Perinatal Depression Can Recur—But Screening and Treatment Can Help

Britney Spears, 40, announced that she's expecting her third child in an Instagram post Monday.

The singer wrote in the caption that, during pregnancy, she previously suffered from perinatal depression: "[I]t's hard because when I was pregnant I had perinatal depression…I have to say it was absolutely horrible…women didn't talk about it back then…some people considered it dangerous if a woman complained like that with a baby inside her."

She went on to say that perinatal depression is talked about more now than it was during her previous pregnancies (2005 and 2006), writing: "Now women talk about it everyday…thank Jesus we don't have to keep that pain a reserved proper secret."

The post raised questions about what perinatal depression is–and whether previously suffering from it once makes you high-risk during a subsequent pregnancy. Below, what to know about the condition, including symptoms and treatment options.

Perinatal Depression, Explained

Perinatal depression is a mood disorder that occurs during the perinatal period, which includes pregnancy and up to a year after giving birth, according to the National Institute of Mental Health (NIMH).

"Anything before, during, and after pregnancy is part of the perinatal period. Even when you're trying to conceive," Tamar Gur, MD, PhD, a women's health expert and reproductive psychiatrist at the Ohio State University Wexner Medical Center, told Health. (Postpartum depression falls under the umbrella of the term "perinatal depression," Dr. Gur explained.)

Perinatal depression impacts up to 20% of pregnant people in the U.S. during pregnancy, the postpartum period, or both, according to a review published in the Cleveland Clinic Journal of Medicine (CCJM) in 2020. The condition can affect children as well as mothers: Untreated perinatal depression has been linked to imparired cognitive, social, and emotional development in the baby, as well as low birth weight, according to the CCJM review.

Past Perinatal Depression Increases Future Risk

Experts say that a previous perinatal depression diagnosis does increase your chances of suffering from it during a subsequent pregnancy. "A previous history of anxiety, depression, or perinatal depression increases the risk," Dr. Gur said. "It doesn't mean you're doomed to have perinatal depression, but there is an increased risk."

Researchers don't yet know why this is the case, Catherine Birndorf, MD, founder of The Motherhood Center in New York City, told Health. However, a woman's stress level and hormones might be contributing factors, she explained.

Research backs up the claim that if you've suffered from postpartum depression, specifically, your chances of doing so again after a subsequent pregnancy are higher. A 2017 study published in PLoS Medicine found that patients are at a higher risk of recurring postpartum depression after an initial diagnosis. Specifically, among 450,000 first-time mothers in Denmark, those who experienced postpartum depression were 27 to 46 times more likely to experience it again after subsequent births.

Perinatal Depression Signs and Symptoms

In order for a woman's condition to be classified as perinatal depression, it must last longer than 14 days and "impair a woman's quality of life," according to the CCJM review.

Some pregnant people experience only a few symptoms of perinatal depression, while others experience several, according to the NIMH. The institute lists the following as some of the more common symptoms of perinatal depression:

• Feeling sad, anxious, or "empty"
• Irritability
• Feelings of guilt, worthlessness, hopelessness, or helplessness
• Loss of interest or pleasure in activities
• Fatigue or decrease in energy
• Restlessness or difficulty sitting still
• Difficulty concentrating, making decisions, or remembering
• Difficulty sleeping (even when the baby is sleeping)
• Waking up early in the morning or oversleeping
• Abnormal appetite, weight changes, or both
• Headaches, cramps, aches, pains, or digestive problems that do not have a clear physical cause or do not ease with treatment
• Trouble bonding or forming an emotional attachment with the new baby
• Persistent doubts about the ability to care for the new baby
• Thoughts about death, suicide, or harming oneself or the baby

If you develop these symptoms during the perinatal period, you should talk to your health care provider, Gloria A. Bachmann, MD, associate dean of women's health at Rutgers Robert Wood Johnson Medical School, told Health.

"Every unusual symptom that a woman has during pregnancy, she should reach to a health care provider or family member for support," Dr. Bachmann said. "No woman should suffer in silence."

Dr. Birndorf echoed this advice: "If you notice you're not yourself, you're very distressed, or you're impaired functionally, you need to speak up."

A good first step would be calling your ob-gyn or primary care physician, Dr. Gur said. Another option would be to ask your health insurance provider for a referral to an expert, she added.

You should seek help urgently if certain symptoms of perinatal depression arise, Janelle Bolden, MD, chief of maternal fetal medicine at Northwestern Medicine, told Health. "You should seek help immediately—call 911, go to an ER, or call the National Suicide Prevention Hotline—with thoughts about hurting yourself or your baby, death, or suicide."

Perinatal depression is common and providers should warn pregnant people about the symptoms to watch for, Dr. Bachmann said: "Perinatal mood disorders are not a rare occurrence. Women should be told from the get-go that if you experience this, you should get help immediately. We have to normalize it and say this is part of the pregnancy experience."

The Importance of Screening for Perinatal Depression

Several health organizations–including the U.S. Preventive Services Task Force, American College of Obstetricians and Gynecologists, American Psychiatric Association, and the American Academy of Pediatrics–recommend that all pregnant people in the perinatal period be screened for perinatal depression.

The following are sometimes used to screen for perinatal depression, according to the CCJM review:

• The Edinburgh Postnatal Depression Scale: a 10-question form used to detect depression
• The Patient Health Questionnaire (PHQ-9): a tool used to determine depression severity. (The CCJM review notes that while the Patient Health Questionnaire is an effective screening tool, it doesn't include questions about anxiety, while the Edinburgh Postnatal Depression Scale does.)

You should receive these screenings during the perinatal period, Dr. Bolden said, and may even undergo them several times during visits to your child's pediatrician.

"The screening methods are good when used properly and with good follow-up," Dr. Gur said

Treatment Options for Perinatal Depression

Multiple treatment options exist, and they include therapy, medications, or a mix of the two, according to the NIMH.

Two forms of psychotherapy called cognitive behavioral therapy (CBT) and interpersonal therapy (IPT) are used to treat perinatal depression. CBT teaches patients different ways of thinking, behaving, and reacting to situations. IPT helps patients improve their communication skills within relationships, develop social support networks, and set realistic expectations that allow them to deal with crises or other issues that impact depression.

Perinatal depression patients are also commonly treated with antidepressants, according to the NIMH. These may improve the way the brain uses certain chemicals that control mood and stress. However, antidepressants can take six to eight weeks to work..

The right treatment for each person "is absolutely individual," Dr. Gur said. "There is always space for therapy and then can include medication if the depression is severe."

But structural changes need to be made to better support pregnant people during the perinatal period, Dr. Gur added. "We don't do an adequate job of supporting women through maternity leave. There is also far too much tearing women down on social media," she said, recalling Spears' Instagram post. "As Britney mentioned, it's better than it was when she was pregnant before–but we still have a long way to go."