Postpartum depression

Dr Sarah Przednowek, Psychiatrist and Psychotherapist (+ certificate in transdisciplinary perinatal care by ULB/UCL) 

What is postpartum depression? 

Postpartum depression is a widespread mental health problem with a prevalence of 10 to 15%.  

The DSM-5 classifies postpartum depression as a major depressive episode that starts either during pregnancy or during the first 4 weeks after delivery. It is however commonly accepted that any depressive episode occurring within the first year after birth is classified as post-partum depression. Knowing that up to 50% of these episodes start during pregnancy, we can also call it “perinatal” or “peripartum” depression. 

It is different from the very common “baby blues”, which last for a few days to maximum 2 weeks after delivery, even though baby blues can actually slightly increase the risk of developing postpartum depression. 

According to the DSM-5, a major depressive episode is characterized by at least 5 or more of the following symptoms, for at least two weeks straight, with at least one of the first two symptoms being present. They also have to cause significant impairment in different areas of functioning. 

-Depressed mood (sadness, emptiness, hopelessness, irritability, uncontrollable tears,…) 

-Diminished interest or pleasure in all or almost all activities 

-Insomnia or hypersomnia 

-Decrease or increase in appetite, with significant weight loss or gain  

-Psychomotor agitation or retardation 

-Fatigue or loss of energy 

-Feelings of worthlessness  

-Diminished ability to concentrate or indecisiveness 

-Recurrent thoughts of death or suicidal ideations  

These are the symptoms that are present in major depressive disorder in general.  

When it comes to perinatal depression, most patients will also experience a high level of anxiety. The anxiety can occur either during pregnancy or after birth and could even get to the point of panic attacks. The anxiety could come from a lot of different things, from fear of not being good enough, to fear of obstetrical complications, fears about the baby’s health, etc … 

Another symptom that is quite common when it comes to perinatal depression would be an inappropriate amount of guilt, often correlated to the fear of not being a “good mother” or not doing things the right way. Something that is also quite common would be guilt around not feeling an instant connection with the baby, which is actually quite common. 

Another big issue when it comes to perinatal depression would be the difficulty for mothers to feel any sort if interest in taking care of their baby. Looking after the baby is just done without pleasure, some patients say that they feel “like a robot”. This can also lead to a lot of guilt and increases the symptoms of depression. 

Another set of symptoms that could occur after birth could be psychotic symptoms, even though they are much more rare. These include hallucinations or delusions, which can sometimes accompany depressive symptoms.  

Perinatal depression is a very serious issue and could have a great impact on the mother but also on her child. Notable consequences include an increase likelihood of persistent depression, with all the psychological and physical complications that can result from that. Moreover, there is also a higher risk of suicide or suicide attempts.  

Depression during pregnancy, also increases the risk of obstetrical complications, with potential premature delivery or small baby weight at birth. 

Maternal depression, during the first few months of a baby’s life, could also have an impact on attachment, leading to potential later difficulties in development for the baby. 

What are the risk factors for developing perinatal depression?  

It is interesting to know some of the risk factors that could lead to perinatal depression, in order to either prevent the episode or to find the appropriate solutions when the issue presents itself. 

First, having had depression in the past could be a risk factor, especially if this depression has not been treated or if there are still ongoing difficulties when the pregnancy starts. Previous anxiety disorders, OCD, bipolar or personality disorder are also risk factors for perinatal depression.  

However, this could also be seen as a strength. If the patient has found a way to overcome these issues in the past, they now have more tools to know how to overcome it again.  It also means that the patient knows how to reach out to professionals, they maybe already know a psychologist or a psychiatrist who will be able to support them through this new phase in life. 

Motherhood is a big transition and due to hormonal changes but also due to the psychological aspect of becoming a parent, it is possible that old issues will reappear. By becoming a mother herself, the new mother can be confronted to past memories (of how her parents took care of her for example), which for some people can be very difficult memories.  In some cases, becoming a parent could be a trigger for past traumas to resurface. 

Past trauma or abuse is a risk factor for perinatal depression, but so is more recent trauma. Indeed, a traumatic birth experience or delivery could lead to actual PTSD symptoms. Sometimes health issues after birth (for the mother or the baby) or forced separation from the baby after birth could also be traumatic events, which could increase the risk of developing perinatal depression.  

Post-traumatic symptoms can have an impact on emotion regulation, mentalization abilities, and on the capacity to connect with the baby, which then leads to worsened self-esteem and guilt, which in return increase the depressive symptoms, putting these new mothers in a vicious circle. It is where therapy becomes very helpful, in order to find new tools to break this circle. 

Another big risk factor would be the socio-economic context and the environment in which the parents live.  Of course having financial issues will put another layer of difficulties in a situation that is already very hard.  

An environment where there is physical or emotional violence would also increase greatly the risk of perinatal depression, on top of physical and developmental risks for the mother and the baby of course. 

Instability in the couple’s relationship could make things more difficult as well, the same goes for unplanned pregnancies and for monoparental pregnancies, isolation and lack of spousal support being a big risk factor for perinatal depression. 

This is also why local politics around parental leave for both parents could also have an impact on the risk of developing perin atal depression. 

It is also worth mentioning that it is possible for fathers to also struggle with depression around the perinatal period.  Becoming a parent can of course be a big transition for fathers as well, especially if they have any of the risk factors we mentioned previously (episodes of major depression in the past, childhood trauma, family difficulties, socio-economic issues,. ..).  The symptoms will be the same as those in major depressive disorder (see DSM criteria above) and can cause big distress for the father and the family unit. It can also potentially have an impact on the baby’s bonding abilities and the child’s later development 

What can we do about it? 

The good news is that perinatal depression is treatable so of course it is best to seek help as soon as possible. The ideal would be for your healthcare providers and yourself to talk about potential issues, during the pregnancy, to come up with an “emergency” plan just in case things get more difficult later on. The idea that there would already be a network of professionals ready to be contacted could also be very reassuring for the future mother. 

If you know you might be at risk, it would then be a good idea to talk about it with your gynecologist and/or midwife who can help you get in touch with a psychologist or a psychiatrist before birth. 

If none of that was possible to arrange before birth, you can still contact either your midwife (who can come at home after birth), your gynecologist or your GP who will be able to find you the support your need. 

Of course you can also directly contact a psychologist or a psychiatrist (who can either be specialized  or not in perinatal health). 

The treatment for perinatal depression will sometimes be psychotherapy alone, and sometimes psychotherapy combined with medication. Some medications are completely safe to use during pregnancy and breastfeeding, but not all of them are, so this will be a good conversation to have with your doctor (either GP or psychiatrist). 

Therapy can come in different forms, sometimes it will be through individual therapy, sometimes it could involve both parents and the baby together. This will depend on the professional you will meet but also on the context of the situation.  

Treatment for perinatal depression also depends on the underlying issues.  

In some situations, help from a social worker might be useful, either from the social worker of the hospital or from the “ONE” office in your commune. They have social workers, nurses or midwifes who can make the connections between you and some other services that you might need. These could be services from such organizations as “Le Petit Vélo Jaune” or “Maisons vertes” which can provide help by sending someone at home once a week for additional support  for example. There is also the possibility of getting additional help with practical issues, such as help with housing, cleaning, meal preparation, etc… 

In some situations, it might also be very helpful to join a support group to feel a sense of community, the BCT website is very useful for that. 

Of course, in more urgent or dangerous situations, there is also the option of hospitalization. There are a few “mother/parent-baby” units in Belgium which can be of course very helpful when the situation requires in-patient intensive care. These solutions can be discussed with your psychiatrist or doctor. 

In all situations, it is critical not to stay alone with your difficulties, professionals exist and it is very important to reach out for help. 


  1. DSM-5 Manual – American Psychiatric Association 
  1. A meta-analysis of treatments for perinatal depression :Sockol L, Neil Epperson C, Barber J, Clin Psychol Rev. 2011 Jul 
  1. Risk Factors of Postpartum Depression : Agrawal I, Mehendale A,  Malhotra R. Cureus. 2022 Oct 
  1. Predictors of Postpartum Depression: A comprehensive review of the last decade of evidence : Guitivano J., Manuck T, Meltzer Brody S, Clin Obstet Gynecol.2018 Sept