Changes in emotions and mood swings may be expected during and for a period after childbirth. What may not be unexpected are symptoms of depression. Perinatal depression is depression experienced during pregnancy (antenatal) and up to one year after childbirth (post-partum). World-wide, the occurrence of perinatal depression is estimated to be between 10 and 13%, with slightly higher rates reported in the United States (U.S.). In 2018, one in five and one in eight women in the U.S. reported experiencing antenatal and post-partum depression, respectively. Women from all social economic, racial/ethnic backgrounds, and geographic locations in the U.S. reported experiencing perinatal depression. However, there are several factors that increase the risk of experiencing perinatal depression including a pre-pregnancy episode of depression, being younger than 19 years old at the time of the pregnancy, intimate partner violence, and limited physical support. In addition, having antenatal depression increases the risk for post-partum depression. Risks associated with perinatal include elevated potential for pre-term delivery, decreased mother-child bonding, and delayed cognitive/emotional development. Identifying and addressing the symptoms of perinatal depression are important steps to ensure the current and future welfare of the mother and the child.
Symptoms of perinatal depression include:
- Persistent sadness, anxiousness, or feeling empty
- Feelings of guilt, worthlessness, hopelessness, or helplessness
- Loss of interest or pleasure in hobbies and activities
- Fatigue or abnormal decrease in energy
- Difficulty concentrating, remembering, or making decisions
- Difficulty sleeping (even when the baby is sleeping), awakening early in the morning, or oversleeping
- Abnormal appetite, weight changes, or both
- Trouble bonding or forming an emotional attachment with the new baby
- Persistent doubts about the ability to care for the new baby
- Thoughts about death, suicide, or harming oneself or the baby
If you believe you or someone you know is experiencing perinatal depression, it is important to have the symptoms assessed by a qualified medical and/or a mental health professional to ensure the appropriate diagnosis and course of treatment. Once perinatal depression is confirmed, there are several options available to help alleviate the symptoms.
Medication and psychotherapy are effective methods to address the symptoms of perinatal depression. Health care providers can assess your symptoms and coordinate appropriate treatment which may include medication and/or psychotherapy. Antidepressant medications may be prescribed by a medical provider after consideration of the medical history, the physical condition of mother and child, as well as the potential risks to their future health. Cognitive Behavior Therapy (CBT) and Interpersonal Therapy (IPT) are mental health strategies that have been effective in helping to address the symptoms.
Taking care of yourself helps to decrease the depressive symptoms. Components of self-care include eating nutritious food throughout the day, getting regular exercise to reduce stress, getting an appropriate amount of sleep, having time for yourself each day, and creating a support network.
Joining a support group may be beneficial. Support groups offer the opportunity to discuss concerns with people familiar with and who have experienced like symptoms while decreasing the sense of isolation. There are support groups specifically for perinatal depression. Your health care provider can direct you to local groups, groups may be found by searching the Psychology Today database, and the Post-partum Support International organization has information on local chapters.
Perinatal Depression in the time of COVID-19
Limited information indicates there has been a substantial increase in women experiencing symptoms of perinatal depression during the pandemic. A Canadian study reported rates in excess of 40%. Stay at home mandates, worries about contracting and transmitting the virus to the baby, limits or bans on birth support, contracting the virus during the hospital stay, and having other young children to care for so there’s limited time for rest or relief are factors cited by women reporting depressive symptoms. In addition to the strategies listed above limiting exposure to media is suggested to reduce symptoms.
Perinatal depression is estimated to affect more than 10% of women in the U.S. Recognizing the symptoms and seeking treatment are important first steps. There are effective treatment options to reduce the severity of the symptoms and the potential for future health risks for the mother and child.
Alessandra Biaggi a,n , Susan Conroy b , Susan Pawlby b , Carmine M. Pariante bJournal of Affective Disorders 191 (2016) 62–77 Identifying the women at risk of antenatal anxiety and depression: A systematic review
Rebecca M. Pearson, PhD; Jonathan Evans, MD; Daphne Kounali, PhD; Glyn Lewis, PhD; Jon Heron, PhD; Paul G. Ramchandani, DPhil; Tom G. O’Connor, PhD; Alan Stein, FRCPsych Maternal Depression During Pregnancy and the Postnatal Period Risks and Possible Mechanisms for Offspring Depression at Age 18 Years Original Investigation jamapsychiatry.com
Brenda L. Bauman, MSPH1; Jean Y. Ko, PhD1; Shanna Cox, MSPH1; Denise V. D’Angelo, MPH1; Lee Warner, PhD1; Suzanne Folger, PhD1; Heather D. Tevendale, PhD1; Kelsey C. Coy, MPH1; Leslie Harrison, MPH1; Wanda D. Barfield, MD1 Vital Signs: Postpartum Depressive Symptoms and Provider Discussions About Perinatal Depression — United States, 2018 US Department of Health and Human Services/Centers for Disease Control and Prevention MMWR / May 15, 2020 / Vol. 69 / No. 19
National Institute of Mental Health. Perinatal Depression. Retrieved from Maternal%20depression/20-MH-8116.
Pregnancy Anxiety and Postpartum Depression During COVID-19. The uncertainties of the situation have presented challenges for our families. Dr. Dawn. Psychology Today.
Perinatal Depression Treatment Options BC Reproductive Mental Health Program. BC mental health and addition services. August 2011.
Moms Are Not OK: COVID-19 and Maternal Mental Health. Margie H. Davenport1*, Sarah Meyer1, Victoria L. Meah1, Morgan C. Strynadka1 and Rshmi Khurana2 Front. Glob. Womens Health, 19 June 2020 https://doi.org/10.3389/fgwh.2020.00001