Clinical Presentations

These conditions can develop at any time during pregnancy and within the first two years after birth, most commonly, however, in the first weeks following delivery. The severity can range from mild adjustment difficulties to severe, potentially suicidal forms. In many cases, symptoms develop gradually. Approximately 10–20% of all mothers are affected.

Common signs and symptoms may include:

• Persistent fatigue, exhaustion, lack of energy
• Sadness, frequent crying
• Feelings of guilt
• A sense of inner emptiness
• General loss of interest, absence of sexual desire
• Ambivalent feelings towards the baby
• Difficulties with concentration, appetite, and sleep
• Headaches, dizziness, heart palpitations, and other psychosomatic symptoms
• Anxiety, extreme irritability, panic attacks, obsessive thoughts (recurrent distressing thoughts, images, or ideas that are not acted upon)
• Suicidal thoughts

Perinatal anxiety disorders are considered a distinct category, as anxiety symptoms are predominant. Depressive symptoms may be present but are not necessarily required for diagnosis. These conditions involve severe and recurring anxiety and/or panic. Anxieties and worries may be vague and relate to life or the world in general, or they may arise in specific situations. Commonly, fears and worries focus on the well-being of the baby. Perinatal panic disorders (episodes of intense fear) and perinatal obsessive–compulsive disorders (persistent, intrusive anxiety-related thoughts, images, or fears) represent particularly severe forms of perinatal anxiety responses.

Perinatal psychosis may occasionally develop during pregnancy, but it most commonly occurs within the first two weeks after childbirth. In some cases, it may also emerge from a depressive episode. It is considered the most severe form of a perinatal mental health crisis and affects approximately one to three out of every 1,000 mothers.

Possible signs and symptoms include:

• Markedly increased drive and activity levels
• Motor restlessness (manic phase)
• Loss of drive, reduced movement, and social withdrawal (depressive phase)
• Extreme anxiety
• Confusion, delusions, and hallucinations

The increased drive, which may manifest in a range of unproductive activities, does not indicate an elevated or positive mood. During hallucinations and delusional experiences, affected women may hear voices or see people, animals, or objects that do not exist, or develop delusional beliefs, for example of a religious nature. For the person affected, these experiences feel entirely real.

Postpartum blues, also known as the baby blues (a commonly used term in international medical literature), refers to a short-lived period of low mood occurring within the first 14 days after childbirth. It affects approximately 50–80% of mothers. Symptoms usually begin between the third and fifth day after birth and typically last from a few hours up to several days.

Typical signs of postpartum blues include:

• Fatigue, exhaustion, and lack of energy
• Increased sensitivity and mood swings
• Sadness and frequent crying
• Insomnia and restlessness
• Difficulties with concentration, appetite, and sleep
• Anxiety and irritability

As the baby blues are a common and time-limited experience, they are generally considered a non-clinical response to the physical, hormonal, and emotional changes following childbirth and do not require treatment. However, recognising the baby blues as a normal condition should not lead to them being dismissed. If low mood persists for longer than two weeks, this may be an early indication of postpartum depression and should be taken seriously.