Depression and Pregnancy

Depression During Pregnancy: An Introduction

Depression can be described as feeling sad, down, blue, unhappy, hopeless or miserable.  While it is normal for almost everyone to have these feelings for short periods of time, with clinical depression the feelings of sadness, loss, hopelessness, anger, or frustration interfere with everyday life for an extended time. Depression can be mild, moderate, or severe.

All too often depression during pregnancy is not diagnosed properly because people think it is "only" a temporary hormonal imbalance or a reaction that will quickly pass.  These assumptions can be dangerous if indeed the woman is suffering from clinical depression. 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.

If, for a period of two weeks or longer, a woman is very unhappy, feels sad or blue, and has some of the other symptoms listed below, she may have clinical depression and be in need to treatment:

• 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 may also include being afraid of hurting the baby or oneself and not having any interest in the baby.

Help is available for depression.  There are different types of individual and group therapies that can help a woman with depression feel better and live more effectively.  Pregnancy support groups can also be very helpful.  Additionally, many women with depression improve when treated with anti-depressant medicine.  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.

Types of Depression

In addition to being classified as mild, moderate or severe, pregnancy related depression can be seen as falling into one of the following types: 

Perinatal Depression

Perinatal Depression is depression that occurs during pregnancy or within a short time after delivery. Perinatal depression can happen to any woman.

There may be a number of reasons why a woman gets depressed during her pregnancy including hormonal changes or a stressful life event, including her pregnancy. Some women with depression have difficulty caring for themselves during pregnancy including trouble eating and gaining a healthy amount of weight, trouble sleeping, they may miss prenatal visits, may not follow medical instructions, have a poor diet, or may use harmful substances like tobacco, alcohol, or illegal drugs.

"Baby Blues" Depression

The onset of "baby blues" usually takes place about 3-5 days after delivery and fades away as your hormonal levels stabilize.  Symptoms generally do not last for more than a few weeks. "Baby blues" are very common, occurring in up to 80% of pregnant women.  Baby blues are characterized by mood swings, sadness, crying spells, loss of appetite, sleep problems, and feelings of being irritable, restless, anxious, and lonely. Symptoms are usually not severe and treatment is not usually required.

The difference between "baby blues" and the next type of depression, postpartum depression, is that postpartum depression often affects overall well-being and keeps the woman from functioning well for a longer period of time. If you continue to experience moods swings or feelings of depression for more than two weeks after the birth of your child the depression may be postpartum depression.

Postpartum or Peripartum Depression

Depression after pregnancy is called postpartum depression or peripartum depression. Approximately 10-13% of women who have recently delivered a baby suffer from postpartum depression after delivery. In fact postpartum depression is the most common complication among women who have just had a baby.  Postpartum depression is a serious condition and should not go untreated.

A woman who has postpartum depression feels sad, hopeless, or depressed and typically will have several of the following symptoms which last for a period of at least two weeks:

• Trouble sleeping (even when the baby is asleep or when others are caring for the infant)

• Lack of interest

• Feelings of guilt

• Loss of energy

• Difficulty concentrating

• Changes in appetite

• Restlessness or slowed movement

• Thoughts or ideas about suicide

It is thought that the causes of postpartum depression include:

• hormonal changes in a woman's body
  

• fatigue and broken sleep
  

• feeling overwhelmed with a baby and doubting your ability to be a good mother

• feeling stress from changes in work and home routines

• trying to be the perfect "super mom"

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

• loss of control of your daily schedule and life in general

• 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 you and your ability to parent but can also affect her baby. Researchers believe that postpartum depression in the mother can affect the infant by causing delays in language development, problems with emotional bonding to others, lower activity levels, and sleep problems.

The three most common types of treatment for postpartum depression include talking to a psychologist, social worker, or other mental health professional, 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 can include psychotic reactions such as false beliefs and visual and auditory hallucinations, refusal to eat, inability to cease activity, frantic energy, extreme confusion, memory loss, incoherence, and irrational statements.  A woman who is diagnosed with PPP should be hospitalized until she is in stable condition.

Additional Information

American Pregnancy: Depression during pregnancy

March of Dimes: Depression during pregnancy

Postpartum Support International

March of Dimes: Postpartum depression