Clinically reviewed by: Meghan McGinty, DNP, PMHNP-BC, PMH-C — psychiatric nurse practitioner whose work centers on women’s mental health, particularly the emotional complexity of fertility, pregnancy, and the postpartum period.
Pregnancy looks different for everyone. For some, it brings excitement and a sense of possibility. For others, it ushers in worry, exhaustion, and even fear.
Hormones are fluctuating, your body is transforming, and your entire life is about to change. It’s no wonder pregnancy and the postpartum period are among the most common times for mental health challenges to emerge or intensify.
If they do, you have options. Here’s what every patient should know about mental health during pregnancy and after birth, including what medications are available and why leaving symptoms untreated carries its own risks.
What Are Peripartum and Postpartum Mental Health Disorders?
Mental health conditions that develop during or after pregnancy are called peripartum conditions — a term that covers the full window from the start of pregnancy through the first 12 months after birth. Postpartum depression and other postpartum conditions fall within this category.
Research suggests that between 50–85% of people who give birth experience some form of mood disturbance following pregnancy.1 The well-known “baby blues,” a short stretch of emotional ups and downs in the days after birth, affects many new parents and typically resolves on its own within two weeks.
Clinical conditions are a different story. Someone might experience:
- Depression — persistent low mood, loss of interest, fatigue, or feelings of hopelessness that go beyond typical emotional adjustment.
- Anxiety — excessive worry, restlessness, or fear that’s difficult to control and interferes with daily life.
- Post-Traumatic Stress Disorder (PTSD) — can take two forms: prenatal PTSD, where existing trauma from experiences like pregnancy loss, sexual trauma, or a difficult fertility journey surfaces or intensifies during pregnancy; and birth-related or postpartum PTSD, which develops in response to a traumatic birth itself.
- Obsessive Compulsive Disorder (OCD) — intrusive, unwanted thoughts or images, often about a baby’s safety, paired with compulsive behaviors (constant reassurance seeking, avoidance, repetitive checking, etc.), to reduce the anxiety those thoughts or images cause.
- Postpartum psychosis — a rare but serious condition that requires immediate medical attention, involving hallucinations, delusions, rapid mood shifts, and decreased need for sleep with elevated energy levels.
Their causes are as varied as the individuals who experience them. Hormonal shifts, particularly the dramatic changes in estrogen and progesterone that accompany pregnancy and birth, play a significant role. So can births that are traumatic, complicated, or different from what someone hoped for. Grief, relationship stress, financial pressure, lack of support, and previous mental health diagnoses or symptoms can all factor in, too.
Society often frames pregnancy as an exclusively joyful time. Those who feel overwhelmed or disconnected are frequently afraid to speak out, worried that something is wrong with them, or that feeling this way makes them a bad parent.
That kind of shame has no place during one of the most physically and emotionally demanding seasons of life. No one should suffer in silence, especially when effective treatment is available and untreated symptoms pose real risks.
When Does Postpartum Depression Start?
Postpartum depression symptoms may begin during pregnancy and continue after birth, or they may not surface until much later — sometimes around six weeks postpartum or several months in.
Depression commonly occurs alongside anxiety, PTSD, and OCD symptoms, conditions that fall under a broader category clinicians refer to as perinatal mood and anxiety disorders, or PMADs.2 They can develop on their own or in combination, and their timing is equally unpredictable, with onset ranging from shortly after birth to much later within the first year. Of all of them, postpartum OCD tends to be the least recognized, partly because the intrusive thoughts and images can be so alarming that people avoid discussing them.
Whatever the timing, if symptoms persist beyond two weeks, interfere with daily life, or feel significantly different from your normal baseline, it’s worth having a conversation with a provider.
The Risks of Untreated Postpartum Depression
There’s an assumption that avoiding medication during pregnancy is the cautious choice. The research paints a more nuanced picture:
Untreated depression during pregnancy has been associated with preterm birth, low birth weight, and babies small for their gestational age.3 After birth, untreated postpartum depression has been linked to impaired mother-infant bonding, which then leads to disrupted cognitive development in infants and an increased risk of behavioral and emotional difficulties in children.4
For the mother, untreated postpartum depression is connected with low self-esteem, social relationship difficulties, and breastfeeding problems, all of which compound the challenges of new parenthood.5 In serious cases, it carries an increased risk of suicide.
This information isn’t meant to alarm, but to help you make the most informed decision for your situation. The question is never simply whether a specific medication is safe during pregnancy. It’s how the considerations around that medication compare to the consequences of leaving symptoms unaddressed.
Is It Safe to Stop Antidepressants During Pregnancy?
People often decide to stop their psychiatric medications immediately upon learning they’re pregnant, assuming this is the safest choice for their baby. It’s an understandable instinct, but one that can create significant complications.
Stopping antidepressants or other psychiatric medications abruptly carries risks, including antidepressant discontinuation syndrome, where symptoms return rapidly and sometimes more intensely than before. Research shows that women who discontinue antidepressant therapy often relapse during pregnancy, with the risk being highest among those with recurrent or severe depression.6
Hesitation around antidepressants during pregnancy is common, but it’s worth considering current data. Birth defects occur in 1 of every 33 pregnancies in the general population, and studies have not shown antidepressants to significantly raise that baseline risk.7,8 For anti-anxiety and antidepressant medications, there is a 20% chance that a newborn may experience mild withdrawal symptoms after birth. These symptoms respond well to supportive care and resolve quickly.
Providers draw on research combined with years of real-world clinical experience to guide their recommendations. What many agree on, is that newer medications without a long track record in pregnant populations are generally best approached with caution until more data exists.
A psychiatrist who specializes in maternal mental health can help you think through whether to continue, adjust, or transition to something better studied in pregnancy — so that whatever decision you make, you’re making it with a clear head and proper support behind you.
Safe Medications During Pregnancy and Postpartum
For those considering medication, there are well-studied options for managing mental health during pregnancy and after birth.
SSRIs and SNRIs — commonly prescribed antidepressants — are generally considered to have positive safety profiles during pregnancy and are frequently used to treat peripartum depression and anxiety. They have been studied extensively in pregnant populations, and while no medication is entirely without considerations, they are among the better-understood options available.
The FDA approved Zuranolone (Zurzuvae) in 2023, the first oral medication developed specifically for postpartum depression.9 This provides an additional option for patients who may not respond to traditional antidepressants or do not have a previous history of mental health conditions.
As with any treatment decision, the right medication depends on your individual history, symptoms, and circumstances.
Postpartum Depression: Medication, Therapy, or Both?
For some expectant mothers, therapy alone provides meaningful relief. Interpersonal therapy (IPT) is considered the gold standard for perinatal mood and anxiety disorders, and cognitive behavioral therapy (CBT) has strong evidence for depression and anxiety. Both can be effective standalone treatments for those with milder symptoms or a preference to avoid medication during pregnancy.
For others, medication is a necessary and important part of managing symptoms. Often, a combination of therapy and medication works best, addressing both psychological and biological dimensions.
Wherever you are in your pregnancy or postpartum journey, the goal is a treatment plan tailored to you that evolves as your needs change. That kind of care exists, and you deserve to have it.
Rivia Mind’s team includes providers who specialize in women’s mental health and understand the particular complexity of this season of life. Whether you’re looking for therapy, medication management, or both, we’re here to help you find a path forward that feels right for you. Contact us or find a provider to learn more.
FAQs
When does postpartum depression start?
Postpartum depression can begin during pregnancy or at any point in the first year after birth. Many people notice symptoms in the first few weeks postpartum, but onset varies. If you’re experiencing low mood, anxiety, or emotional changes that interfere with daily functioning for longer than two weeks, it’s worth speaking with a provider.
Is it safe to take antidepressants during pregnancy?
SSRIs and SNRIs are generally considered among the safer options for managing depression and anxiety during pregnancy. Your psychiatrist can help you evaluate the specific risks and benefits based on your situation, medical history, and the medication in question.
What happens if I stop my medication when I find out I’m pregnant?
Stopping antidepressants abruptly without medical supervision can cause antidepressant discontinuation syndrome, which may include anxiety, mood changes, dizziness, flu-like symptoms, insomnia, and nausea. It can also cause the symptoms the medication was managing to return. The right course of action depends on your individual history and circumstances, which is why it’s important to speak with a psychiatrist before making medication changes during pregnancy.
What is postpartum anxiety?
Postpartum anxiety is a common condition characterized by ongoing, excessive worry especially for the safety and wellbeing of your baby following birth. This can come with intrusive and unwanted thoughts and images that are distressing and hard to talk about. It can occur alongside postpartum depression or on its own, and it responds well to both therapy and medication when needed. Postpartum anxiety medication typically includes SSRIs or SNRIs, which are well-studied options for managing anxiety after birth and are generally compatible with breastfeeding.
Is postpartum PTSD real?
Yes. Birth can be a traumatic experience for some people — whether due to complications, loss of control, or a birth that felt dangerous or frightening. Postpartum PTSD involves re-experiencing, avoidance, and heightened alertness following that trauma, and deserves the same care and attention as any other form of PTSD.
References:
- Massachusetts General Hospital. Postpartum Psychiatric Disorders.
- UNC School of Medicine. What are PMADs?
- Jahan N, Went TR, Sultan W, et al. Untreated Depression During Pregnancy and Its Effect on Pregnancy Outcomes: A Systematic Review. Cureus. 2021;13(8):e17251. Published 2021 Aug 17. doi:10.7759/cureus.17251
- Saharoy R, Potdukhe A, Wanjari M, Taksande AB. Postpartum Depression and Maternal Care: Exploring the Complex Effects on Mothers and Infants. Cureus. 2023;15(7):e41381. Published 2023 Jul 4. doi:10.7759/cureus.41381
- Slomian J, Honvo G, Emonts P, Reginster JY, Bruyère O. Consequences of maternal postpartum depression: A systematic review of maternal and infant outcomes. Womens Health (Lond). 2019;15:1745506519844044. doi:10.1177/1745506519844044
- Massachusetts General Hospital. What is the Risk for Relapse After Stopping Antidepressants During Pregnancy?
- CDC. Data and Statistics on Birth Defects.
- CDC. New Study Finds Few Risks of Birth Defects from Antidepressant Use During Pregnancy.
- US Food and Drug Administration. FDA Approves First Oral Treatment for Postpartum Depression.
