Depression During Pregnancy
Depression during pregnancy and postpartum is a serious health concern with potential consequences including preterm delivery and impaired child development. Yet women and their healthcare providers are often unaware of its prevalence, what signs and symptoms to watch for, or how to treat it.
Pregnancy and the first year postpartum are considered periods in which women are susceptible to depression and related mood disorders. The exact reasons for why some women are more vulnerable to depression during these periods are not known but it appears to be related to hormonal fluctuations. Although the prevalence rates for a mood disorder in non-pregnant and pregnant or postpartum women are actually similar, ranging from approximately 9-14% (i.e. approximately 1 in 10 women), the health consequences are considerably higher in this period and problems during the pregnancy (both health and life stressors) can increase the risk for depression. Further, many women are taken by surprise when they experience a mood disorder that is biologically/hormonally triggered despite having a wanted pregnancy/baby. These women may feel tremendous guilt and confusion because they cannot understand why they are feeling depressed.
Postpartum mood disorders are typically divided into postpartum blues, postpartum depression and postpartum psychosis. The blues occur in 50-80% of all women and include mood swings, feeling overwhelmed, tearfulness, and mild agitation or anxiety. These symptoms are short-lived and resolve within 1-2 weeks postpartum.
Postpartum depression is the equivalent of a depressive episode. Depression is different than feeling down or sad or being in a depressed mood which is short-lived and passes within a few hours or a couple of days. In contrast, when someone suffers from a depressive disorder, the depression is present all the time for a minimum of 2 weeks and interferes with social and occupational functioning. Onset of depression can occur during pregnancy or, if postpartum, can develop within 24 hours to 5 months postpartum. A depressive episode includes a combination of symptoms including depressed mood and loss of interest in pleasurable activities. Other symptoms include:
- Persistent sad, anxious or "empty" feelings
- Feelings of hopelessness and/or pessimism
- Feelings of guilt, worthlessness and/or helplessness
- Irritability, restlessness
- Fatigue and decreased energy
- Difficulty concentrating, remembering details and making decisions
- Insomnia, early–morning wakefulness, or excessive sleeping
- Increased or decreased appetite
- Thoughts of suicide, suicide attempts
As you can see, many of these symptoms would not be uncommon for a pregnant or postpartum woman to experience such as low energy, sleep disturbance, or appetite changes, so it is important to pay close attention to the symptoms that together signal depression. In addition, perinatal (during pregnancy) and postpartum depression also frequently include symptoms of anxiety and excessive worry or rumination. The most predictive risk factor for a pregnancy or postpartum depression is a prior history or family history of depression, particularly a previous pregnancy or postpartum depression. Other risk factors include emotional stress, lack of social support, financial stress and health problems during/after pregnancy. For some women, setting unrealistic expectations for motherhood may also put them at risk to develop depression. Postpartum depression may last several months if untreated but the good news is that treatments are available!
Postpartum psychosis is rare and occurs in about 1% of postpartum women worldwide. Onset of symptoms is usually within 1-2 weeks of delivery but may start during pregnancy or as late as 6 weeks postpartum. Postpartum psychosis is often either an exacerbation of bipolar or schizophrenic psychiatric disorders or may be the trigger for their onset. Symptoms include a loss of reality with visual or auditory hallucinations (seeing or hearing things that are not there), delusions (fixed false beliefs), paranoia, agitation and confusion. Women with postpartum psychosis are at risk for suicide and/or infanticide.
Treatment
Treatment for pregnancy or postpartum depression can include brief psychotherapy/counseling and/or antidepressant medication. Even women who are pregnant or breastfeeding may consider discussing medication use with their healthcare provider. Although the first reaction for pregnant or breastfeeding women is to stop any psychiatric medicine or not to start any, what is often forgotten is the risk of untreated depression. These consequences can include poor pre-natal care, preterm delivery and impaired mother-infant attachment and significant developmental problems. Further, research has shown that formerly depressed women stable on an antidepressant who then stopped the medicine when pregnant had a 68% relapse rate.
Regardless of which treatment you and your doctor may decide on remember that postpartum depression is common and not something you can resolve by pulling yourself up by the bootstraps. It is treatable. In addition to professional treatment, here are a few suggestions to help cope with the stress of pregnancy or being a new mother:
- Share your feelings and worries with your partner, a close friend or family member
- Ask for help-whether with childcare, chores etc. Getting help is not a sign of weakness or failure as a parent.
- Set reasonable expectations for accomplishing tasks if you are the primary caretaker for an infant. Some days, even finding time to brush your teeth should count as a major accomplishment!
- Recognize that good mother’s are not “perfect” but rather “good enough”
- Ask your healthcare provider for referrals for counseling or support groups in your area
