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Depression During & After Pregnancy: You Are Not Alone

Did things change after you became pregnant? 

Are things different than you expected as a new mother?  

For many mothers, the experience of pregnancy and childbirth is often followed by sadness, fear, anxiety, and difficulty making decisions. Many women have difficulty finding the energy to care for themselves, their infants, and their families. Some even have feelings about harming themselves and their children. These may be symptoms of depression. If this sounds like you or someone you know, there are two important things you should know. 

You are not alone. Help is near.

This article will begin to explain the possible causes for your feelings—and more importantly— how to find the help you need.

Hormones as Triggers

There are many reasons why you may get depressed. As a woman, your body undergoes many hormonal changes during and after pregnancy. When a woman is pregnant, her body produces the female hormones estrogen and progesterone in much greater amounts. But in the first 24 hours after childbirth, these hormone levels drop rapidly back down to their non‐pregnant levels. These hormone changes may lead to depression in a similar way that menstrual hormone changes can trigger similar symptoms during and after your period.

In some women, another possible cause of these symptoms following pregnancy is a drop in thyroid hormones, which are produced by the thyroid gland (located in the neck). These hormones help regulate the way your body uses energy. Low thyroid levels can cause depressed or irritated moods, problems with sleep and concentration, and weight gain.

Combine these changes in your body with the dramatic changes in your life—the normal feelings of being overwhelmed with new responsibilities, pressures to be a "great" mom, a sense of loss regarding the life you had before—and you can be at risk for the baby blues, perinatal/postpartum depression, or rarely postpartum psychosis.

Risk Factors

Some women are more at risk for depression during and after pregnancy: 

  • A mother's personal history of depression or another mental illness is the largest overall risk factor 

  • A family history of depression or another mental illness

  • A lack of support from family and friends

  • Depression or mental illness in the woman's partner

  • Anxiety or negative feelings about the pregnancy

  • Problems with a previous pregnancy or birth

  • Marriage or money problems

  • Stressful life events

  • Pregnancy at a young age

  • Substance use disorders

  • Family violence

  • Chronic illness

The risk is also higher with multiple births, preterm birth, and congenital or acquired physical or neurodevelopmental deficits in the infant. Stressful transitions, such as returning to work, may also be a risk factor.

Minority, immigrant, and refugee populations are especially at risk, because they face the added stress of adjusting to and learning to function in a new environment without as much local family support and with added financial concerns or cultural barriers.

While these risk factors help identify those more likely to develop perinatal depression, any woman can be affected during pregnancy or in the year following childbirth. 

Types of Depression During & After Pregnancy 

Depression during and after pregnancy is typically divided into the following categories: (1) the baby blues (2) perinatal depression (encompassing prenatal and postpartum depression) and (3) postpartum psychosis. In all cases, help is available.

The Baby Blues

Many women have the baby blues in the days after childbirth. In fact, it is estimated that 50% to 80% of all mothers experience "postpartum blues" after birth. For most women, the baby blues is temporary—it's usually gone within a few days and lasting up to 2 weeks after childbirth.

If you have the baby blues, you may:

  • Have mood swings

  • Feel sad, anxious, or overwhelmed

  • Have crying spells

  • Lose your appetite

  • Have trouble sleeping

The symptoms aren't usually severe, and there are effective ways to handle them:

  • Get plenty of sleep. Take naps when your baby does.

  • Take the pressure off yourself. You can't do everything by yourself—who can? Do what you can and leave the rest for later or for others to take care of.

  • Avoid spending too much time alone.

  • Get help and support from your spouse or partner, family members, and friends.

  • Join a support group for new mothers.

  • Get plenty of exercise.

Perinatal Depression (encompassing prenatal and postpartum depression) 

Perinatal depression is a term that includes both prenatal depression (during pregnancy) and postpartum depression (in the first year following childbirth). The symptoms of perinatal depression last longer than "the baby blues" and are more severe. It occurs in about 1 in 5 women. 

Pregnant and new mothers who find themselves overwhelmed, frustrated, anxious, persistently teary, or depressed should not be silent or ashamed. Instead, they should talk with their doctors right away and get the support—and in some cases, the treatment—they need.

Symptoms of perinatal depression can range from mild to severe. They can include the same symptoms of the baby blues, but can also include:

  • Sleeping too much or not at all

  • Lack of joy in life

  • Emotional numbness

  • Trouble concentrating, remembering things, and making decisions

  • Loss of interest in caring for yourself

  • Not feeling up to doing everyday tasks

  • Withdrawal from family and friends

  • Loss of sexual interest or responsiveness

  • A strong sense of failure or inadequacy

  • Severe mood swings

  • Showing too much ﴾or not enough﴿ concern for the baby

  • High expectations and overly demanding attitude

  • Difficulty making sense of things

There are effective treatments for perinatal depression. Most often, treatment will include talk therapy or at times some combination of antidepressant medication, talk therapy, and supportive community resources. Many women do not seek treatment despite their effectiveness. Some are hesitant specifically when considering antidepressant medications out of concern for any health risk they pose to their baby. It is important to discuss any concerns carefully with your doctor.

The same tips for getting through "the baby blues" can also be very helpful in getting through postpartum depression. Whatever steps you and your doctor decide are best, it's important that you stick to your treatment plan for depression. If things are not getting better, don't hesitate to reach out to your doctor or your child's pediatrician. 

Postpartum Psychosis

A very small number of women (1 or 2 in 1,000 women) suffer a rare and severe form of depression called postpartum psychosis. Women who have been diagnosed with bipolar disorder or a condition called schizoaffective disorder are at higher risk for getting postpartum psychosis. 

The symptoms of postpartum psychosis typically begin during the first 4 weeks after delivery and may include:

  • Extreme confusion

  • Hopelessness

  • Cannot sleep ﴾even when exhausted﴿

  • Refusing to eat

  • Distrusting other people

  • Seeing things or hearing voices that are not there

  • Thoughts of hurting yourself, your baby, or others

Postpartum psychosis is temporary and treatable with professional help, but it is an emergency and requires immediate help.

Partners Also Get Depressed

New fathers are also at an increased risk of developing depression. In general, men are more likely to avoid expressing and discussing their emotions. They deny that they are at risk and do not seek help when they need it.‍ However, fathers with depression struggle to support their partners and children; this increases a mother's risk of depression. Depression in fathers is believed to be just as treatable, but it often is not recognized. See Dads Can Get Depression During and After Pregnancy, Too  for more information. 

There is not much research on depression in same-sex or nonbiological parents, but clinical experience suggests that starting a new family can be a difficult transition for all parents. Therefore, any parent who has difficulty coping with the stress of parenting or experiences any symptoms of depression should talk with a their doctor or child's pediatrician.   

Talk to a Health Care Professional

Screening for depression once during your pregnancy and at 1, 2, 4, and  6 months after pregnancy should be a routine part of yours and your baby's health care. Health care professionals—such as your doctor, your baby's doctor, a nurse, or other health care provider—are familiar with the types of depression new and expectant mothers face. They know ways to help and can explain your options to you. They are ready to listen to you and can put you on the road to recovery. 

Remember…

Any woman may become depressed during pregnancy or after having a baby. It doesn't mean you are a bad or "not together" mom. In fact, getting treatment and support helps you care for your baby.  You and your baby don't have to suffer. There is help available.

All children deserve the chance to have a healthy mom. And all moms deserve the chance to enjoy their life and their children. If you are feeling depressed during pregnancy or after having a baby, don't suffer alone. Please tell a loved one and call your doctor right away.

Additional Information:


Last Updated
12/17/2018
Source
American Academy of Pediatrics (Copyright © 2018)
The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.
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