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Postpartum, perinatal and hormonal psychiatry

Silvia A. Bernardi, M.D. · Psychiatrist & Neuroscientist · New York & Milan · Updated October 2026

Pregnancy, the months after delivery, the premenstrual phase and perimenopause are times when the brain is exposed to large hormonal shifts — and when depression, anxiety, obsessive thoughts, sleep collapse and, rarely, psychosis can appear or return. These conditions are common, they are treatable, and they deserve care that takes the biology seriously.

What we treat

• Depression and anxiety in pregnancy and after delivery, including intrusive, frightening thoughts about the baby.
• Medication decisions in pregnancy and breastfeeding, made with the actual evidence on risks of treating and of not treating.
• Bipolar disorder around pregnancy, where planning and postpartum monitoring matter greatly.
• Premenstrual dysphoric disorder (PMDD).
• Mood, anxiety, sleep and cognitive changes in perimenopause.

How we approach it

Sleep is often the first system to fail after delivery, and one of the most informative to follow: with consent, wearable data shows recovery or deterioration week by week. Medication history is read in detail, because a medication that “failed” during a period of severe sleep deprivation may never have had a fair trial. We coordinate with obstetricians, gynecologists and pediatricians.

The biology of these conditions is the founding research focus of Neuroscience for the Mind, the 501(c)(3) nonprofit Dr. Bernardi founded for clinical research and education, which studies hormonal and stress biology across pregnancy and the postpartum months (see Teaching and talks). We are currently conducting research on the role of hormones in perinatal mood and anxiety. See also Case: a complex postpartum course.

Postpartum psychosis is an emergency. Confusion, severe insomnia, paranoia or thoughts of harming oneself or the baby after delivery require immediate care: call 911 or go to the nearest emergency room.

Questions

Can I take antidepressants while breastfeeding?
Many antidepressants are considered compatible with breastfeeding, and some have extensive safety data. The decision weighs the risks of medication exposure against the risks of untreated depression for both mother and baby, and should be made with a psychiatrist familiar with the evidence.

Is postpartum depression different from regular depression?
It occurs in a distinct biological context, with abrupt hormonal changes and profound sleep disruption, and may differ in mechanism. It is treatable with psychotherapy and medication.

Can perimenopause cause anxiety, depression or brain fog?
Yes. Fluctuating estrogen, disrupted sleep and vasomotor symptoms can all contribute to mood, anxiety and cognitive complaints in perimenopause. Evaluation should consider these together.

Related reading

• Case: a complex postpartum course
• Attention problems and brain fog: measure first
• Insomnia and sleep problems, measured over months

MIND FIRST sees patients in Midtown Manhattan (Grand Central) and the Financial District, and by telehealth for patients located in New York, Florida or Milan. Dr. Bernardi is licensed to practice medicine in New York, Florida and Italy.