Depression: During and After Pregnancy

As many as one in four women will suffer from depression throughout their lifetime, and often will experience it during the childbearing years. Depression is one of the most common complications during and after pregnancy.

Pregnant women were once considered immune to depression; however, doctors now believe that pregnancy can actually trigger it. The physical and emotional changes a woman experiences during pregnancy and after pregnancy, such as fatigue, weight gain and insomnia, can resemble symptoms associated with depression, and can go unrecognized and untreated.

Deborah Kim, MD, a psychiatrist at the University of Pennsylvania Health System says, “If a woman is experiencing prolonged sadness, guilty feelings, hopelessness or low self-esteem, she may be suffering from depression. These symptoms can make it difficult to ask for help."

Perinatal Depression
Depression that occurs during pregnancy and continues for up to one year following delivery is called perinatal depression. The following factors may increase a woman’s chance of depression during this time:

• History of depression, mental illness or substance abuse
• Lack of support from family or friends
• Problems with a previous pregnancy or birth
• Marital or financial problems
• Young age

Depression during pregnancy can affect birth weight and cause premature delivery. Limited research suggests that women with perinatal depression improve when treated prior to delivery. Prenatal treatment options include therapy and/or medication. Women may be concerned that treatment of depression with medications may be harmful to the fetus if taken during pregnancy, or that the baby may have symptoms from medication exposure after delivery.

If you are experiencing symptoms of depression and are pregnant, talk to your doctor about which treatment options are right for you.

Postpartum Depression
Postpartum depression can occur anytime within the first year after childbirth. Throughout pregnancy, progesterone and estrogen levels increase greatly; however, during the first 24 hours of childbirth, the amount of these hormones drops rapidly. This rapid change in hormone levels may trigger depression.

Symptoms of postpartum depression include sadness, lack of energy, trouble concentrating, anxiety and feelings of guilt and worthlessness. Postpartum depression can seriously affect a woman’s well-being and keep her from functioning properly.

A variety of factors contribute to postpartum depression, including:

• Fatigue – Due to disrupted sleep patterns.
• Feeling overwhelmed – Due to taking care of a new baby, and possibly other children, a partner, and a household.
• Changes in work and home life – Staying at home with the baby can be isolating and returning to work can make a mother feel as if she is abandoning her baby.
• Loss of identity – New mothers may long for the life they had before the baby arrived.

Management of Postpartum Depression
Many women feel guilty and ashamed about being depressed during what is supposed to be a very happy time in their life. It is important to understand that depression is a medical problem, and to contact a health care provider to find out how to get help. “An obstetrician can help a woman decide whether her symptoms are signs of depression and if further treatment by a psychiatrist is necessary,” comments Dr. Kim.

In addition to seeking professional help during this time, women can also follow these helpful tips to deal with the symptoms they are experiencing:

• Get as much rest as possible.
• Ask your partner, family members, or friends for help with chores or feedings.
• Talk to family or friends about how you are feeling.
• Spend time alone with your partner.
• Join a support group for new mothers or for women with depression.

Postpartum Psychosis
Postpartum psychosis is rare and usually begins in the first six weeks after delivery. If you experience delusions, hallucinations or have obsessive thoughts about your baby, contact your health care provider immediately.

"In certain instances, postpartum depression can be a true medical emergency and women should seek immediate medical attention for these symptoms. Patients, their family, friends and co-workers should be aware of the symptoms of depression and postpartum psychosis", says Dr. Byun. Talk to family and friends about how you are feeling. Support from others is vital during this time.

Perinatal and postpartum depression can happen to any woman. Talk to your doctor or midwife about the steps to take if you experience symptoms of depression, including seeing a mental health professional. It is important to receive the appropriate professional treatment, either during or after your pregnancy, so that depression does not adversely impact your life or the life of your baby.

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