Addressing Postpartum Depression and Perinatal Mental Health: Q&A with Soudabeh Givrad, MD

Q. What is your role at Stanford Medicine Children’s Health?

A. I’m a perinatal and infant psychiatrist and a clinical associate professor at Stanford University in the Division of Child and Adolescent Psychiatry and Child Development. I also direct our Perinatal and Infant Psychiatry Fellowship. My work centers on supporting the mental health of women and other individuals during pregnancy and postpartum, with attention to the well-being of their infants and families.

At the Johnson Center, I serve as medical director of the Wanstrath Mental Health Initiative, our perinatal mental health program. Made possible by a generous philanthropic gift, this initiative is expanding access to compassionate, integrated mental health care from pre-conception through the first year postpartum. Our team offers individual, group, and couples therapy, as well as medication support.

I oversee and work closely with our team to help make that support available across the continuum of care, from outpatient obstetric visits to hospital stays during pregnancy and the experience of having a baby in the Neonatal Intensive Care Unit. We want mental health care to feel like a connected, accessible part of the care that patients and families receive during this important time.

Another meaningful part of my role is training the next generation of clinicians. Through our fellowship, we recruit and train a new fellow each year to care for women, infants, and families during pregnancy and postpartum, a period that can bring both tremendous joy and significant vulnerability.

Q. What is postpartum depression?

A. Postpartum depression is a mental health condition that can affect how someone feels, thinks, and functions after having a baby. It can begin anytime during the first year after birth. For many people, symptoms actually start during pregnancy, which is why we often use the broader term “perinatal depression” to include both pregnancy and postpartum.

It’s more than feeling sad. Someone might lose interest in things they usually enjoy, feel overwhelmed by guilt or hopelessness, have trouble concentrating, or struggle to sleep even when they have the opportunity. Anxiety is also common. Some parents worry constantly that they aren’t doing a good enough job or find it difficult to feel connected to their baby. These experiences can be especially painful when everyone around them expects this to be a happy time. In more severe cases, people may have thoughts of death or harming themselves, which need immediate attention.

It’s important to distinguish postpartum depression from the “baby blues.” The baby blues are very common and can involve tearfulness, irritability, and emotional ups and downs in the first few days after birth. They are usually mild and resolve within about two weeks. With postpartum depression, symptoms are more persistent or intense and can interfere with daily life and caring for yourself or your baby. You don’t need to wait two weeks to seek help if symptoms are severe or you’re struggling to function.

Q. What factors increase a person’s risk for postpartum depression?

A. There isn’t one single cause. Hormonal changes, a person’s genetic vulnerability, disrupted sleep, and the physical and emotional demands of pregnancy and caring for a newborn can all play a role. A history of depression, particularly postpartum depression, is one of the strongest risk factors. Depression or anxiety during pregnancy, especially when untreated, also increases the risk. Other factors include limited support, relationship difficulties or abuse, financial strain, and major life stresses. Pregnancy complications, premature birth, or having a baby with medical needs or in the NICU can add further stress and increase vulnerability.

But postpartum depression can happen even without any obvious risk factors. It is not a reflection of how much someone loves their baby or how capable they are as a parent. It is a treatable condition, and no one should have to go through it alone.

Q. Why is it important to identify postpartum depression, and how is it diagnosed?

A. Recognizing and treating depression matters at any point in someone’s life because it affects so much more than mood. It can change how we function, how we relate to other people, and how we experience everyday life. During pregnancy and postpartum, the parent’s well-being matters in its own right, and it also has implications for the baby and the whole family.

Becoming a parent is a major psychological transition. You’re adjusting to changes in your identity, your relationships, your responsibilities, and your expectations of yourself. Even under the best circumstances, that can be a lot to navigate. When depression or anxiety becomes part of that experience, it can make an already vulnerable time much harder.

Untreated depression can make it difficult to care for yourself, connect with your baby, and manage daily family life. It can strain relationships and is associated with a greater risk of longer-term emotional, behavioral, and developmental difficulties for children. In severe cases, it can lead to thoughts of suicide and become life-threatening. These outcomes are not inevitable, and the reason to talk about them is to help families get support, never to add guilt or blame. Depression is treatable, and identifying it early gives us an opportunity to support both the parent and the developing relationship with their baby.

The diagnosis itself is clinical, meaning it comes from a careful conversation and assessment with a health care professional. We have validated screening tools, such as the Edinburgh Postnatal Depression Scale and the PHQ-9, which are short questionnaires that help identify people who may need further evaluation. But a questionnaire alone does not make the diagnosis. We talk with the person about their symptoms, how long they’ve been present, how they’re affecting daily life, and their mental health history. We also assess safety and consider other conditions that could explain or contribute to what they’re experiencing. The goal is to understand the person’s experience and connect them with the right care.

Q. What are some myths about postpartum depression we’d like to bust, or facts people may not be aware of?

A. One of the biggest myths is that postpartum depression happens because someone isn’t trying hard enough or is somehow failing as a parent. Like many other illnesses, it has complex biological, psychological, and social roots. Having postpartum depression does not mean you’re a bad mom or that you don’t love your baby. Depression itself can bring intense guilt and self-blame, so parents may already be questioning their ability to parent when what they need is care and support.

Another misconception is that feeling this way is simply part of having a newborn. Sometimes parents share that they’re struggling and hear, “Of course you’re overwhelmed. You’re not sleeping. What did you expect?” Those comments may be well-intentioned, but they can leave someone feeling dismissed. Some exhaustion and emotional ups and downs are common, but persistent sadness, intense anxiety, or difficulty functioning deserve attention. I encourage parents to reach out so we can help them understand whether what they’re experiencing is part of the adjustment or something that needs treatment. You don’t have to figure that out on your own.

We also hear parents say that getting treatment feels selfish, or that they should just put up with how they’re feeling and focus on the baby. Your well-being matters in its own right. You deserve care because you are a person who is struggling. And caring for yourself also supports your family. A parent’s mental health can affect relationships, family life, and a baby’s emotional and physical development. Getting help is an act of care for yourself and for the people you love.

Q. Could you tell us about the perinatal mental health program at Stanford Medicine Children’s Health and the services or resources available to patients experiencing postpartum depression or other perinatal mood and anxiety disorders?

A. Through the Wanstrath Mental Health Initiative at the Johnson Center, we offer psychiatric assessment, medication management, and psychotherapy throughout the perinatal period, from preconception consultations through the first year postpartum.

Our approach is holistic. We want to understand the person we’re caring for, including their experiences, relationships, and sources of support. As we treat depression, anxiety, or other mental health concerns, we also consider the family as a whole, the relationship with a partner, and the developing bond between parent and baby. Our services include individual, group, couples, and parent-infant therapy, so we can tailor support to each person’s needs.

We also work to provide continuity of care across different settings, including outpatient obstetric care, hospital stays during pregnancy, and times when a baby needs care in the NICU. Our goal is for patients and families to feel supported by a connected team as their needs change throughout pregnancy and postpartum.

Q. What is unique about our offerings, or what differentiates our program?

A. What makes our program distinctive is that we bring together care for the parent, the infant, and their relationship, while keeping the whole family in mind. We focus on helping patients feel better and supporting them as they adjust to parenthood and build a bond with their baby.

Our multidisciplinary team offers a range of evidence-based treatments tailored to each patient’s symptoms, clinical needs, preferences, and circumstances. These include psychiatric care, medication management, and individual, group, couples, and parent-infant therapy. Within these services, we use different therapeutic approaches depending on what each patient is experiencing and what will best support them.

We also work closely with our colleagues in obstetrics, maternal-fetal medicine, and neonatology. Those partnerships help us provide connected care across outpatient visits, hospital stays during pregnancy, and NICU admissions, with continuity as patients and families move through different stages of care.

Q. What does the future hold for this patient population? Are there studies or cutting-edge treatments on the horizon that could help improve outcomes?

A. There are several exciting developments in this field. One is zuranolone, which became the first oral medication specifically approved by the FDA for postpartum depression in adults in 2023. It’s taken over a 14-day course, and clinical trials showed that improvement can begin within days. Having a treatment that can work quickly is a meaningful advance for someone who is struggling during such an important time. As with any treatment, we consider whether it is the right fit for each patient and what ongoing support they may need.

Researchers are also working to identify more precise predictors of who may develop perinatal depression. Studies are looking at biological markers alongside psychological and social factors to better understand individual risk. This work is still developing, but the hope is that we can identify people who need additional support earlier and offer more personalized prevention and treatment.

I also see an important part of the future in how we organize and deliver care. We need to better integrate mental health support into routine care throughout pregnancy and postpartum, with a holistic, family-centered approach. That means understanding the parent’s needs, supporting relationships and the bond with the baby, and bringing mental health, obstetric, and infant care teams together. My hope is that these advances will help families receive care earlier and feel more supported throughout the transition to parenthood.

Q. If a person suspects that they are at risk of or are experiencing postpartum depression, what should they do?

A. I would encourage them to reach out to their obstetric or primary care team and share what they’re experiencing and what concerns they have. You don’t need to be certain that you have postpartum depression before asking for help. If something doesn’t feel right, or you’re worried about your risk, that is enough to start a conversation.

When needed, our social work team can provide an assessment, help identify the support that would be most helpful, and make appropriate recommendations and referrals. We want patients to feel comfortable speaking openly so we can work together to connect them with care that meets their needs.

There are also resources available beyond your care team. In the United States, the National Maternal Mental Health Hotline provides free, confidential support 24/7. You can call or text (833) TLC-MAMA (833-852-6262) to speak with a trained counselor. Partners and family members can reach out, too. Postpartum Support International also offers support and help finding local resources through its HelpLine at (800) 944-4773, although this is not an emergency or crisis line.

If you’re in a mental health crisis or having thoughts of suicide, you can call 988 or text 988 for crisis support. If there is immediate danger, call 911 or go to the nearest emergency department.

You don’t have to navigate this on your own. Support is available, and reaching out is an important first step.