type

• Symptoms begin during pregnancy.
• Often associated with stress, unplanned pregnancy, relationship problems, or fear of childbirth.

Early Postpartum Type (0–6 weeks postpartum)

• Can overlap with the baby blues period.
• Associated with rapid hormonal shifts plus severe sleep disruption.

Late Postpartum Type (6 weeks–12 months postpartum)

• In some women, symptoms slowly build from chronic fatigue, financial stress, relationship strain, and long-term childcare pressure.
• Often overlooked because people around them think “it’s no longer the postpartum period, so it’s unrelated.”

4.3 Mechanism-based / Contextual Subtypes (Mechanistic Concepts)

Not official diagnostic categories, but useful for understanding real-life patterns:

• Hormone-Sensitivity Type — the brain is highly sensitive to hormonal changes (often has a history of severe PMS/PMDD before pregnancy).
• Stress-Overload Type — driven by stress from finances, work, family, and accumulated sleep deprivation.
• Trauma / Relationship-Conflict Type — history of trauma, abuse, or lack of support from a partner.
• Comorbidity-Linked Type — co-occurring conditions such as Anxiety, OCD, Chronic Pain, ADHD, Bipolar Disorder, etc.

🧠 5. Brain & Neurobiology — The Brain and Hormones Behind Postpartum Depression 

Peripartum / Postpartum Depression is not just about “hormonal swings,” as many people believe.
It is a complex process at the level of the brain and biochemical systems, linking hormones, the nervous system, stress, immunity, and the adaptation of brain regions involved in motherhood.

After childbirth, a woman’s body goes through “one of the most intense biological transitions in human life.”
In just a few days, hormones that were extremely high throughout pregnancy plummet like a plane diving, and the brain has to adapt to this change while simultaneously caring for a newborn.

5.1 Changes in Sex Hormones (Estrogen / Progesterone)

During pregnancy, estrogen and progesterone levels increase more than 30 times to prepare the body for pregnancy, childbirth, and lactation.
But within a few days after delivery, these hormones drop sharply to levels lower than what the body is used to.

Some women’s brains can naturally rebalance.
But in others — especially those with hormone sensitivity or genetic variations affecting serotonin/GABA receptor function — this shift can strongly impact mood-regulating brain regions.

• Estrogen promotes the synthesis of serotonin and dopamine, which are involved in happiness and motivation.
• When estrogen levels fall → serotonin signaling decreases.
• This explains why mood drops, motivation declines, and the brain enters a depressive mode.

Progesterone and its derivative, allopregnanolone, affect the GABA system, which helps the brain relax and reduce anxiety.
After childbirth, allopregnanolone levels fall sharply → the brain “loses its stress-braking mechanism.”
This leads to hyperarousal, anxiety, and irritability even over small issues.

Brexanolone and Zuranolone, new-generation medications for postpartum depression, were developed directly from this understanding, mimicking the action of these neurosteroids to “restore GABAergic system balance” in a deficient brain.

5.2 Stress System: HPA Axis (Hypothalamus–Pituitary–Adrenal)

During pregnancy, the body upregulates the HPA axis, which controls the stress hormone cortisol, to help tolerate physiological changes.
After childbirth, this system must quickly reset.

In people whose system “resets incorrectly,” the brain may over-respond to stress or secrete cortisol at abnormal rhythms, resulting in chronic fatigue and depressive mood.
Many studies have found that mothers with abnormally high or low cortisol after childbirth tend to have significantly higher postpartum depression scores.

This is not just a transient stress reaction but a “brain circuit imbalance.”
When the HPA axis is overactive → the amygdala is frequently stimulated → threat perception increases → chronic anxiety and negative thinking arise.
Meanwhile, the prefrontal cortex — responsible for rational control of emotion — becomes underactive.
The result is a “fear–sadness–self-blame circuit” that is hard to escape.

5.3 Neuroactive Steroids & the GABAergic System

The GABA (Gamma-Aminobutyric Acid) system is the brain’s primary inhibitory neurotransmitter system — the “brake” that prevents excessive arousal.
Under normal conditions, neurosteroids such as allopregnanolone enhance GABA function → the brain relaxes and stress is reduced.
After childbirth, allopregnanolone levels drop sharply, leaving the brain without sufficient braking → increased anxiety, irritability, and vulnerability to depression.

Research in Nature Neuroscience has found that in some postpartum women, there are structural changes in GABA receptors that reduce sensitivity to neurosteroids.
This explains why some women become depressed even when their hormone levels are not drastically different from other mothers.

5.4 Inflammation and the Immune System

Childbirth is a “naturally inflammatory biological state.”
The body releases various cytokines such as IL-6, TNF-alpha, and CRP to repair tissues after delivery.
If this inflammatory state “lingers” or becomes excessive, these cytokines can cross the blood–brain barrier and affect emotion-regulating regions such as the hippocampus and prefrontal cortex.

The result is a decrease in BDNF (Brain-Derived Neurotrophic Factor), a protein crucial for neuron repair and neurogenesis.
When BDNF drops → the brain’s capacity for emotional learning and resilience diminishes → depression becomes more chronic.

Additionally, elevated microglial activation (immune cells in the brain) has been associated with depressive symptoms in postpartum groups, suggesting the brain may be in a state of “low-grade chronic inflammation.”

5.5 Neural Circuitry Changes

Brain imaging (MRI / fMRI) in postpartum women with depression shows several prominent changes:

• Prefrontal Cortex — reduced activity, making emotional regulation harder and decision-making slower.
• Amygdala — hyperactive, leading to strong responses to stress, the baby’s crying, and feelings of guilt.
• Anterior Cingulate Cortex (ACC) — abnormal connectivity in this region that links emotion and reasoning.
• Hippocampus — may show reduced volume, similar to chronic depression in general.
• Nucleus Accumbens / Ventral Striatum — key areas in the reward system show reduced activity, causing a lack of joy “even when seeing the baby.”
• Oxytocin Pathway — reduced responses in brain regions receiving oxytocin (the bonding hormone) in those with postpartum depression.

All of this reflects that “the brain of a postpartum mother is not broken; it is struggling to adapt under overwhelming conditions.”
But if stressors exceed its capacity to recover, the brain can become stuck in a prolonged depressive loop.

🌿 6. Causes & Risk Factors — Deep Dive into Causes and Risk Factors

Postpartum depression does not arise from “weak will” or “being overly sensitive.”
It is the result of the convergence of biology, psychology, and social factors at a time when a woman’s body is at its most vulnerable.
We can divide risk factors into four major categories.

6.1 Biological Factors

Genetic Vulnerability

• Studies show that women with first-degree relatives (mother or sister) who have had postpartum depression are 2–3 times more likely to develop it themselves.
• Genes related to serotonin transporter function (5-HTTLPR), BDNF, and CRHR1 play important roles in hormonal and stress responses.

Hormones and Neurochemistry

• Rapid declines in estrogen, progesterone, and allopregnanolone.
• Dysregulation of GABAergic and serotonergic systems → mood instability.

Medical Comorbidities

• Hypothyroidism, anemia, vitamin D or B12 deficiency.
• Chronic back pain or postpartum physical complications.

Sleep Deprivation

• Several consecutive sleepless nights are a “key accelerator” of depression.
• Research shows that sleeping less than 4 hours per night for just 3–4 consecutive days can alter brain function in ways similar to depressive states.

6.2 Psychological Factors

Stress-Sensitive Personality

• For example, perfectionists, highly self-critical individuals, or those with high baseline anxiety.
• When confronted with the inevitable imperfections of parenting, they intensely blame themselves.

History of Trauma

• Such as past physical or emotional abuse.
• Brains with trauma histories often have fragile amygdala–prefrontal connectivity, causing exaggerated fear responses.

Self-efficacy (Perceived Capability)

• If a woman believes she is “not good enough” or “a failure as a mother,” her risk of depression increases.

Antenatal Anxiety

• High stress during pregnancy is associated with 2–3 times higher risk of postpartum depression.

6.3 Social / Environmental Factors

Lack of Emotional Support

• Partners who do not understand, no one to help with childcare, or living far from family.
• Research indicates that “perceived support” is more important than the sheer number of people around.

Relationship Conflict

• Frequent conflicts with a partner or feeling like the partner is not helping with childcare is one of the strongest triggers of postpartum depression.

Low Socioeconomic Status (Low SES)

• Financial burdens and job loss can create a sense of hopelessness.

Unplanned Pregnancy / Single Motherhood

• Fear of the future, social judgment, and carrying full responsibility alone.

Cultural and Social Norms

• Some cultures pressure mothers to be “perfect.”
• Harmful beliefs such as “a good mother never complains and is always happy with her baby” intensify guilt and discourage seeking help.

6.4 Pregnancy & Birth-Related Factors

Difficult Labor / Severe Pain / Emergency C-Section

• A traumatic birth experience can trigger PTSD, which is linked to depression.

Health Complications in Mother or Baby

• NICU admission, prematurity, or congenital illness → increased guilt and chronic stress.

Loss of a Child or Twin Pregnancy with Loss of One Fetus

• Grief and self-blame often last long and require specialized therapy.

Breastfeeding / Prolactin and Oxytocin Imbalance

• Oxytocin influences bonding, but if stress diminishes oxytocin release → the joy of breastfeeding decreases.

6.5 Additional Factors

• Use of medications / abrupt discontinuation of sedatives / postpartum contraceptives.
• Seasonal modulation — in cold-climate countries, rates of postpartum depression are higher in winter.
• Brains highly sensitive to circadian disruption (e.g., chronic “jet lag” from night-time infant care).

🔍 Integrated View Summary

Peripartum / Postpartum Depression is “a brain system under overload.”
It arises from the collision of:

• a rapidly collapsing hormonal system,
• a weakened GABA system,
• an overactive HPA stress system, and
• unsupportive psychological and social contexts.

When the brain is pushed into this loop, negative thinking, guilt, and chronic exhaustion build up and crystallize into true clinical depression.

7. Treatment & Management — Care and Treatment

This information is for understanding only and must not be used as a substitute for seeing a physician/psychiatrist/clinical psychologist.
If there are thoughts of harming oneself or the baby → this is an emergency and emergency services or a hospital must be contacted immediately.

Overall approaches from ACOG, APA, and international guidelines: ScienceDirect+5ACOG+5ACOG+5

7.1 Screening

Use standardized tools such as the Edinburgh Postnatal Depression Scale (EPDS) or PHQ-9.

ACOG recommends screening during:

• The first prenatal visit.
• Mid/late pregnancy.
• Each appropriate postpartum follow-up visit. ACOG+2Lippincott Journals+2

7.2 Non-pharmacological Treatment (Psychological / Psychosocial)

Psychotherapy

• CBT (Cognitive Behavioral Therapy) — helps manage negative thoughts and behaviors that worsen depression.
• IPT (Interpersonal Therapy) — focuses on relationships, role transition into motherhood, and family conflicts.
• Mother–infant–focused therapies (mother–infant therapy) to strengthen bonding.

Social Support

• Postpartum support groups / peer support circles.
• Cooperation from partners/family in sharing childcare and housework.

Self-care

• Arrange as much rest as possible within realistic limits.
• Ask for help explicitly (instead of forcing oneself to do everything alone).
• Maintain good nutrition, hydration, and light physical activity.

Appropriate Postpartum Exercise

• Meta-analytic research shows that more than 1 hour per week of moderate exercise helps significantly reduce the risk and severity of postpartum depression. The Guardian+1
• Physical condition after delivery must be considered, and exercise should begin after consulting a doctor, starting with gentle walking and gradually increasing.

7.3 Pharmacotherapy

The same principles used in treating depression generally apply, but with additional consideration for:

• Pregnancy (effects on the fetus).
• Breastfeeding (medications pass into breast milk to varying degrees). PubMed+2Project Teach NY+2

The most commonly used medications are SSRIs (type and dosage must be selected jointly by a psychiatrist and obstetrician).

In severe cases or those with psychotic features, antipsychotic medication and inpatient care may be required.

7.4 New Targeted Medications for Postpartum Depression

• Brexanolone (IV allopregnanolone analogue)
• Zuranolone (oral neurosteroid)

These medications were developed from an understanding of neurosteroids and the GABA system, but they still have limitations regarding cost, access, and safety considerations. They must therefore be used under close supervision by specialized medical teams. MDPI+2Frontiers+2

7.5 Treatment in Severe Cases

If there are:

• Clear suicidal thoughts or plans.
• Thoughts or plans to harm the baby.
• Psychotic symptoms (delusions, hallucinations).

→ Hospitalization is usually required, and in some cases ECT (Electroconvulsive Therapy) may be used, which research supports as effective in severe or treatment-resistant postpartum depression.

8. Notes — Additional Key Points

It is not the mother’s fault.

This condition arises from the interplay of hormones, brain function, life experiences, and stress — not from “being weak.”

Fathers/partners can experience it too.

Emerging research shows that partners/fathers also have higher rates of depression after childbirth compared to the general population, even though they are not technically included in the DSM peripartum specifier.

There is no single correct way to parent.

Some mothers deeply love their children but do not enjoy the infant phase, and feel guilty about this.
This does not mean they “do not love their child”; more often, it is a sign of burnout or depression.

Distinguishing Baby Blues / Depression / Psychosis is critical.

• Baby blues → mild and self-limiting.
• Depression → more severe, longer lasting, and functionally impairing.
• Psychosis → delusions/hallucinations — requires immediate hospitalization.

Early treatment = better outcomes for mother and child.

Leaving postpartum depression untreated not only harms the mother but also affects the child’s emotional and social development in the long term. Nature+2MDPI+2

If you suspect yourself or someone close to you may be affected:

• Encourage seeing an obstetrician, psychiatrist, or clinical psychologist.

• Simple words like:

“Lately I’ve been feeling so sad and drained that some days I can hardly take care of the baby. I’d like to talk to the doctor about this.”

can be the starting point of treatment.

📚 Reference (2024–2025 Updated Edition)

• American Psychiatric Association (APA).
  Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR), 2022 — Section Depressive Disorders: Major Depressive Episode with Peripartum Onset.

• ACOG – American College of Obstetricians and Gynecologists.
  Screening for Perinatal Depression (Committee Opinion No. 757), reaffirmed 2023.
  Clinical Practice Guideline: Perinatal Mental Health Conditions (2024).

• StatPearls Publishing (NCBI Bookshelf).
  Perinatal Depression, 2024 update — overview of epidemiology, pathophysiology, and treatment modalities.

• World Health Organization (WHO).
  Maternal Mental Health and Perinatal Depression Fact Sheet, 2023 revision.

• Khamidullina Z. et al. (2025).
  “Postpartum Depression: Epidemiology, Risk Factors, and Consequences.” Journal of Clinical Medicine, 14(2): 2025-234.

• Wenzel E.S. & Maguire J. (2025).
  “The Neurobiology of Postpartum Depression.” Trends in Neurosciences, 48(3), 145–168.

• Maguire J. & Mody I. (2019).
  “Neuroactive Steroids and GABAergic Involvement in Postpartum Depression.” Frontiers in Cellular Neuroscience, 13: 83.

• Gavin N.I. et al. (2024).
  “Perinatal Depression: A Systematic Review of Prevalence and Incidence.” Obstetrics & Gynecology, 143(5), 987–1003.

• Chai Y. et al. (2023).
  “Cortisol and HPA Axis Dysregulation in Postpartum Depression.” Psychoneuroendocrinology, 155, 105097.

• Dennis C.L. & Falah-Hassani K. (2022).
  “Interventions for Postpartum Depression — Meta-Analysis of CBT and IPT Effectiveness.” JAMA Psychiatry, 79(11), 1043–1055.

• O’Hara M.W. & Wisner K.L. (2020).
  “Perinatal Depression: Prevalence, Course, and Treatment.” Annual Review of Clinical Psychology, 16, 305–326.

• Pongpidet S. (2024).
  “Risk Factors and Effective Treatments of Postnatal Depression in Young Adult Mothers.” VMED Journal (Thailand).

• Harvard Health Publishing.
  Postpartum Depression and the Brain: Hormones, GABA, and Neurosteroids, 2024 edition.

• Mayo Clinic.
  Postpartum Depression – Symptoms and Causes, updated 2025.

• National Institute of Mental Health (NIMH).
  Perinatal Depression: Facts and Statistics, 2024.

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