Perinatal Mental Health: Beyond Postpartum Depression
This article is general information published by the practice of Dr. Sholeh Toobaei, Specialist Psychiatrist, Dubai. It has not yet been individually reviewed by a clinician and is not a substitute for personal medical advice. Published: 1 September 2026.
Scope: This article is general information about perinatal mental health. It is not a treatment plan. If you are pregnant or postpartum and experiencing mental health difficulties, a professional assessment can help.
What is the perinatal period?
The perinatal period covers pregnancy (the antenatal period) and the first year after delivery (the postpartum or postnatal period). It is one of the most vulnerable times for mental health — the hormonal, physical, psychological, and social changes are enormous, and they interact in complex ways.
Mental health conditions are the leading cause of maternal mortality in many high-income countries, not because of what happens at the time of delivery, but because of what happens during the perinatal period and beyond. This is not a failure of individuals. It is a consequence of a system that routinely screens for physical health during pregnancy while treating mental health as optional or secondary.
The word "perinatal" exists because mental health problems do not start at delivery. They can start during pregnancy, and they can persist or begin after delivery. Treating them as separate problems — pregnancy mental health versus postpartum mental health — is artificial. The perinatal period is one continuous period of massive change, and mental health care should be continuous too.
Conditions that affect perinatal mental health
Postpartum depression. Often called "the baby blues" when mild, but clinical postpartum depression is more severe and lasts longer than a few days. It affects approximately 1 in 7 women — and the rising recognition of men and non-binary people as birthing parents means this is not exclusively a "women's" condition. Symptoms include persistent low mood, loss of interest in activities, changes in appetite or sleep (beyond what is expected with a new baby), feelings of guilt or inadequacy, difficulty bonding with the baby, and in severe cases, thoughts of self-harm.
Postpartum anxiety. Anxiety during pregnancy and after delivery is common and frequently overlooked because the dominant cultural narrative expects new parents — especially mothers — to feel only love and joy. If you are feeling anxious rather than joyful, you may feel ashamed or broken. Anxiety in the perinatal period often manifests as excessive worry about the baby's health, panic attacks, obsessive checking, or racing thoughts that prevent sleep even when the baby is sleeping.
Postpartum OCD. Intrusive thoughts about harming the baby are the hallmark of postpartum OCD. These thoughts are ego-dystonic — the exact opposite of what the person wants. New parents with OCD are terrified of being alone with their baby because of these thoughts. They do not want to harm their baby. The thoughts are a symptom of OCD, not a prediction of behaviour, and the person with OCD is no more likely to act on them than anyone else. But the distress they cause is real and severe.
Postpartum psychosis. A rare (approximately 1–2 per 1,000 deliveries) but severe psychiatric emergency. Symptoms include hallucinations (hearing or seeing things that are not there), delusions (fixed false beliefs, often about the baby), severe disorganisation, and confusion. Postpartum psychosis is a medical emergency requiring immediate hospitalisation. The person is at significant risk of harming themselves or the baby during an acute episode. If you experience any of these symptoms, seek emergency help immediately.
Pre-existing conditions. If you had depression, anxiety, bipolar disorder, or any other mental health condition before pregnancy, there is a significant risk that it will recur during or after pregnancy. Pregnancy is not a cure. Medication decisions during pregnancy are complex — some medications carry risks, but untreated mental health conditions also carry risks for both parent and baby. This is not a decision to make alone. A specialist can help you weigh the evidence.
The physical basis
The hormonal changes during and after pregnancy are the most extreme the body experiences. During pregnancy, oestrogen and progesterone levels rise to levels 10–50 times above normal. After delivery, they fall to near-zero within 48 hours. This hormonal crash is one of the biological drivers of postpartum symptoms.
Thyroid function is also significantly affected by pregnancy. Postpartum thyroiditis — inflammation of the thyroid gland after delivery — affects approximately 5–10% of women and can cause symptoms that are indistinguishable from depression or anxiety (fatigue, low mood, irritability, or panic and racing heart). If postpartum symptoms are severe or unusual, a simple blood test to check thyroid function can identify this cause, which is treatable.
Sleep deprivation. New parents are sleep-deprived. Chronic partial sleep deprivation impairs cognitive function, emotional regulation, and physical health. For someone with no mental health history, this is uncomfortable. For someone with a predisposition to mental health conditions, sleep deprivation is a powerful trigger for episodes. This is not a moral failing or a sign of weakness — it is a biological fact.
The psychological and social context
The transition to parenthood is a major life transition. It involves identity change, loss of autonomy, changes in relationships, and often a dramatic shift in daily routine. The psychological weight of this transition varies enormously depending on the person's circumstances.
Unplanned or unwanted pregnancy. A pregnancy that was unplanned, unwanted, or coerced is a significant risk factor for perinatal mental health difficulties. The psychological impact of carrying a pregnancy to term when it was not desired can be severe, and the cultural narrative that all mothers feel immediate love for their baby can make these feelings impossible to acknowledge.
Loss and infertility. The perinatal period includes pregnancy loss (miscarriage, stillbirth) and infertility treatment. Both carry significant mental health risks. The grief of pregnancy loss is often minimised culturally ("you can try again"), which compounds the suffering.
Domestic abuse. Pregnancy and the postpartum period are times of increased risk for domestic abuse. If you are in an abusive relationship and are pregnant or have recently had a baby, the situation requires specific professional support. In the UAE, call 600 590 000 (WASSIL) or go to the nearest emergency department.
Cultural isolation. In Dubai's expatriate population, many people are far from their extended family. The isolation of new parenthood is amplified when you have no local support network, when you do not speak the language, or when cultural expectations about parenting differ from what you have been told.
Medication during pregnancy and breastfeeding
This is one of the most discussed and least understood topics in perinatal mental health.
Pregnancy. Some medications carry risks during pregnancy. But untreated mental illness also carries risks — poor nutrition, substance use, stress on the pregnancy, and in the case of bipolar disorder, a very high risk of relapse (up to 70% without medication). The decision to continue or adjust medication during pregnancy should be made with a specialist who understands the specific evidence for the specific medication.
Breastfeeding. Most psychiatric medications pass into breast milk in very small amounts. For many medications, the amounts are so small that the clinical significance is minimal. For others, there is more caution needed. Again, this is not a decision to make alone or to decide through general internet research — it requires discussion with a specialist who can review the specific evidence for your specific medication.
The evidence base for perinatal psychopharmacology is growing but remains incomplete — ethical constraints limit research in pregnant people. This means decisions are often based on the best available evidence rather than definitive data. That is still better than deciding through fear or anecdote.
Screening and early identification
Universal screening for perinatal mental health conditions is increasingly recommended but not universally implemented. The Edinburgh Postnatal Depression Scale (EPDS) is the most widely used screening tool, but it detects depression — not anxiety, OCD, or psychosis.
If you are pregnant or postpartum and experiencing mental health difficulties, you do not need a screening score to deserve help. You need help because you are struggling. The threshold for seeking help should be your own assessment that something feels wrong.
Treatment options
Psychotherapy. CBT and interpersonal therapy (IPT) are the most evidence-based psychotherapies for perinatal depression and anxiety. They are effective for mild to moderate symptoms and can be combined with medication for moderate to severe symptoms.
Medication. For moderate to severe symptoms, medication is often necessary. Several antidepressants are well-studied in pregnancy and breastfeeding and are considered relatively safe. The key is working with a prescriber who specialises in perinatal mental health.
Support groups. Connecting with other new parents — particularly those who are open about the difficulties — can reduce isolation and shame. In Dubai, there are expatriate parenting groups from many cultural backgrounds.
Family support. Involving the partner or family members in treatment improves outcomes. When the people around you understand what you are experiencing, they can provide more effective support.
When should I seek help?
If you are pregnant or postpartum and feeling anxious, low, overwhelmed, or "not right" — seek help. You do not need to be "severe enough." You do not need to have already harmed yourself. If you are worried enough to read this article, that is enough.
Seek urgent help — call 999 (police) or 998 (ambulance) in the UAE, or go to the nearest emergency department — if you are having thoughts of self-harm, if you are experiencing hallucinations or delusions, if you are severely distressed, or if you are in any way a danger to yourself or your baby. For non-urgent enquiries, use the appointment request form on this website. This practice does not operate a monitored telephone line, and a message sent through the form may not be read straight away.