Perinatal Depression: Symptoms, Causes, and Treatment

Perinatal depression is a type of depression that can occur during and after pregnancy. It is a serious condition that can affect the health of pregnant people and their children.

Perinatal Depression at a Glance

• Pregnancy and motherhood can produce a range of emotions, including excitement, joy, sadness, loneliness, and emptiness.
• These ups and downs are usually temporary, but for some women, these feelings persist or intensify over time.
• Perinatal depression can occur during and after pregnancy and can have severe symptoms and impact the health of pregnant people and their children.

Understanding Perinatal Depression

• Perinatal depression is a mood disorder that involves feelings of hopelessness and sadness during or after pregnancy.
• It affects 1 in 7 women, making it one of the most common medical complications during pregnancy and the postpartum period.
• There are several terms used to describe mood disorders resulting in depressive feelings during pregnancy or after birth, including postpartum depression, maternal depression, prenatal depression, and postnatal depression.
• Depression during pregnancy typically covers the period of pregnancy through the first 12 months after delivery.
• Approximately 26.3% of pregnant people are estimated to experience perinatal depression.

Recognizing the Symptoms of Perinatal Depression

• It is normal to experience emotional ups and downs during pregnancy and the postpartum period, and mild mood changes are common.
• However, persisting depressive feelings or anxiety during or after pregnancy that interferes with daily activities should be addressed.
• Symptoms of perinatal depression include:
  • Persistent sadness
  • Loss of interest in enjoyable activities
  • Feelings of emptiness and hopelessness
  • Frequent crying
  • Reduced ability to think or concentrate
  • Trouble sleeping
  • Fatigue or low energy
  • Irritability
  • Increased anxiety and worry
  • Loss of interest in self-care and caring for the baby
  • Poor bonding with the baby
  • Changes in appetite and weight
  • Thoughts of death or suicide

How Is Perinatal Depression Diagnosed?

• Diagnosing pregnancy depression follows similar guidelines as other forms of depression, but considers the peripartum onset as an essential specifier, often resulting in a diagnosis of Major Depressive Disorder (MDD) with peripartum onset.
• There are some discrepancies in the time frame of perinatal depression between the DSM-5 and organizations like the American College of Obstetricians and Gynecologists (ACOG).
• The DSM-5 cites symptom onset as occurring any time during pregnancy or within four weeks of delivery, while some professional organizations acknowledge that symptoms can occur up to 12 months after delivery.

Perinatal Depression vs. The "Baby Blues"

• Mild mood changes, unhappiness, and exhaustion commonly occur in the first two weeks after childbirth, often referred to as the "baby blues."
• It is often related to the stress and exhaustion of caring for a newborn.
• Distinguishing between the baby blues and symptoms of postpartum depression is essential. Severe symptoms or symptoms lasting more than two weeks warrant a discussion with a healthcare provider.

Getting Screened for Perinatal Depression

• ACOG recommends at least one screening for depression and anxiety symptoms during the perinatal period and a follow-up screening during the comprehensive postpartum visit.
• ACOG and the American Academy of Pediatrics (AAP) recommend screening with a validated tool like the Edinburgh Postpartum Depression Scale (EPDS), a 10-question screen completed by the mother.
• A referral from a doctor for additional mental health services may be necessary if further treatment is required.

What Causes Perinatal Depression?

• The causes of perinatal depression involve a combination of medical, social, and psychiatric vulnerabilities.
• Depression is more prevalent in women than in men, and hormone activity is thought to be one of the causes of pregnancy depression due to shifting hormones during pregnancy and the postpartum period.
• Several risk factors exist for perinatal depression, including:
• Personal or family history of depression
  • Maternal anxiety
  • Life stress
  • Lack of social support
  • Unintended pregnancy
  • Smoking
  • Poor relationship quality
  • History of physical or sexual abuse
  • Pregnancy complications

How Is Perinatal Depression Treated?

• The symptoms of perinatal depression can feel overwhelming, but it is important to remember that it is treatable.
• Treatment usually involves a combination of therapy, medications, and self-care.

Therapy and Counseling

• Psychotherapy is often the first line of defense for treating perinatal depression.
• Therapy helps individuals understand their diagnosis, develop strategies to manage symptoms, and support them through the challenges of pregnancy and parenting.
• Two forms of psychotherapy have been studied specifically for treating perinatal depression:
• Cognitive-behavioral therapy (CBT)
  • Interpersonal psychotherapy (IPT)

Antidepressants

• Antidepressants are a class of drugs commonly prescribed for treating depression.
• They work by increasing levels of neurotransmitters (primarily serotonin, norepinephrine, and dopamine) in the brain, which regulate mood.
• There are varying opinions on the use of antidepressants during pregnancy and breastfeeding.
• Selective serotonin reuptake inhibitors (SSRIs) are commonly prescribed during these periods.
• Consultation with a doctor about the risks and benefits of medication during pregnancy and untreated depression is crucial.

Acupuncture

• Preliminary research suggests that complementary therapies like acupuncture and acupressure may be helpful in managing depression symptoms during pregnancy.

Coping With Perinatal Depression

• Managing depression symptoms while pregnant and caring for a newborn can be challenging.
• In addition to treatment plans involving therapy or medication, self-care and coping tips can help alleviate symptoms of pregnancy depression.
• Self-care and coping tips include:
  • Joining a support group
  • Practicing relaxation techniques
  • Getting regular exercise
  • Eating a healthy diet
  • Getting enough sleep
  • Seeking support from family and friends