- Depression during pregnancy and after
- Depression During Pregnancy
- Depression After Childbirth
- The Child’s Response
- Drug Therapy
- Depression & pregnancy
- Prenatal depression may be the most severe form of maternal depression
- Depression in pregnant women and mothers: How it affects you and your child
- What are the signs of depression?
- How does depression affect pregnant women?
- What’s the difference between “baby blues” and postpartum depression?
- If I’m depressed, will it affect my children?
- Can depression be cured?
- If I take antidepressants during my pregnancy, will they hurt my baby?
- If I am taking antidepressants, can I breastfeed my baby?
- Can I take herbal remedies such as St. John’s Wort?
- Is there anything else I should do?
- More information from the CPS:
- Additional resources:
- Reviewed by the following CPS committees:
- Depression During Pregnancy & Postpartum
- Risk Factors
- Depression in Pregnancy
- Depression During Pregnancy: Signs, Symptoms, and Treatment
- What is depression in pregnancy?
- What are the signs of depression in pregnancy?
- What are the possible triggers of depression during pregnancy?
- Can depression during pregnancy cause harm to my baby?
- What is the treatment for depression during pregnancy?
- Are there any natural ways to treat depression during pregnancy?
- Recognizing and Treating Depression During Pregnancy
- What causes prenatal depression
- Symptoms of pregnancy depression
- More About Depression and Pregnancy
- Treatments for pregnancy depression
Depression during pregnancy and after
Updated: March 21, 2017Published: April, 2005
For too many women, joyfully anticipated pregnancy and motherhood bring depression as an unexpected accompaniment. Children as well as mothers suffer. Depression during pregnancy may result in poor prenatal care, premature delivery, low birth weight, and, just possibly, depression in the child. Depression after childbirth (postpartum depression) can lead to child neglect, family breakdown, and suicide. A depressed mother may fail to bond emotionally with her newborn, raising the child’s risk of later cognitive delays and emotional and behavior problems. Fortunately, if the depression is detected soon enough, help is available for mother and child.
Depression During Pregnancy
Depression in pregnant women is often overlooked, partly because of a widespread misconception that pregnancy somehow provides protection against mood disorders. In reality, almost 25% of cases of postpartum depression in womem start during pregnancy, and depression may peak at that time, according to a study published in the British Medical Journal.
More than 9,000 women recorded their moods during the fourth and eighth month of pregnancy and again two and eight months after giving birth. The questionnaire, which was specially designed for pregnant women and new mothers, concentrated on thoughts and feelings—emotional swings, crying spells, low self-esteem, hopelessness, irritability, and inability to enjoy normally pleasurable activities. The researchers paid less attention to physical symptoms, because they did not want to mistake physical effects of pregnancy (such as appetite loss, fatigue, and insomnia) for symptoms of depression. Depression ratings were highest at the eighth month of pregnancy and lowest eight months after childbirth. Fourteen percent of the women scored above the threshold for probable clinical depression just before the child’s birth, compared with 9% two months later.
Ignoring depression during pregnancy can be risky for both mother and child. Depressed women often take poor care of themselves. They may smoke, drink to excess, or neglect proper diet. And some research suggests that depression in pregnant women can have direct effects on the fetus. Their babies are often irritable and lethargic, with irregular sleep habits. These newborns may grow into infants who are underweight, slow learners, and emotionally unresponsive, with behavior problems such as aggression.
Depression After Childbirth
Postpartum depression in women is usually divided into three categories: baby blues, nonpsychotic postpartum depression, and postpartum psychosis.
Baby blues, the most common mood disturbance after childbirth, may affect nearly 50% of new mothers. The cause of this usually brief and harmless condition may be hormonal changes, especially the rapid fall in estrogen levels after birth. Some symptoms are appetite loss, fatigue, confusion, sadness, nervousness, crying spells, oversensitivity, and a feeling of being overwhelmed. These symptoms appear within a few days of delivery and subside in about two weeks. If they last longer, a woman may be suffering from clinical depression, a condition that occurs in 10%–15% of new mothers.
The American Psychiatric Association defines “depression with postpartum onset” as a depressive episode that occurs within four weeks of birth, but many researchers regard the postpartum period as lasting up to six months after delivery. Women have a higher than average rate of hospital admissions for depression during this period and for as long as three years after childbirth. The symptoms may include headaches, chest pain, heart palpitations, and panic attacks as well as fatigue, sadness, hopelessness, irritability, and loss of interest and pleasure in life. Often worrying obsessively about the child’s health, depressed women feel guilty about their inadequacy as caregivers—and even about not being as happy as they think they should be.
Mood disorders, either major depression or bipolar disorder, are the most common cause of maternal psychosis, with delusions, hallucinations, or both. The danger is especially great when delusions center on the baby. Many mothers with postpartum depression are afraid they will harm the baby. Few actually do, but the risk is greater if the woman is psychotic. A woman who suffers a psychotic postpartum depression once is likely to have similar episodes after the birth of other children.
The Child’s Response
A mother’s depression itself can make some of her worries about her child realistic. Infants are highly sensitive to a mother’s sadness, silence, and inattentiveness. In one study, mothers of 3-month-old infants were asked to simulate depression for three minutes. They spoke in a monotone, remained expressionless, and avoided touching the child. Even at that age infants could respond to fleeting changes in their mothers’ apparent mood. They looked away from their mothers and showed signs of distress, which continued for a time even after the women began to behave normally.
In the long run, child development may be affected. Children of depressed parents in general are highly vulnerable to depression, and long-term adjustment is sometimes a problem for the children of mothers with postpartum depression. In one study, teachers’ reports were used to compare the children of 55 women with postpartum depression to the children of 40 healthy controls over a five-year period beginning a few months after childbirth. Boys from lower-class families were affected most. In that group, investigators found a higher than average rate of clinically significant behavior problems (chiefly hyperactivity and distractibility) after five years if and only if their mothers suffered from postpartum depression. With or without depressed mothers, serious behavior problems were rare in middle-class children.
Depressed women may be reluctant to seek help because they fear they will be regarded as bad mothers. Family doctors can help by reassuring them about their child’s health and asking about depressive symptoms.
Antidepressant drugs are a standard treatment for depression during pregnancy and after birth, but many women are understandably worried about drug effects on the child. Some potential risks are birth defects, neonatal toxicity (jitteriness, difficulty in feeding, and irregular heart rate or breathing associated with exposure to a medication before or during delivery), and longer-term cognitive, emotional, or behavioral effects.
Some women who are already taking antidepressants may want to quit before conceiving a child, and some who become depressed while pregnant or nursing may prefer to avoid drugs. Much depends on how severe the depression is and how well both mother and child can cope with its symptoms. Pregnant and nursing women should be aware that prolonged depression may be riskier than drug side effects, both for themselves and for their children.
Electroconvulsive therapy is a highly effective treatment for severe postpartum depression—especially psychotic depression. It can be safely administered a week after childbirth. The most important side effect is some loss of memory for the period immediately surrounding the treatment.
Another somatic (physical) treatment is bright light therapy (phototherapy). It is already thought to be effective for postpartum depression, and a trial reported in the American Journal of Psychiatry suggests that it is also an option for depression during pregnancy. Sixteen pregnant women with major depression sat close to a bright light source one hour a day for three to five weeks. Average depression ratings improved by 49% after three weeks and by 59% in the seven patients who had five weeks of treatment. When the treatment ended, their symptoms became worse. The results are promising, but controlled studies are needed.
Psychotherapy is a proven treatment for mild to moderate depression in three common forms: cognitive behavioral, psychodynamic, and interpersonal.
Interpersonal therapy may be especially useful for depression during pregnancy and the postpartum period because it is designed to help people cope with changing circumstances and social roles. Being constantly alone with an infant is not good for new mothers. Group therapy and self-help groups can provide needed companionship and advice, especially for a woman who has limited family contact or few other social outlets. Couples therapy may help when marital problems have been contributing to depression.
Researchers looking for ways to prevent depression are investigating risk factors during pregnancy and the postpartum period. An unplanned pregnancy, an unhappy marriage, or a child with a difficult temperament may raise the risk. Questionnaire responses by more than 5,000 Danish women indicate that emotional distress and social isolation during pregnancy are associated with postpartum depression. In another study, 38 new mothers answered questionnaires on fatigue and depression one day after giving birth and again after one, two, and four weeks. Women with a high level of fatigue after one and two weeks were more likely to report symptoms of depression after four weeks.
The studies reflect an understanding that depression among pregnant women and new mothers is a serious public health problem. The more effectively it is prevented and the sooner it is treated, the better the family environment and the more hopeful the outcome for both mother and child.
As a service to our readers, Harvard Health Publishing provides access to our library of archived content. Please note the date of last review on all articles. No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.
Depression & pregnancy
During pregnancy and again in the postnatal period, most women in Australia will be screened for depression.
You will be screened using a questionnaire that asks a number of set questions about how you are feeling. Your answers will let the health professional know whether or not you have symptoms of depression. Reasons for screening include:
- Women with depression may not recognise they have it (especially if they have never had depression before).
- Depression can have serious consequences for both you and your baby.
- Early treatment is the most effective, and screening can detect symptoms early.
Ten to fifteen per cent of women will be diagnosed with depression during pregnancy and in the postnatal period. The most likely time for depression to begin is in the first few weeks after the baby’s birth. Common symptoms and signs of depression during and following pregnancy include:
- feeling depressed or miserable consistently for most of the day and for most days of the week
- feeling irritable, angry or anxious a lot of the time
- increased crying, sometimes for no apparent reason
- reduced interest in things that you would normally enjoy
- not able to sleep (even when your baby is sleeping) or sleeping more than usual
- reduced appetite or over-eating
- excessive fatigue and tiredness
- difficulty concentrating and being forgetful
- preoccupation with morbid thoughts or being anxious about multiple things, such as bad things happening to you, your pregnancy, your baby or your partner
- feeling disconnected from your baby, that your baby is not really yours or that you do not have a bond with your baby
- excessive feelings of guilt and/or failure, that you are a ‘bad mother’
- thoughts of harming yourself
- thoughts that things would be better for you and your baby if you (and your baby) were dead, leading to thoughts of suicide.
What causes depression?
There are many things that can contribute to, or make you vulnerable to depression, including:
- a history of depression or anxiety
- family members who have had or have depression or anxiety
- stress during your pregnancy or if it was unplanned
- your expectations of motherhood are unrealistic and you can’t meet them
- a traumatic or complicated birth
- relationship/marriage difficulties
- lack of social support
- your baby is sick or unsettled.
If you have depression or anxiety during pregnancy you are more likely to have postnatal depression. It is important to get professional help and treatment during pregnancy, rather than leaving it until after your baby arrives.
Treatment for depression
The first step to getting treatment is to see your GP. Initially, your GP may do some blood tests to rule out any medical illnesses that mimic depression, such as iron deficiency, anaemia or thyroid problems. They can then tailor a management plan according to the severity of your illness. Mild to moderate depression can be improved with psychological treatment and increasing the supports around you. In some cases of more severe depression, you may need to take antidepressants. There are antidepressants that are quite safe when you are pregnant and when you are breastfeeding.
If you are already taking antidepressants when you get pregnant you will need to talk with your GP about your ongoing treatment. If you stop taking your antidepressants when you discover that you are pregnant it can cause a relapse of your symptoms.
Herbal and complementary treatments such as St John’s Wort may not be safe in pregnancy or may interact with other medicines.
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Prenatal depression may be the most severe form of maternal depression
(iStock) By Juli Fraga August 29, 2016
My patient felt ecstatic when she saw the two dark pink lines on her pregnancy test. She wasn’t surprised when fatigue and nausea soon followed. But she began to worry when she couldn’t sleep and became engulfed in sadness that eclipsed her maternal joy.
She confided in a couple of close girlfriends.
“Everyone told me that I was hormonal and that I would begin to feel better during my second trimester,” she said.
By the end of her first trimester, the nausea and fatigue had lifted, but her tearfulness and insomnia lingered. She would toss and turn through the night worrying that she wouldn’t be a “good enough” mother to her baby.
Her husband told her that she had “always been a worrier” and that she just needed to try to rest and relax.
A constant stream of worries raced through her mind: “What if there’s something wrong with the baby and the ultrasound didn’t detect it yet?” “What if I develop gestational diabetes and I have to go on bed rest?” “What if I have one of those difficult babies who cries all of the time because of colic?”
“On top of all that, I began to worry that my thoughts were hurting my baby,” she said.
Even though she had heard of postpartum depression (PPD), the mental health disorder that affects up to 20 percent of new mothers, she was unaware that depression often begins during pregnancy.
When her obstetrician asked her how she was feeling during her pregnancy, she broke down in tears. Her doctor asked her a few more questions about how she was sleeping and if she was feeling overwhelmed. When she finally opened up to her doctor about her struggles, she learned that she was suffering from prenatal depression.
As a psychologist specializing in prenatal and postpartum depression, I’ve treated many women like this patient, who may not be aware that depression can begin during pregnancy, not just after giving birth.
Similar to postpartum depression, prenatal depression is accompanied by feelings of worry, sadness and anxiety. But there are some unique symptoms as well, which is why researchers at Northwestern University are raising awareness by informing women and their doctors about the signs of pregnancy-related depression.
Results from their recent study suggest that such women who develop depression before or during their pregnancies suffer from a more severe version of this mental-health concern and experience more intense feelings of sadness, along with sleep concerns and, in rare instances, paranoia.
“These women are often juggling a multitude of life stressors, such as pregnancy complications, as well as family and financial stress. In many instances, they struggled with depression or anxiety before they became pregnant,” says Sheehan Fisher, a psychiatry professor and a lead researcher in the study.
“I felt ashamed to tell my doctor that I was struggling during my pregnancy. I wanted to believe that my feelings would go away on their own, like my friends reassured me that they would,” she told me.
This past year, the U.S. Preventive Services Task Force recommended that all expectant and new mothers receive maternal mental-health screenings, yet many women continue to fall through the cracks of the health-care system. Often, it’s not until after the birth of their babies that these women receive the mental-health treatment that they needed during pregnancy.
Even when women are assessed, they are often screened with the Edinburgh Postnatal Depression Scale, a 10-item, self-reported questionnaire that asks women to respond to such statements as “I have felt sad or miserable” and “I have been anxious or worried for no good reason.” While this questionnaire helps screen expectant and future mothers for depression, it asks only about symptoms for the past seven days, which doesn’t account for symptom severity and length of maternal suffering.
“It’s important to recognize that the symptoms of prenatal and postpartum depression vary for each woman,” said Meg Earls, director of the Perinatal Task Force for California Pacific Medical Center in San Francisco. In addition to using screening tools such as the Edinburgh, Earls recommends asking two more questions when working with pregnant and postpartum women: “Do you have any thoughts that disturb you?” and “Are you feeling more agitated or irritable?” She says that these questions can help clinicians garner more accurate data about the patient’s emotional well-being.
Because her doctor asked her those kinds of questions, she recognized that the mother-to-be was suffering. She referred her for psychotherapy at the local mental-health clinic for expectant and new mothers.
“When I began therapy, I was able to connect the dots,” she said. “I had experienced a depressive episode when I left home for college, but I didn’t realize how these two experiences were related. My therapist helped me understand that I was more sensitive to stress, and with her support and weekly therapy, I learned some tools that helped me to feel calmer for the duration of my pregnancy.”
Sometimes, individual therapy is not enough to help women suffering from prenatal depression. “It’s so important for each pregnant woman to have a postpartum team of care providers — doctors, midwives and mental health therapists,” says Patricia Robertson, an obstetrician at the hospital of the University of California at San Francisco. She recommends that all expectant mothers join a pregnancy support group so that they can connect with their peers as they prepare for the path to motherhood.
This patient is now the mother of a beautiful baby girl. Even though her depression improved, she remains in psychotherapy and hopes to break the stigma associated with maternal mental-health concerns.
“I want all women to know that they are never alone. If you are feeling sad, worried or frightened during your pregnancy or after your baby is born, seek help,” she said.
Wendy Davis, director of Postpartum Support International, echoes these sentiments.
“It’s important for each and every woman to know that she’s never to blame, and with help, she will feel better.”
This post has been updated.
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Depression in pregnant women and mothers: How it affects you and your child
Depression is an illness that affects the way people think, act and feel. About 6% of women will experience depression at some point in their lives. This number increases to about 10% (1 in 10) for women who are pregnant.
Women are more at risk of depression while they are pregnant, and during the weeks and months after having a baby. During pregnancy, hormone changes can affect brain chemicals and cause depression and anxiety. Sometimes, pregnant women don’t realize they are depressed. They may think they have symptoms of pregnancy or the “baby blues,” which many women experience right after birth.
It’s also important to know that as many as 10% of fathers experience postpartum depression after the birth of a child.
The good news is that depression can be treated. Read the signs listed below, and talk to your doctor if you have any of them. Let your partner and family members know the signs so that they can also be aware.
If you don’t get help, depression can cause problems for you and your baby.
What are the signs of depression?
Depression can come on slowly. The symptoms are different for everyone. They can be mild, moderate or severe. Some of the more common signs are:
- changes in appetite, like eating too much or having little interest in food,
- changes in sleep, such as trouble sleeping or sleeping too much,
- lack of energy,
- feeling sad, hopeless or worthless,
- crying for no reason, and
- loss of interest or pleasure in activities you normally enjoy.
New moms with depression may have trouble caring for their baby. They might not want to spend time with their baby, which can lead to a baby who cries a lot.
How does depression affect pregnant women?
If you have depression while you’re pregnant, you may have trouble caring for yourself.
Depression during pregnancy can also lead to:
- delivering before the due date (preterm),
- giving birth to a small baby (low birth weight).
If depression during pregnancy isn’t treated, it can lead to postpartum depression. Postpartum depression is a serious condition that can last for months after giving birth. It can affect your health and how well you bond with your baby.
What’s the difference between “baby blues” and postpartum depression?
The “baby blues” is a mild form of postpartum depression that many new moms experience. It usually starts 1 to 3 days after the birth and can last for 10 days to a few weeks. With “baby blues”, many women have mood swings—happy one minute and crying the next. They may feel anxious, confused, or have trouble eating or sleeping. Up to 80% of new moms have the “baby blues”. It’s common, and it will go away on its own.
About 13% of new mothers experience postpartum depression, which is more serious and lasts longer. You are at a greater risk if you have a family history of depression or have had depression before.
Some of the symptoms include:
- feeling like you can’t care for your baby,
- extreme anxiety or panic attacks,
- trouble making decisions,
- feeling very sad,
- hopelessness, and
- feeling out of control.
No one knows exactly what causes postpartum depression. If you think you have the symptoms, it’s important to get help right away. Postpartum depression needs to be treated. Talk to your doctor or call your local public health office.
If I’m depressed, will it affect my children?
Depression is treatable. But if it is not treated, it will affect your children.
Moms who are depressed may have trouble caring for their children. They may be loving one minute and withdrawn the next. They may respond to their child in a negative way or not respond at all. Your feelings and your behaviour will affect your ability to care for your children.
Depression can also affect attachment, which is important for your child’s development. Attachment is a deep emotional bond that a baby forms with the person who provides most of his care. A “secure attachment” develops quite naturally. A mother responds to her crying infant, offering whatever she feels her baby needs—feeding, a diaper change, cuddling. Secure attachment helps protect against stress and is an important part of a baby’s long-term emotional health. It makes a baby feel safe and secure, and helps him learn to trust others.
If you’re depressed, you may have trouble being loving and caring with your baby all the time. This can lead to an “insecure attachment,” which can cause problems later in childhood.
How a mother’s depression affects her child depends on the child’s age.
Babies who don’t develop a secure attachment may:
- have trouble interacting with their mother (they may not want to be with their mother, or may be upset when with them),
- have problems sleeping,
- may be delayed in their development,
- have more colic,
- be quiet or become passive, or
- develop skills or reach developmental milestones later than other babies.
Toddlers and preschoolers whose mothers are depressed may:
- be less independent,
- be less likely to socialize with others,
- have more trouble accepting discipline,
- be more aggressive and destructive, or
- not do as well in school.
School-aged children may:
- have behaviour problems,
- have trouble learning,
- have a higher risk of attention deficit hyperactivity disorder (ADHD),
- not do as well in school, or
- have a higher risk of anxiety, depression and other mental health problems.
Teens whose mothers suffer from depression are at high risk for a number of problems such as major depression, anxiety disorder, conduct disorder, substance abuse, ADHD, and learning difficulties.
Can depression be cured?
With treatment, most people recover from depression. Treatment can include one or more of the following:
- Social support: Community services or parenting education.
- Family therapy: With your partner and/or children. This can help when children are older.
- Individual therapy: Talking one-on-one with a family doctor, psychologist, psychiatrist, social worker, or other professional.
- Medication: Drugs used most often to treat depression are SSRIs (selective serotonin reuptake inhibitors).
If I take antidepressants during my pregnancy, will they hurt my baby?
You may think you should stop taking medication for depression when you are pregnant. Remember that, if left untreated, depression can have serious effects for both you and your baby. If you are taking antidepressants and are thinking about getting pregnant (or are already pregnant), talk to your doctor first, before stopping any medication.
Some newborn babies may have symptoms such as irritability, fast breathing, tremors and poor feeding if their mothers took antidepressants during pregnancy. These symptoms are almost always mild and pass quickly, usually within 2 weeks. Serious problems are very rare.
After your baby is born, she will be watched closely to make sure she is healthy. Your doctors and nurses will make sure that you are both well before letting you go home. You may need to stay an extra day or two in the hospital so that they can be sure.
If I am taking antidepressants, can I breastfeed my baby?
Breastfeeding provides many health benefits for babies. It also helps mothers and babies bond. If you are taking antidepressants, small amounts will come out through your breast milk. But studies have shown that children exposed to these drugs through breast milk have not had problems.
Even if you are taking antidepressants, you can breastfeed your baby for as long as you wish. Stopping an antidepressant during breastfeeding may cause the depression to return.
Can I take herbal remedies such as St. John’s Wort?
There is not enough information about St. John’s Wort to say that it is safe for pregnant or breastfeeding mothers. If you are pregnant or breastfeeding, talk to your doctor before taking any herbal products.
Is there anything else I should do?
If you are feeling any of the symptoms listed above, it is very important to tell someone. The early days of taking care of a new baby can be hard. You’re probably not sleeping much as you try to meet your baby’s needs around the clock. Find a friend, family member or someone else you trust who can look after your baby for short periods while you get a break. If people offer help, accept it.
There are many support programs for new mothers. Talk to your doctor, nurse, midwife, or contact your local public health office for a listing of services in your area.
More information from the CPS:
- Prenatal health
- Colic and crying
- Never shake a baby
- Attachment: A connection for life
- Maternal depression and child development (position statement)
- Depression during pregnancy (Health Canada)
- Depression in Pregnancy (Public Health Agency of Canada)
- Nobody’s Perfect – Parenting Tip Sheets (Public Health Agency of Canada)
- Postpartum Depression (Canadian Mental Health Association)
- Helping children cope (Mood Disorders Society of Canada)
Reviewed by the following CPS committees:
- Fetus and Newborn Committee
- Mental Health and Developmental Disabilities Committee
Last Updated: March 2017
Depression During Pregnancy & Postpartum
Depression during and after pregnancy occur more often than most people realize. Depression during pregnancy is also called antepartum or prenatal depression, and depression after pregnancy is called postpartum depression.
Approximately 15% of women experience significant depression following childbirth. The percentages are even higher for women who are also dealing with poverty, and can be twice as high for teen parents. Ten percent of women experience depression in pregnancy. In fact, perinatal depression is the most common complication of childbirth.
Symptoms can start anytime during pregnancy or the first year postpartum. They differ for everyone, and might include the following:
- Feelings of anger or irritability
- Lack of interest in the baby
- Appetite and sleep disturbance
- Crying and sadness
- Feelings of guilt, shame or hopelessness
- Loss of interest, joy or pleasure in things you used to enjoy
- Possible thoughts of harming the baby or yourself
It is important to know the risk factors for antepartum and postpartum depression. Research shows that all of the things listed below put you at a higher risk for developing these illnesses. If you have any of these factors, you should discuss them with your medical provider so that you can plan ahead for care should you need it.
- A personal or family history of depression, anxiety, or postpartum depression
- Premenstrual dysphoric disorder (PMDD or PMS)
- Inadequate support in caring for the baby
- Financial stress
- Marital stress
- Complications in pregnancy, birth or breastfeeding
- A major recent life event: loss, house move, job loss
- Mothers of multiples
- Mothers whose infants are in Neonatal Intensive Care (NICU)
- Mothers who’ve gone through infertility treatments
- Women with a thyroid imbalance
- Women with any form of diabetes (type 1, type 2 or gestational)
Postpartum and antepartum depression are temporary and treatable with professional help. If you feel you may be suffering from one of these illnesses, know that it is not your fault and you are not to blame. You can use our Get Help page to reach out now. We understand what you are going through and will connect you to people who can help.
Depression in Pregnancy
Depression During Pregnancy: Signs, Symptoms, and Treatment
Pregnancy is supposed to be one of the happiest times of a woman’s life, but for many women, this is a time of confusion, fear, stress, and even depression. According to The American Congress of Obstetricians and Gynecologists (ACOG), between 14-23% of women will struggle with some symptoms of depression during pregnancy.
Depression is a mood disorder that affects 1 in 4 women at some point during their lifetime, so it should be no surprise that this illness can also touch women who are pregnant. But 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 in pregnancy is an illness that can be treated and managed; however, it is important to seek out help and support first.
What is depression in pregnancy?
Depression during pregnancy, or antepartum depression, is a mood disorder just like clinical depression. Mood disorders are biological illnesses that involve changes in brain chemistry.
During pregnancy, hormone changes can affect the chemicals in your brain, which are directly related to depression and anxiety. These can be exacerbated by difficult life situations, which can result in depression during pregnancy.
What are the signs of depression in pregnancy?
Women with depression usually experience some of the following symptoms for 2 weeks or more:
- Persistent sadness
- Difficulty concentrating
- Sleeping too little or too much
- Loss of interest in activities that you usually enjoy
- Recurring thoughts of death, suicide, or hopelessness
- Feelings of guilt or worthlessness
- Change in eating habits
What are the possible triggers of depression during pregnancy?
- Relationship problems
- Family or personal history of depression
- Infertility treatments
- Previous pregnancy loss
- Stressful life events
- Complications in pregnancy
- History of abuse or trauma
Can depression during pregnancy cause harm to my baby?
Depression that is not treated can have potential dangerous risks to the mother and baby. Untreated depression can lead to poor nutrition, drinking, smoking, and suicidal behavior, which can then cause premature birth, low birth weight, and developmental problems. A woman who is depressed often does not have the strength or desire to adequately care for herself or her developing baby.
Babies born to mothers who are depressed may be less active, show less attention and be more agitated than babies born to moms who are not depressed. This is why getting the right help is important for both mom and baby.
The Pregnant Woman’s Companion: Nine Strategies That Work to Keep Your Peace of Mind Through Pregnancy and Into Parenthood Christine D’Amico
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What is the treatment for depression during pregnancy?
If you feel you may be struggling with depression, the most important step is to seek help. Talk with your health care provider about your symptoms and struggles. Your health care provider wants the best for you and your baby and may discuss options with you for treatment.
Treatment options for women who are pregnant can include:
- Support groups
- Private psychotherapy
- Light therapy
Are there any safe medications to treat depression during pregnancy?
There is a lot of debate over the safety and long-term effects of antidepressant medications taken during pregnancy. Some research now shows that certain medications used to treat depression may be linked to problems in newborns such as physical malformations, heart problems, pulmonary hypertension and low birth weight.
A woman with mild to moderate depression may be able to manage her symptoms with support groups, psychotherapy, and light therapy. But if a pregnant woman is dealing with severe depression, a combination of psychotherapy and medication is usually recommended.
Women need to know that all medications will cross the placenta and reach their babies. There is not enough information about which drugs are entirely safe and which ones pose risks.
But when treating major depression, the risks and benefits need to be examined closely. The medication that can offer the most help, with the smallest risk to baby, should be considered carefully.
If medication seems like the best treatment for your depression, forming a collaborative treatment team is the best course of action. This would include your prenatal care provider and your mental health provider.
Ask both health care professions about what treatments will be best for you and your baby. Find out if you have options for medications and do research on them.
What long term effects do they have? Is your baby likely to deal with withdrawal symptoms after birth? Is this medication linked to health problems in the newborn or developmental delays in the future? Also, always remember that you need to weigh the possibilities of problems in the future versus the problems that can occur right now if your depression is not treated appropriately.
Are there any natural ways to treat depression during pregnancy?
With the controversy regarding the use of some antidepressants during pregnancy, many women are interested in other ways to help treat depression. As mentioned above, support groups, psychotherapy, and light therapy are alternatives to using medication when treating mild to moderate depression.
In addition to these, you may want to talk with your health care providers about some of the other natural ways to help relieve the symptoms of depression.
- Exercise – Exercise naturally increases serotonin levels and decreases cortisol levels.
- Get adequate rest – Lack of sleep greatly affects the body and mind’s ability to handle stress and day to day challenges. Work on establishing a routine sleep schedule that has you going to sleep and getting up at the same time.
- Diet and Nutrition – Many foods have been linked to mood changes, the ability to handle stress and mental clarity. Diets high in caffeine, sugar, processed carbohydrates, artificial additives, and low protein can all lead to issues regarding your mental and physical health. Make a conscious decision to start fueling your body with the foods that can help you feel better.
- Acupuncture – New studies report acupuncture to be a viable option in treating depression in pregnant women.
- Omega-3 fatty acids – For years it’s been known that omega-3 can help with a number of health issues, but the newest studies are showing that taking a daily supplement of omega-3/fish oils can decrease symptoms of depression. Pregnant women would want to make sure to take a mercury-free version of fish oil and check with their care provider or nutritionist on a recommended amount.
- Herbal remedies – There are a number of herbal and vitamin supplements known to affect moods and the hormone serotonin. Talk with your health care provider and nutritionist/herbalist about whether to use St John’s Wort, SAM-e, 5-HTP, magnesium, vitamin B6 and flower remedies. Many of these can not be used in conjunction with antidepressants and should be evaluated on the dosage for pregnant women.
If you do not feel comfortable talking with your health care provider about your feelings of depression, find someone else to talk with. It is important that someone knows what you are dealing with and can try to help you. Never try to face depression alone. Your baby needs you to seek help and get treatment.
More Helpful Articles:
- Do I Have the Baby Blues or Postpartum Depression?
- Do I have a Form of Postpartum Depression?
- Pregnancy Symptoms – Early Signs of Pregnancy
Compiled using information from the following sources:
Recognizing and Treating Depression During Pregnancy
It’s not easy being blue — especially when everyone around you thinks you’re feeling rosy. The truth is, pregnancy depression is common, effecting between 14 and 23 percent of expecting women. And it’s no wonder women are even more susceptible to depression when they’re expecting: Surging hormones coupled with stress, anxiety and societal pressure to feel a certain way can do a number on any woman’s emotional state during pregnancy. Some factors can put you at greater risk for depression, but it’s an illness that strikes women of all ages at all stages of their lives — and there’s no shame in asking for help.
Although pregnancy depression can be severe, leaving some women feeling so sad and hopeless that they have trouble taking care of themselves and their babies, the good news is the symptoms of depression can be effectively treated with the right help. Drug-free approaches like talk therapy can help. So can some antidepressants, which recent research has shown to be more effective and safer during pregnancy than previously believed.
Deciding what treatment is right for you is a highly personal decision, and your doctor can walk you through the details and options specific to you. Read on for more information on the causes and symptoms of depression during pregnancy, and learn ways to cope with the condition.
What causes prenatal depression
No one knows for sure what causes depression during pregnancy, but it’s a pretty sure bet that those raging hormones play a significant role. Here’s a closer look at some of the factors that can put an expectant mom at risk:
- Hormones: Hormones directly affect the brain chemistry that controls emotions and mood. Those same hormonal fluctuations that wreak premenstrual emotional havoc can lead to prenatal depression. In fact, research has found that women who suffer from pronounced PMS are at greater risk for depression during pregnancy.
- A history of depression: If you’ve been diagnosed with depression in the past, tell your practitioner, since there’s a greater chance you’ll experience depression while you’re expecting.
- Genetics: Depression tends to run in families. If anyone in your family has a history of depression or any other mood disorder, you’re more susceptible to experiencing it, too.
- Stressful life events: Caring for an aging parent, grieving over the loss of a loved one, fighting with your partner or being worried about finances are all examples of stress factors that can take an emotional toll on you and trigger depression.
- A difficult pregnancy: If you had trouble getting pregnant, have had a miscarriage in the past or are experiencing a high-risk pregnancy, you may be worried about losing the baby you’ve tried so hard to conceive. Women under this kind of stress are at greater risk for depression.
- Being young: Young women are more susceptible to depression during pregnancy.
- Being the victim of abuse: Feelings of low self-esteem, helplessness and isolation can all contribute to depression symptoms.
- A thyroid condition: Levels of thyroid hormone, which regulate how your body uses and stores energy in food, can fluctuate during pregnancy, which can cause symptoms of depression. A simple blood test can tell if a thyroid condition is causing these symptoms.
Symptoms of pregnancy depression
It’s often difficult to diagnose prenatal depression because its symptoms mirror so many “normal” pregnancy symptoms: sleep and appetite changes, loss of interest in sex, anxiety, inability to concentrate and general emotional instability. What’s not normal is to feel consistently sad, hopeless or generally uninterested in life — especially if those feelings are keeping you from eating properly, sleeping regularly or otherwise taking good care of yourself. If you’re not sure whether your feelings are within a healthy range, it’s best to discuss your symptoms with your doctor to be safe.
More About Depression and Pregnancy
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If you have any of the following symptoms of depression for most of the day every day during the same two-week period, you should seek help:
- Sad, restless or depressed mood
- Crying a lot
- Withdrawal from friends and family
- Loss of interest or pleasure in activities you used to enjoy
- Weight loss
- Weight gain that exceeds your target pregnancy weight gain
- Wanting to eat all the time, or no appetite at all
- Trouble sleeping or sleeping too much
- Fatigue or loss of energy
- Feelings of worthlessness or guilt
- Having trouble thinking, concentrating or making decisions
- Thoughts of death or suicide
- Having headaches, stomach problems or other pains that don’t go away
- Missing prenatal visits or not following medical instructions
- Using harmful substances like tobacco, alcohol or illegal drugs
Some women don’t seek treatment for their pregnancy depression out of embarrassment, shame, guilt or simply because they think their depression symptoms are just “normal” pregnancy symptoms that will go away on their own. But studies show that untreated or undertreated depression can lead to preterm delivery, low birth weight, possibly gestational diabetes and, in severe cases, developmental delays in baby. What’s more, depression may not end when your pregnancy does. Being depressed when you’re pregnant also puts you at a higher risk of postpartum depression. So if you think there’s any chance you’re suffering from pregnancy depression, ask for help — for yourself, but also because your baby needs a mother who’s healthy in both body and mind.
Treatments for pregnancy depression
The good news is you can treat depression during pregnancy. Most doctors suggest starting with nondrug approaches including psychotherapy (talk therapy), light therapy (exposure to high-intensity lamps that increase levels of the mood-regulating hormone serotonin in the brain), acupuncture and meditation.
Antidepressants during pregnancy
If your symptoms are more severe, your doctor may want to treat your depression more aggressively with antidepressants. Research is still inconclusive about the long-term effects of antidepressants during pregnancy, and there’s some evidence that newborns exposed to SSRIs in the womb may experience short-term withdrawal symptoms. Still, experts say those risks shouldn’t keep pregnant women from taking medication, since the risks of untreated depression are often greater than taking an antidepressant.
If you were taking antidepressants before you got pregnant, you’ll need to work with both your practitioner and your psychiatrist to determine if you should continue once you conceive. Your doctors may want to change your dosage, switch you to a different kind of antidepressant or keep your meds exactly the same to minimize the risk of relapse. Stopping your medication altogether can be dangerous — especially if you have a history of mood disorders.
Don’t take any medication — herbal or otherwise — without consulting your practitioner. You and your doctor need to carefully weigh the possible benefits against the possible risks to decide the treatment that’s right for you.
Whatever treatment or combination of treatments you follow to help manage your depression, it’s important to be good to yourself. Taking care of yourself emotionally as well as physically should be your top priority. This list of suggestions is a good place to start:
- Rest as much as you can. Fatigue can intensify normal pregnancy mood swings, so make sure you’re getting enough rest. Go to bed early, sleep late or take naps when you can.
- Spend time outdoors. Being in nature has been proven to reduce stress and depression symptoms. So take a walk in the woods, have a picnic in the park or plan a day at the beach.
- Put chores on hold. You don’t have to set up the nursery, reorganize your closets and stock up on baby supplies all at the same time (really!). So resist the urge to get everything done — and if there are to-dos on your list that absolutely have to get done, ask your partner, family and friends for help.
- Eat a balanced pregnancy diet. Regular snacks and meals can keep your blood sugar up, keeping moods stable. Avoid caffeine, sugar and processed foods, and opt instead for a diet rich in omega-3 fatty acids (try walnuts, fish and enriched eggs), which has been shown to lower the risk of depression during pregnancy.
- Exercise. Regular, frequent physical activity boosts feel-good endorphins and has been shown to help stabilize your moods — some research has even found that regular aerobic exercise is as effective at treating depression as taking an antidepressant. Not sure where to start? Try any of these depression-busting workouts (once you get the OK from your practitioner first, of course).
- Spend time with your family and friends. Make time to visit friends and be alone with your partner, whether it’s dinner out or just for a night of movies and popcorn. Intimacy of any kind — from simple cuddling to handholding — can help you feel closer and boost your mood.
- Avoid big life changes if possible. Avoiding unneeded stress is key to managing depression. So whenever possible, postpone big life changes like moving or starting a new job until you’ve got your symptoms of depression under control. If making a big change is unavoidable, try to arrange support ahead of time.
- Discuss your feelings. If you’re worried, anxious or feeling unsettled about the future, don’t hold it in. Get support from your partner, family and friends.
- Join a support group. Ask your doctor about support groups in your area where you can talk to other pregnant women in similar situations, or look for online groups (try the depression group or the pregnancy depression group on WhatToExpect.com). Building your support network now will be helpful after your baby arrives, too.
Millennial women are more likely than their mothers to experience antenatal depression, or depression during pregnancy, according to a JAMA Network Open Study. Prepartum depression is fairly common, affecting between 10 and 15% of pregnant women.1
“It’s estimated that about 1 in 7 pregnant women is depressed,” says Katherine L. Wisner, MD, professor of psychiatry and behavioral sciences and obstetrics and gynecology at Northwestern University in Evanston, Illinois. “The depression is a whole-body physiologic disorder that affects the pregnancy.”
The signs of depression in pregnancy can range from a loss of interest in pleasant activities and feelings of worthlessness to changes in appetite and fatigue, explains Amy Kranzler, PhD, attending psychologist in the department of psychiatry and behavioral sciences at Montefiore Medical Center/The University Hospital for Albert Einstein College of Medicine in New York City.
“The symptoms of depression during pregnancy are largely the same as depression that occurs in other times of life,” Dr. Kranzler says. “The pregnant woman may also have worries about the delivery of her baby or about her inadequacy as a mother.”
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Pregnant women who have anxiety issues, who have an unplanned pregnancy, or who feel stressed about the well-being of the baby are at an increased risk for depression while pregnant, according to Mitchell S. Kramer, MD, FACOG, chairman of the department of obstetrics and gynecology at Northwell Health’s Huntington Hospital in Huntington, New Yorl. “Women who receive fertility treatment are at an increased risk as well,” he says. “They may worry about the effect of the treatment on the pregnancy and they may consider the pregnancy as a ‘premium’ pregnancy’.”
The JAMA Network Open Study comprised a two-generation cohort: mothers (first generation) and their daughters (second generation) who later got pregnant. Some 17% of the first generation mothers reported experiencing high depression symptoms, while 25% of the second generation reported being depressed while pregnant. The moms in both groups were between the ages of 19 and 24 when they were surveyed.
Why would younger moms like those in the JAMA Network Open Study be depressed? “We know that financial stress and inadequate support increase the risk of depression, and younger moms may be less likely to have those financial and interpersonal resources,” Dr. Kranzler says. “However, depression during pregnancy can affect women of all ages.”
Can Maternal Depression Affect an Unborn Baby?
If not treated, depression in a mom can adversely affect the baby, Dr. Kranzler says. “There are risks to the developing fetus,” she says. “When the mother is under stress, cortisol is produced and can adversely affect the baby’s development.” A baby of a depressed mother can be born too small or too early, according to the study.
Experts say that pregnant women suffering from depression should be aware that there are effective treatments to help them learn how to combat depression.
The JAMA Network Open Study says that the rate of depression in young pregnant women is higher than it was in the 1990s and that steps should be taken to provide support for these mothers-to-be. “The (study) findings highlight the need for increased screening and resources to support young pregnant women and minimize the potentially far-reaching impact of depression on mothers, their children, and future generations,” the study authors wrote.
Is There an Effective Treatment?
Both medication and psychotherapy are effective treatments for depression in pregnancy, experts say. What tends to happen, Dr. Krantzer says, is that when a woman finds out she is pregnant, she stops taking her psychiatric medication. Unfortunately, this is not necessarily indicated.
“There are risks involved with both medication and with untreated depression,” she says. “Pregnant women should always consult with a psychiatrist but oftentimes, especially in cases of severe depression, the benefits of antidepressants can outweigh the risks.”
In addition to medication, social support is crucial for a pregnant woman who is experiencing depression, Dr. Kranzler says. A formal support group may help, or simply connecting with peers and reaching out to friends can be key in helping a mom-to-be not feel isolated. Treatments like Interpersonal Psychotherapy and Cognitive Behavioral Therapy (CBT) have also been shown to be helpful. Bright morning light therapy may also be suggested, Dr. Wisner says.
To determine what course of treatment is best for you, have a discussion with your health care provider to discuss benefits and risks. The goal is to come up with a plan that is meant to optimize overall health for mother and baby, Dr. Wisner says.
New dads-to-be can really be on the frontline in terms of providing social support during a pregnancy, Dr. Kranzler says. “The men are also the ones to notice that there may be some depression going on, and to encourage women to speak to their doctor about it,” she says.
Does Depression End When the Baby is Born?
Depression in pregnancy typically does not resolve with delivery, Dr. Kramer says. “Depression is likely to get worse before it gets better, necessitating more aggressive treatment,” he says. That’s why it is so important to seek treatment sooner rather than later.”
For a free consultation about medication during pregnancy from a government-funded organization, visit MotherToBaby and for support and additional information, visit Postpartum Support International.
Article Sources Last Updated: Mar 7, 2019