Peripartum depression (PPD) is an episode of depression that begins either during pregnancy or following delivery. The technical psychiatric term for PPD in American psychiatry, per the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), is a depressive episode “with peripartum onset”, i.e., one which began during pregnancy (antepartum) or within 4 weeks of delivery (post-partum). The depressive episode may be an episode of major depression, of dysthymia, or of unspecified depressive disorder.^[1] However, other definitions of PPD allow for onset up to one year following delivery.^[2] Roughly 1 in 10 to 1 in 5 new birthing parents experience PPD, with higher rates in adolescents.^[3][4] Globally, the number may be closer to 1 in 4.^[2] It’s also possible for a non-birthing parent (such as a father) to experience PPD.^[5][6] PPD is different from the “baby blues,” which are a normal occurrence that affects the majority of new birthing parents.

There are no signs of PPD, and the symptoms largely overlap with depression. The American Psychiatric Association lists the following symptoms of PPD on its website:ref

• Feeling sad or having a depressed mood
• Loss of interest or pleasure in activities once enjoyed
• Changes in appetite
• Trouble sleeping or sleeping too much
• Loss of energy or increased fatigue
• Increase in purposeless physical activity (e.g., inability to still still, pacing, handwringing) or slowed movements or speech. These actions must be severe enough to be observable by others.
• Feeling worthless or guilty
• Difficulty thinking, concentrating, or making decisions
• Thoughts of death or suicide
• Crying for “no reason”
• Lack of interest in the baby, not feeling bonded to the baby, or feeling very anxious about/around the baby
• Feelings of being a bad mother
• Fear of harming the baby or oneself

To be considered PPD, the depressive episode must begin during pregnancy or within four months of birth (per the APA).

The American College of Obstetricians and Gynecologists recommends depression and anxiety screening for all birthing parents using a standardized, validated tool, such as the Edinburgh Postnatal Depression Scale (EPDS).^[7]

Anyone identified by screening, or who suspects they may be experiencing PPD, should be diagnosed by a healthcare provider, who will assess their depressive symptoms. Per the American Psychiatric Association, the diagnostic criteria for peripartum depressive episodes match those of the respective depressive episode, with the additional criterion of onset within 4 months of delivery.^[1]ref

Unlike the “baby blues,” which are a normal part of pregnancy and childbirth and resolve without treatment, treatment is essential for PPD. Treatment for PPD is similar to treatment for non-peripartum depression, and may include:

• Talk therapy, such as cognitive behavioral therapy (CBT), interpersonal psychotherapy (IPT), and/or group therapy
• Medication
• Lifestyle changes
• Social supports

Pregnant or nursing people should discuss risks and benefits of any medication with a healthcare provider.ref^[8]

Supplements studied for PPD include vitamin B6,^[9] vitamin D,^[10][11][12] fish oil/omega-3 fatty acids,^{[13][14][15][16][17]} folate,^[18] and saffron.^[19][20]

While the symptoms of PPD match those of major depression, many more supplements have been studied for major depression than have been evaluated for safety during pregnancy/ postpartum and for efficacy in PPD.

A healthy diet, i.e., a balanced diet that is rich in fruits and vegetables and low in processed foods, may help reduce the risk of perinatal depression. A 2015 systematic review found an association between poor or unhealthy diets and prenatal depression/stress. However, the postnatal evidence they reviewed was mixed.^[21] A 2019 review found an inverse association between a “healthy” diet and perinatal anxiety and depression.^[22] Finally, a 2020 systematic review noted an inverse association between healthy postpartum diet and postpartum depression.^[23] All three reviews concluded that more research is needed: more longitudinal studies with plenty of participants, as well as studies of specific dietary interventions.

Several alternative treatments have been studied, including repetitive transcranial magnetic stimulation, exercise, massage, bright light therapy, acupuncture, and yoga.

While no single cause of PPD has been determined, many risk factors have been identified. A 2023 meta-analysis found the following as major risk factors: a personal history of mental illness, childcare stress, the baby’s temperament (e.g., infantile colic, inconsolable crying), stressful life events, inadequate social support, the maternity blues, and conflict or dissatisfaction with one’s partner.^[2] Low socioeconomic status, abuse, gestational diabetes, vitamin D deficiency, and pregnancy or delivery complications have also been identified as risk factors for PPD.^[8][24] Additionally, a 2013 Canadian study found that women who lived in cities of over 500,000 people were at higher risk of postpartum depression, possibly due to lack of social support.^[25] Neuroendocrinological factors, genetic predisposition and family history may also be at play.^[26] Exclusive breastfeeding is associated with a lower risk of PPD,^[27] although it’s unclear whether this is a cause or effect.