Perinatal Depression

Postpartum depression—the depression that occurs in new mothers after the birth of a child—may be better known, but mood disorders during the pregnancy itself are more prevalent in expectant mothers than previously thought.

The combination of the two types of depression (both prenatal and postpartum) is known as perinatal depression.

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 unforeseen stress.

The combination of biological and emotional factors may lead to anxiety and depression. It was once believed that pregnancy protected a woman from emotional disorders, but that has turned out to be a myth. This is largely due to the difficulty in diagnosing perinatal depression.

Also, there has been an inordinate focus on postpartum depression in recent years. It is estimated that between 10 and 20 percent of women develop some type of pregnancy-related mood disorder and approximately one in 20 women in the U.S. will suffer from a major depressive disorder (MDD) during the perinatal phase.

Symptoms of Perinatal Depression

Because they share symptoms, signs of depression such as tiredness, insomnia, emotional changes, and weight gain are often masked by the pregnancy itself.

Symptoms to watch for include:

  • frequent crying or weepiness
  • trouble sleeping not related to frequent urination
  • fatigue or low energy
  • changes in appetite
  • loss of enjoyment in once pleasurable activities
  • increased anxiety
  • poor fetal attachment

Symptoms of the 'Baby Blues'

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

During a woman's pregnancy her levels of estrogen and progesterone rise dramatically (to assist in ?the expansion of the uterus and to help sustain the placenta). However, within 48 hours of delivery, the levels of both hormones plummet drastically.

Since these hormones are associated with mood, many researchers believe this "postpartum hormonal crash" causes the baby blues and may make some women more susceptible to postpartum depression.

Symptoms of the baby blues usually resolve within one or two weeks of delivery and may include:

  • irritability
  • anxiety
  • frustration
  • feelings of being overwhelmed
  • rapid mood changes (elation one moment, weeping the next)
  • exhaustion
  • insomnia or hypersomnia (excessive sleeping)

Symptoms of Postpartum Depression

Like perinatal depression, postpartum depression affects between 10 and 20 percent of new mothers. It includes symptoms such as the following that occur for more than 14 days after delivery:

  • feelings of being overwhelmed
  • intense anxiety
  • frequent crying or weeping
  • irritability or anger
  • pervasive sadness
  • fatigue or low energy
  • feelings of worthlessness, hopelessness, or guilt
  • changes in sleeping or eating habits
  • lack of concentration or forgetfulness           
  • intense worries about the baby
  • a lack of interest in the newborn or once pleasurable activities
  • physical symptoms such as headaches, chest pains, or hyperventilation

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

Postpartum psychosis is usually accompanied by symptoms such as hallucinations (either auditory or visual) and delusions. Other symptoms may include suicidal ideation or thoughts of harming the baby.

Postpartum psychosis is an extremely serious condition that requires immediate emergency hospitalization for the safety of both the new mother and her baby.

Treatment

Treatments for perinatal depression are the same as with other forms of depression and the success rates are typically much higher—between 80 and 90 percent of women are helped by either medications, interpersonal cognitive behavioral or psychotherapy, or a combination of drugs and talk therapy.

Antidepressant drugs—especially selective serotonin reuptake inhibitors (SSRIs)—are the most common treatment for perinatal depression both during pregnancy and after the delivery of a child.

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 is 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. The risk of seizures is rare.

It is understandable, however, that new mothers are concerned about any side effects that may affect their infants and, so, many women opt for other treatments besides antidepressants.

Interpersonal therapy has proven very effective for perinatal depression, as have (to a lesser extent) cognitive behavioral therapy and psychotherapy.

Additionally, alternative treatments such as massage and especially acupuncture have shown great promise in the treatment of perinatal forms of depression. A recent Stanford University study found that women who received a depression-specific form of acupuncture (the placement of small needles in the body at specific locations) had a 63 percent response rate to the treatment.

It is important to note that prolonged depression may be more harmful to a mother and her child than the side effects of any treatments or medications. A woman should talk to her doctor about all of the options available in order to make an informed decision before choosing a treatment—one that will be best for both her and her baby.