You have likely heard and read about postpartum depression—depression that happens any time within the first 12 months of childbirth. You may even have a close friend or family member who has experienced a postpartum depression. But you may not have heard about depression during pregnancy, yet that's when postpartum depression often starts.

In the past people believed that pregnancy only made women feel happy. Now we know that a woman may feel tired or sad or may actually be depressed during pregnancy. Research suggests that 12% to 23% of women may experience depression during this time.1-2

How does depression in pregnancy and postpartum affect a mother?

Like depression in general, depression during pregnancy and postpartum affects how a woman feels, her activities, her thoughts and physical well-being. She will often feel down or empty, will find herself crying a lot, and may lose interest in the things she usually enjoys. Depression may impair a mother’s bond with the new baby3 and her capacity to nurture and meet the needs of her baby and any other children.

Many women who experience depression during pregnancy and postpartum may also have symptoms of anxiety such as feeling on edge and a racing heart. They may also have upsetting thoughts or images of harm to the baby, as result of harming the baby herself or someone or something else harming her baby. This makes depression during this time different than depression at other times in a woman’s life. Some of the symptoms of depression and signs of pregnancy are closely linked, which can make it difficult to detect depression. (See sidebar for a symptom checklist.)

Women who are depressed during pregnancy are more likely to avoid prenatal care and therefore not get the care they need. They may not sleep or eat well. These factors, plus the stresses that go along with depression, may lead to medical difficulties such as premature labour and small-birth-weight infants.

Additionally, women who struggle with troubling thoughts and feelings of despair may use alcohol or drugs to cope. This behaviour often results in making poor choices that can have all kinds of costs to a woman’s health, including more exposure to sexually transmitted diseases and violence. These unhealthy coping methods add additional risks to the baby’s well-being, either by affecting the growing fetus or by putting the newborn in risky situations after birth.

‘Why me?’

A woman’s mental health during pregnancy and postpartum can worsen for a variety of reasons. Some of these factors can be related to a woman’s culture, income, education, age, sexual orientation, self-esteem, life stress, or social support.4-8 In particular, social support when not available from the partner, family members or friends adds to the woman feeling overwhelmed and not supported by those around her.

It’s important to consider the realities of women’s everyday lives. A woman is at higher risk of developing depression during pregnancy and the postpartum period if she:

  • Has had depression or anxiety in the past

  • Has family member(s) who have had depression or anxiety

  • Has taken medication for depression or anxiety and stops before/during pregnancy

  • Has poor support from friends, family and community for things like meal preparation or someone to talk to

  • Has conflict in her relationships with partner, friends and family

  • Finds herself alone a lot of the time and/or separated from loved ones

  • Has experienced or is experiencing violence and/or abuse

  • Has a history of using alcohol or other substances to help her deal with things

  • If others around her have unrealistic expectations of her as a mother

  • Has had a complicated pregnancy, or she or her baby had or have health problems

Get help early!

Depression in pregnancy and postpartum can be treated. If left untreated, depression in pregnancy will likely get worse. A subsequent postpartum depression may take longer to respond to treatment because symptoms have had time to become more severe. The length of response to treatment varies, but it is best to start treatment as soon as possible. Untreated depression may also affect how the mother interacts with her baby. The negative effects of depression on the new infant can include problems with bonding3 and negative impacts on the way the child thinks, behaves, and relates to others into toddlerhood9-10 and even school-age years.11-12

If a woman seeks help during pregnancy, she will reduce the risk of depression following the birth of the baby. It’s important to be aware of how you feel during your pregnancy and after, so you can get the support you need to have good physical and mental health for you, your baby and your other children if this is not your first child. If you think you may be depressed, it’s important that you talk to your doctor about your symptoms.

If you experience depression during pregnancy and/or postpartum, you may need counselling and/or medication. Counselling includes educating you about your illness, providing non-judgmental listening and support, and assisting you to develop strategies for coping in this stressful time such as helping to confront negative thinking patterns.

With more severe depression, or when counselling does not decrease the symptoms of depression, the doctor or psychiatrist may prescribe medication. This always involves weighing the risks versus the benefits, which is a discussion best to be had between the woman experiencing depression and her health care provider. The doctor will be able to provide information on the specific medication and the information that is known (or not known) about it in pregnancy and postpartum and weigh this information against the consequences of untreated depression.

Remember that the goal of treatment is to reduce your symptoms and increase your overall well-being so that you can take care of yourself and those who are important to you.

NESTS—A recipe for self-care

Self-care is a way to make some positive changes in your life that will help to lessen your depression. An easy way to remember the basic ingredients of self-care is to think of the acronym “NESTS.”13

Each letter stands for one area of self-care:

  • Nutrition–Eating nutritious foods regularly throughout the day will help you to feel better and carry on your daily activities.

  • Exercise–Regular physical activity can reduce stress and boost your mood. Even a small amount like 10 minutes of walking once a week can help.

  • Sleep and rest–Sleep and rest are very important for both your physical and mental health. It’s worth the effort to work on getting a good night’s sleep. Asking a partner or friend to watch the baby while you sleep, creating a bedtime routine, and giving yourself permission to sleep are a few tips that other women have found useful.

  • Time for yourself–Taking some time to care for yourself is an important part of self-care and a necessary step in helping you to better manage your symptoms of depression.

  • Support–Social support plays an important role in helping you make it through the many life changes that go along with becoming a mother. This includes practical support like child care, emotional support like someone who can remind you of your strengths, and informational support such as finding out about resources in your community.

What can your partner and others do to support you?

You may want someone you trust to go with you to your doctor appointments so that you can learn together. It can also be helpful to discuss what you learn with loved ones who can help you to think through the advantages and disadvantages of your treatment options and how these would fit your life.

Family and friends can listen to your concerns, hold you and comfort you. You may need more help with the responsibilities of daily chores around the house, such as cooking or cleaning. If you have other children, you will need additional help from your partners, family and friends.

Remember…

The early detection of depression in pregnancy is best. Most women who experience depression in pregnancy and receive treatment do improve. They do better after their babies are born, are less likely to develop depression following the birth of their baby, and are better able to meet both their own needs and their babies’ needs.

 
About the authors

Jules is a clinical counsellor who has worked for nearly a decade in the area of depression and anxiety during pregnancy, after the birth of a baby or adoption of a child. She is currently a community and student counsellor on the Sunshine Coast, where she lives with her husband and daughter

Jasmin is currently pursuing her master’s degree in counselling psychology at the University of British Columbia. She has worked in reproductive mental health research for over three years and is currently a research coordinator at the Reproductive Mental Health Clinic in Vancouver

Footnotes:
  1. Bennett, H.A.,Einarson, A., Taddio, A. et. al. (2004). Prevalence of depression during pregnancy: Systematic review. Obstetrics and Gynecology, 103(4), 698-709.

  2. Gaynes, B.N., Gavin, N., Meltzer-Brody, S. et al. (2005). Perinatal depression: Prevalence, screening accuracy, and screening outcomes. Evidence Report: Technology Assessment (Summary), 119,1-8.

  3. Martins C. & Gaffan, E.A. (2000). Effects of early maternal depression on patterns of infant-mother attachment: A meta-analytic investigation. Journal of Child Psychology and Psychiatry, 41(6),737–746.

  4. Altshuler, L.L., Hendrick, V. & Cohen, L. S. (1998). Course of mood and anxiety disorders during pregnancy and the postpartum period. Journal of Clinical Psychiatry, 59(Suppl 2), 29-33.

  5. Beck, C.T.(2001). Predictors of postpartum depression: an update. Nursing Research, 50(5), 275-285.

  6. Melville, J.L., Gavin, A., Guo, Y. et al. (2010). Depressive disorders during pregnancy: Prevalence and risk factors in a large urban sample. Obstetrics and Gynecology, 116(5), 1064-1070.p>

  7. O’Hara, M.W. (1986). Social support, life events, and depression during pregnancy and the puerperium. Archives of General Psychiatry, 43, 569-573.

  8. Robertson, E., Grace, S., Wallington, T. et al. (2004). Antenatal risk factors for postpartum depression: a synthesis of recent literature. General Hospital Psychiatry, 26, 289-95.

  9. Chaudron, L.H. (2003). Postpartum depression: What pediatricians need to know. Pediatrics in Review, 24(5), 154-61.

  10. Misri, S. & Kendrick, K. (2008). Perinatal depression, fetal bonding, and mother-child attachment: a review of the literature. Current Pediatric Review, 4, 66-70.

  11. Misri, S., Reebye, P., Kendrick, K. et al. (2006). Internalizing behaviors in 4-year old children exposed in utero to psychotropic medications. American Journal of Psychiatry, 163(6), 1026-1032.

  12. Oberlander, T.F., Reebye, P., Misri, S. et al (2007). Externalizing and attentional behaviors in children of depressed mothers treated with a selective serotonin reuptake inhibitor antidepressant during pregnancy. Archives of Pediatric and Adolescent Medicine, 161(1), 22-29.

  13. Haring, M., Smith, J., Bodnar, D. et al. (2011). Coping with depression during pregnancy and following the birth: A cognitive behaviour therapy-based self-management guide for women. Vancouver: BC Reproductive Mental Health Program.

 By Author – Jules and Jasmin

Originally Published Here: http://www.heretohelp.bc.ca/visions/having-a-baby-vol7/depression-in-pregnancy-and-postpartum

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