1 in 5 women experience depression during pregnancy or in the postnatal period. ¹Let that land for a moment. That is not a small, niche group of women. That is one in every five. That is your antenatal class, your baby group, your NCT WhatsApp. That is the mum at the swings who looks like she is holding it together. That is possibly you. And yet so many of those women go unrecognised. Unsupported. Quietly convincing themselves that what they are experiencing is just the hard part of new motherhood. That they are not depressed, they are just tired. That they should be grateful. That they are coping, sort of, even if only barely. This blog is for every woman who has ever thought "I do not think I am depressed, I am not crying all the time" and dismissed the idea before she had even properly considered it. Because perinatal depression does not always look the way people expect. And that gap between what people expect and what it actually looks like is exactly why so many women fall through the cracks.
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What people think it looks like
The image most people have of postnatal depression is a woman who cannot get out of bed. Who cries constantly. Who is visibly unable to cope. Who is clearly, obviously struggling in a way that is impossible to miss.
And yes, for some women it does look like that. But for many it does not. Not even close.
Perinatal depression is extraordinarily good at disguising itself, particularly in women who are high functioning, used to pushing through, and surrounded by people who expect them to be happy.
What it actually looks like
Perinatal depression can look like going through the motions. Getting up, feeding the baby, going through all the right actions, and feeling absolutely nothing. Not sad exactly. Just empty. Flat. Like the colour has drained out of everything and you cannot remember what it felt like to actually enjoy your life.
It can look like irritability. Snapping at a partner for no real reason. Feeling rage that feels completely disproportionate and then feeling crushing guilt about it afterwards. Irritability is one of the most common and least talked about symptoms of perinatal depression, and many women do not recognise it as a symptom at all. ²
It can look like exhaustion that sleep does not touch. Not the normal new parent tiredness that everyone warns you about. Something deeper and heavier. A bone-level fatigue that makes even small tasks feel enormous.
It can look like anxiety. Perinatal depression and anxiety frequently occur together, ³ and for some women the anxiety is so prominent that the depression underneath it goes completely unnoticed. Constant worry about the baby. Catastrophic thinking. An inability to switch off even for a moment.
It can look like disconnection. Feeling strangely detached from the baby. Going through the motions of caring for them while feeling like you are watching yourself from the outside. Wondering why you do not feel the overwhelming love everyone told you about, and then feeling so ashamed of that wondering that you cannot say it out loud to anyone.
It can look like intrusive thoughts about not being a good enough mother. Thoughts like "my baby deserves better than me" or "everyone would cope better without me here." These thoughts feel true when you are inside them. They are not. They are symptoms. ²
It can look like not being able to enjoy anything. Things that used to bring pleasure, food, time with friends, moments of rest, feel completely flat. This loss of enjoyment, known clinically as anhedonia, is one of the key markers of depression and one that often goes unnoticed because it does not look like sadness. ⁴
And it can look like functioning perfectly well on the outside while falling apart completely on the inside. Showering. Smiling. Answering messages. Going to baby group. And then coming home and sitting on the kitchen floor wondering how much longer you can keep doing this.
Why it is so easy to miss
Part of the reason perinatal depression is so frequently missed is that some of its symptoms overlap with what is considered normal new parent experience.
Tiredness? Of course you are tired, you have a newborn. Sleep disruption? That is just what this season looks like. Changes in appetite? You are breastfeeding, that is normal. Difficulty concentrating? Sleep deprivation will do that.
Up to 50% of cases of perinatal depression remain undiagnosed, partly because of the stigma around the condition and partly because women are reluctant to disclose their symptoms. ⁵ And even when they do try to reach out, they are sometimes met with reassurance that what they are feeling is normal, when what they actually needed was someone to look a little more carefully.
The Edinburgh Postnatal Depression Scale is the most widely used screening tool for perinatal depression in the UK. It is a short questionnaire that your midwife or health visitor should offer you at various points during pregnancy and after birth. But a screening tool is only as useful as the conversation that follows it. A low score does not necessarily mean someone is fine, and a high score is not a diagnosis. What matters is that women feel safe enough to answer honestly and that the people asking them know what to do with the answers.
Depression during pregnancy
It is worth saying clearly that perinatal depression is not only a postnatal condition. It can begin during pregnancy, sometimes quite early on. Antenatal depression is often overlooked because pregnancy is assumed to be a happy time, but the hormonal changes, physical demands and psychological weight of pregnancy can absolutely trigger depression before the baby has even arrived.
Research suggests that around 39% of women who experience depression during pregnancy go on to experience it after birth as well. ⁶ This means that antenatal depression is not just significant in its own right. It is also a significant risk factor for postnatal depression, and identifying it early gives women the best possible chance of getting support before things become more difficult.
What depression can sound like from the inside
Sometimes the clearest way to understand what perinatal depression actually looks and feels like is to hear the kinds of thoughts it produces.
"I love my baby but I feel nothing.""I do not recognise myself anymore.""I keep thinking everyone would be better off without me.""I do not know why I cannot just enjoy this.""I am so angry all the time and I do not know why.""I am exhausted but I cannot sleep even when the baby sleeps.""I feel like I am pretending to be a mother rather than actually being one."
If any of these feel familiar, please keep reading.
Because depression tells you that these thoughts are facts. They are not. They are symptoms of an illness that is real, recognised and treatable. And you deserve exactly the same care and treatment as anyone else who is unwell.
What to do if this sounds like you
The most important first step is telling someone. A GP, a midwife, a health visitor. You do not need to have the perfect words. You do not need to be certain that what you are experiencing is depression. You just need to say that something is not right and that you need some help.
Treatment for perinatal depression usually involves talking therapy, medication or a combination of both. ⁴ Many women have concerns about medication during pregnancy or while breastfeeding, which is completely understandable. A GP or specialist can help you weigh up the options in a way that feels right for you and your baby.
If you are having thoughts of harming yourself or your baby, please seek help urgently. You can contact your GP, call 111, go to your nearest A&E, or call the Samaritans on 116 123 at any time of day or night.
If this sounds like someone you know
Sometimes the most valuable thing a partner, family member or friend can do is notice. Not fix. Not offer advice. Just notice and say "I have been worried about you. Are you okay? And I mean really okay, not just coping okay."
That question, asked gently and with genuine care, can be the thing that allows a woman to finally stop pretending.
You do not have to be a professional to make a difference. You just have to be willing to ask and willing to listen to the answer.
Tomorrow is the final post in this series, and it feels important to end not with more information but with something quieter. A reminder that no two paths through this look the same. And that wherever you are in yours, you are not alone.
Bex x
References
- Maternal Mental Health Alliance. About maternal mental health. maternalmentalhealthalliance.org
- National Institute of Mental Health. Perinatal depression. nimh.nih.gov
- Postpartum Support International. Perinatal mental health. postpartum.net
- Mind. Postnatal and antenatal depression. mind.org.uk
- NCBI Bookshelf / StatPearls (2025). Perinatal depression. ncbi.nlm.nih.gov/books/NBK519070
- PMC (2021). Perinatal depression: challenges and opportunities. pmc.ncbi.nlm.nih.gov/articles/PMC7891219