Depression and Pregnancy

About 10-25% of women experience some symptoms of depression during pregnancy, and a quarter to half of these will suffer from major depression. This section is designed to help educate you about the cause, affect and available treatments of depression during pregnancy so you can take care of yourself and your baby.

Depression is an illness that involves the body as well as the mind.  It affects mood, thought, and the way a woman feels about herself and her baby.

Depression can be described as feeling sad, blue, unhappy, miserable, or down in the dumps. Most of us feel this way at one time or another for short periods. But true clinical depression is a mood disorder in which feelings of sadness, loss, anger, or frustration interfere with everyday life for an extended time. Depression can be mild, moderate, or severe. The degree of depression, which your doctor can determine, influences how you are treated.

All too often depression is not diagnosed properly during pregnancy because people think it is just another type of hormonal imbalance; this assumption can be dangerous for the mother and the unborn baby.

Depression is an illness that can be treated and managed during pregnancy, but the first step is recognizing that you may be depressed and may need help.

A woman who is depressed feels sad or blue and has other symptoms that last for two weeks or longer. The other symptoms include the following:

• Trouble sleeping
• Sleeping too much
• Crying a lot
• Loss of interest or pleasure in activities
• Feeling worthless and guilty
• Loss of energy
• Difficulty concentrating
• Changes in appetite
• Eating too little or too much
• Feeling restless or irritable
• Feeling sad, hopeless, and overwhelmed
• Withdrawal from friends and family
• Thoughts or ideas about suicide
• After pregnancy, signs of depression may also include being afraid of hurting the baby or oneself and not having any interest in the baby.

If you are suffering from depression you should reach out for help by contacting your health care provider, a psychologist   or other mental health professional, your clergy, or you can always contact the emergency room of your local hospital.

IMPORTANT: If you are taking an antidepressant and find that you are pregnant, do not stop taking your medication without first talking to your health care provider. Call him/her as soon as you discover that you are pregnant.  Additionally, If you ever think about hurting yourself or your baby, contact your health care provider, local hospital emergency room, or dial 911 immediately. 

Pregnancy related depression can be seen as falling into one of four types.  Each of these, adapted from the websites listed at the bottom of the page, is discussed below:

Perinatal Depression
Baby Blues Depression
Postpartum Depression or Peripartum Depression
Postpartum Psychosis

Perinatal Depression

Perinatal Depression is depression that occurs during pregnancy or within a short time after delivery. The exact number of women with depression during this time is unknown.

There may be a number of reasons why a woman gets depressed including hormone changes or a stressful life event, including her pregnancy.  During pregnancy, these factors may increase a woman's chance of depression:

• History of depression or substance abuse
• Family history of mental illness
• Little support from family and friends
• Anxiety about the fetus
• Problems with previous pregnancy or birth
• Marital or financial problems
• Young age (of mother)

Depression not only hurts the mother, but also affects her family. Some researchers have found that depression during pregnancy can raise the risk of delivering an underweight baby or a premature infant. Some women with depression have difficulty caring for themselves during pregnancy. They may have trouble eating and won't gain enough weight during the pregnancy; have trouble sleeping; may miss prenatal visits; may not follow medical instructions; have a poor diet; or may use harmful substances, like tobacco, alcohol, or illegal drugs.

Perinatal depression can happen to any woman. It does not mean you are a bad or "not together" mom. You and your baby do not have to suffer.  Help is available for depression.  There are different types of individual and group "talk therapies" that can help a woman with perinatal depression feel better and do better as a mom and as a person.  Pregnancy support groups can also be very helpful.  Additionally, research suggests that many women with perinatal depression improve when treated with anti-depressant medicine.

Baby Blues Depression

Baby blues are very common, occurring in up to 80 percent of new mothers.  Baby blues are characterized by mood swings, sadness, crying spells, loss of appetite, sleeping problems, and feelings of being irritable, restless, anxious, and lonely. Symptoms are not severe and treatment is not usually required.

The onset of baby blues usually occurs three to five days after delivery, and should subside as hormone levels begin to stabilize.  Symptoms generally do not last for more than a few weeks. The difference between postpartum depression and the baby blues is that postpartum depression often affects a woman's well-being and keeps her from functioning well for a longer period of time.

If the woman continues to experience moods swings or feelings of depression for more than two weeks after childbirth, the problem may be postpartum depression.

Postpartum or Peripartum Depression

Depression after pregnancy is called postpartum depression or peripartum depression.  It is not the same as the "baby blues" or postpartum blues. Postpartum depression is a more serious condition.

About one out of every eight women has postpartum depression after delivery. It is the most common complication among women who have just had a baby.  A woman who has postpartum depression feels sad, "down" or depressed. She also has five or more of the following symptoms lasting two weeks or longer:

Postpartum depression is a serious medical condition. It is not a sign of being a bad mother and it is something a woman can not control.

Causes of postpartum depression

After pregnancy, hormonal changes in a woman's body may trigger symptoms of depression. During pregnancy, the amount of two female hormones, estrogen and progesterone, in a woman's body increases greatly. In the first 24 hours after childbirth, the amount of these hormones rapidly drops back down to their normal non-pregnant levels. Researchers think the fast change in hormone levels may lead to depression.

Occasionally, levels of thyroid hormones may also drop after giving birth. The thyroid is a small gland in the neck that helps to regulate your metabolism (how your body uses and stores energy from food). Low thyroid levels can cause symptoms of depression.

Other factors that may contribute to postpartum depression include:

• Feeling tired after delivery, broken sleep patterns, and not enough rest often keeps a new mother from regaining her full strength for weeks.

  
  

• Feeling overwhelmed with a new, or another, baby to take care of and doubting your ability to be a good mother.

• Feeling stress from changes in work and home routines. Sometimes, women think they have to be "super mom" or perfect, which is not realistic and can add stress.

• Having feelings of loss -- loss of identity of who you are, or were, before having the baby, loss of control, loss of your pre-pregnancy figure, and feeling less attractive.

• Having less free time and less control over time. Having to stay home indoors for longer periods of time and having less time to spend with the your partner and loved ones.

Postpartum depression affects not only a mother's ability to parent but can also effect her baby. Researchers believe that postpartum depression can affect the infant by causing delays in language development, problems with emotional bonding to others, behavioral problems, lower activity levels, sleep problems, and distress.

The three most common types of treatment for postpartum depression include talking to a therapist, psychologist, or social worker to learn to change how depression makes you think, feel, and act, getting assistance in a support group, and taking antidepressant medication.

Postpartum Psychosis

In very rare cases, a woman may experience postpartum psychosis (PPP), a condition that affects about one-tenth of 1 percent of new mothers.  Onset is quick and severe, and usually occurs within the first two to three weeks following childbirth. 

Symptoms are similar to those of general psychotic reactions such as delusions (false beliefs) and hallucinations (false perceptions), and often include:

A woman who is diagnosed with PPP should be hospitalized until she is in stable condition. Doctors may prescribe a mood stabilizer, antipsychotic or antidepressant medication.