Perinatal Depression

Medically reviewed by Debra Rose Wilson, PhD, MSN, RN, IBCLC, AHN-BC, CHT on June 26, 2017Written by Michael Kerr

Overview

Postpartum depression—the depression that occurs in new mothers after their baby’s born — may be better known, but mood disorders during the pregnancy itself are more common in pregnant women than experts once thought.

There’s a collective term now for prenatal depression before the baby’s born and postpartum depression after the baby’s born — perinatal depression.

Causes and prevalence

Pregnancy can be one of the happiest times in a woman’s life. But it can also play havoc with hormones and create plenty of stress.

It was once believed that pregnancy protected a woman from emotional disorders, but that turned out to be a myth. Plus, in recent years, there’s been a great deal of media focus on postpartum depression. That may be why it took some time for word to get out that the combination of biological and emotional factors in moms-to-be may lead to anxiety and depression.

Now those symptoms may lead to a diagnosis of perinatal depression. It’s estimated that between 10 and 20 percent of women develop some type of pregnancy-related mood disorder. Plus, about 1 in 20 women in the U.S. will experience a major depressive disorder (MDD) while they’re pregnant.

Symptoms of perinatal depression

Normal pregnancy shares some symptoms and signs of depression. For instance, with either, you’re likely to be tired, have some insomnia, experience emotional changes, and gain weight. That means your pregnancy can mask any symptoms of depression.

To help you recognize depression during pregnancy, it’s worth talking with your doctor about any of these symptoms:

  • frequent crying or weepiness
  • trouble sleeping not because of frequent urination
  • fatigue or low energy
  • changes in appetite
  • loss of enjoyment in once pleasurable activities
  • increased anxiety
  • trouble feeling connected to your developing baby (called poor fetal attachment)

If you had depression before pregnancy, your symptoms may be more significant during it than they were before.

Symptoms of the ‘Baby Blues’

As many as 80 percent of women are affected by what is known as the “baby blues.”

During pregnancy, your levels of estrogen and progesterone rise dramatically. They’re needed to help your uterus expand and to sustain the placenta. These hormones are also associated with mood.

Within 48 hours after your baby’s arrived, the levels of both hormones plummet drastically. Many researchers believe this “postpartum hormonal crash” causes the baby blues.

For about 1 or 2 weeks after your baby’s born, you may have symptoms of the baby blues. They usually go away after that. Until then, you may feel especially:

  • irritable
  • anxious
  • frustrated
  • overwhelmed
  • likely to have rapid mood changes (elation one moment, weeping the next)
  • exhausted
  • sleepy, like you want to sleep all the time (hypersomnia)
  • unable to sleep (insomnia)

Symptoms of postpartum depression

Experts think the same plunge of estrogen and progesterone after delivering a baby may make some women more susceptible to postpartum depression. Postpartum depression affects between 10 and 20 percent of new mothers.

One difference between the baby blues and postpartum depression is duration. Symptoms of postpartum depression last for more than 2 weeks after your baby’s born. They include feeling:

  • overwhelmed
  • intensely anxious
  • weepy or like you’re crying all the time
  • irritable or angry
  • sad all the time
  • extremely tired and without energy
  • worthless, hopeless, or guilty
  • like you want to sleep or eat more or less than you usually do
  • unable to concentrate or forgetful
  • intensely worried about your baby
  • uninterested in your newborn or doing things you used to enjoy
  • headachy or pain in your chest or like you can’t catch your breath (hyperventilate)

Symptoms of postpartum psychosis

A more severe form of postpartum depression is called postpartum psychosis. It is an extremely rare condition that affects between 1and 2 women per 1,000.

Common symptoms of postpartum psychosis include:

  • either auditory or visual hallucinations
  • delusions, which is believing something that isn’t true
  • suicidal thoughts
  • thoughts about harming your baby

Postpartum psychosis is an extremely serious condition. It requires immediate emergency care. A mother may be hospitalized for her own safety as well as her baby’s.

Treatment

The methods used to treat perinatal depression are the same ones used for other types of depression. The good news is that success rates are typically much higher for perinatal depression. Between 80 and 90 percent of pregnant women and new moms are helped by medications, talk therapy, or a combination of drugs and talk therapy.

Medications

Antidepressant drugs are the most common treatment for perinatal depression. Doctors especially prescribe selective serotonin reuptake inhibitors (SSRIs). You and your doctor may talk about taking an antidepressant while you’re pregnancy, after your child’s born, or both.

Several studies, both in the U.S. and the U.K., have determined that SSRIs are generally safe for pregnant women and nursing mothers. There’s currently no evidence that antidepressant drugs have long-term harmful effects on a child when taken during pregnancy. However, there is a chance of drug withdrawal reactions in newborns that may include jitteriness or irritability. In rare cases, there’s a risk of seizures.

It’s understandable that mothers are concerned about any their infants being at risk for side effects. So many women opt for other treatments instead of antidepressants.

Talk Therapy and Alternative Treatments

Talk therapy has proven very effective for perinatal depression.

A few alternative treatments have also shown great promise helping women with perinatal depression. They include massage and especially acupuncture. For acupuncture, a specialist inserts small needles at specific parts of the body. A recent Stanford University study found that 63 percent of women who received a depression-specific form of acupuncture responded well.

Make note that prolonged depression may be more harmful to a mother and her child than the side effects of any treatments or medications. Family and friends should encourage early assessment and care.

If you notice signs of depression during or after your pregnancy, talk to your doctor about all of your treatment options. You and your doctor can work together to make an informed decision about a treatment that’s best for you and your baby.

Preventing perinatal depression

Studies have found that mothers who breastfeed for at least 3 continuous months have less incidence and severity of postpartum depression.

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