Etiology and factors involved in perinatal depression

Perinatal depression is a complex condition with multiple causes, involving biological, psychological, and social factors. Understanding these elements provides a comprehensive view of the disorder and guides intervention from a preventive and therapeutic perspective.

Biological factors

Hormonal changes during pregnancy and postpartum play a key role in the onset of depressive symptoms. One of the main mechanisms involved is the sudden decrease in hormones such as estrogen and progesterone after childbirth, which directly affects serotonin levels, a neurotransmitter essential for mood regulation.

Likewise, an alteration in 5HT receptors, responsible for serotonin uptake, has been observed, which aggravates emotional vulnerability.

The hypothalamic-pituitary-adrenal (HPA) axis, which regulates the stress response, is also involved. During pregnancy, this axis exhibits different activity, and its postpartum dysregulation is associated with increased susceptibility to depression.

In addition, decreased levels of oxytocin and prolactin, hormones related to mother-baby bonding and breastfeeding, have been identified in some depressed women.

Neuroimaging studies have even shown temporary structural changes in the prefrontal cortex of women during pregnancy, suggesting a neurobiological basis for certain cognitive and affective difficulties during this period.

Psychological factors

From a psychological perspective, pregnancy and motherhood represent a period of great emotional vulnerability. The need to adapt to a new maternal role involves an internal reorganization that can be overwhelming, especially in women with low resilience or obsessive or dependent personality styles.

Idealized expectations of motherhood also play a significant role. Many women expect to experience an immediate and positive connection with their babies, but when faced with a different reality—exhaustion, persistent crying, breastfeeding difficulties—they may feel guilty, inadequate, or even like “bad mothers.”

This dissonance between expectations and reality can cause deep distress. The fear of not living up to the social ideal of the “perfect mother,” coupled with constant self-demand, increases internal pressure.

In addition, women often hide their emotions for fear of judgment or stigma, maintaining an appearance of functionality that makes early diagnosis difficult.