An Overview of Perinatal Depression

Perinatal Depression: Symptoms, Causes, Diagnosis, Treatment, and Coping

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Pregnancy and the weeks immediately following birth are physically, emotionally, and mentally challenging. It’s not uncommon to experience feelings of elation and happiness one minute, only to feel sadness, fatigue, and increased anxiety the next. While all of these emotions can be attributed to mood swings during pregnancy and postpartum changes, there are instances when these changes in mood may be reflective of something more serious. 

Perinatal depression is one of the most common medical complications during pregnancy and the postpartum period, affecting one in seven women. There are several terms used to describe mood disorders that result in depressive feelings during pregnancy or after birth including, postpartum depression, maternal depression, prenatal depression, and postnatal depression.

Perinatal depression covers the period of pregnancy through the first 12 months after delivery. 

Symptoms

It’s natural to experience emotional ups and downs during pregnancy and the postpartum period; mild mood changes during pregnancy are common. However, if they persist or get worse, it’s time to talk to your doctor. Symptoms of perinatal depression include:

  • Persistent sadness
  • Feelings of emptiness
  • Feelings of hopelessness
  • Frequent crying
  • Reduced ability to think or concentrate
  • Trouble sleeping
  • Fatigue or low energy
  • Irritability 
  • Increased feelings of anxiety and worry
  • Loss of interest in caring for self and/or child
  • Loss of interest in activities you once enjoyed
  • Poor bonding with baby
  • Changes in appetite and weight

In general, if feelings of depression or anxiety persist for a few weeks or interfere with daily activities, it is time to ask for help.

Causes

The causes of perinatal depression range from a variety of medical, social, and psychiatric impairments. That said, depression is more common in women than men, with twice as many women being affected.

The initial onset of symptoms often peaks during the reproductive years, which points to one of the causes of perinatal depression. 

Additionally, shifting hormones during pregnancy and in the postpartum period may play a role in symptoms of depression. 

Several risk factors exist for perinatal depression including:

  • Personal or family history of depression
  • Maternal anxiety
  • Life stress
  • Lack of social support
  • Unintended pregnancy
  • Smoking 
  • Poor relationship quality
  • History of physical or sexual abuse
  • Pregnancy complications

Women with current depression or anxiety that become pregnant should be closely monitored during pregnancy and the postpartum period. 

Diagnosis 

Diagnosing perinatal depression follows some of the same guidelines as diagnosing other forms of depression, but your doctor will consider the peripartum onset as the main criteria, often resulting in a diagnosis of Major Depressive Disorder (MDD) with Peripartum Onset.

That said, there are some slight discrepancies in the time frame of perinatal depression between the DSM-5 and other organizations such as the American College of Obstetricians and Gynecologists (ACOG).

The DSM-5 cites symptom onset as occurring any time during pregnancy or within four weeks of delivery, yet many professional organizations, including the ACOG, acknowledge that symptoms of perinatal depression may last up to 12 months after delivery.

The ACOG recommends screening women at least once during the perinatal period for depression and anxiety symptoms, with a follow-up screening during the comprehensive postpartum visit. The ACOG and the American Academy of Pediatrics (AAP) both recommend screening with a validated tool such as the Edinburgh Postpartum Depression Scale (EPDS), which is a simple, 10-question screen that is completed by the mother. Depending on the responses, your doctor may treat you, or refer you for additional mental health services. 

Treatment

Even though the daily symptoms can feel overwhelming and permanent at times, perinatal depression is treatable. Through a combination of different therapies, medications, and self-care, you can begin to feel better. 

Since perinatal depression is under the umbrella of depressive disorders, adhering to the proven therapeutic options for treating depression should be followed. That said, special consideration needs to be given to antidepressant medications while pregnant and breastfeeding.

Psychotherapy is often the first line of defense when treating perinatal depression. During therapy, you can begin to understand your diagnosis and how it impacts your life. A therapist will also work with you to develop strategies that decrease the severity of the symptoms. There are several forms of psychotherapy, but two, in particular, have proven successful in treating perinatal depression. 

Cognitive-behavioral therapy (CBT) emphasizes the link between thoughts and feelings. Through counseling sessions, you will work to identify and reframe negative thinking patterns into positive thoughts. This can help you recognize how your thinking influences your emotions. 

The use of interpersonal therapy has also been successful in treating perinatal depression. This type of therapy focuses on treating interpersonal issues thought to contribute to the development of psychological disorders, with the goal of social adjustment and improving your relationships with other people.

Your doctor may also talk to you about antidepressants, which are a group of drugs commonly prescribed for treating depression. They work by increasing levels of a group of chemicals in the brain called neurotransmitters (primarily serotonin, norepinephrine, and dopamine) which are involved in regulating mood. While differing opinions exist on the use of antidepressants during pregnancy, selective serotonin reuptake inhibitors (SSRIs) are the most commonly prescribed antidepressants during pregnancy and the postpartum period. 

Talk with your doctor about the risks associated with taking medication during pregnancy, as well as any risks associated with untreated depression. They can help you decide what’s best for you.

Additionally, acupuncture during pregnancy may be a helpful intervention in the management of depression symptoms. 

Coping

Managing the symptoms of depression while pregnant and caring for a newborn can feel overwhelming at times. In addition to any treatment plan that involves therapy or medication, there are some self-care and coping tips you can try in order to alleviate some of the symptoms. hile help them cope with stress and reduce symptoms of maternal depression

  • Exercise and physical activity. Staying physically active and engaging in exercises that you enjoy not only benefits your health, but it can also reduce the symptoms of depression. Try to include some form of exercise most days of the week. Talk with your doctor if you’re unsure of the safety of a particular activity.
  • Adequate rest. Quality sleep and rest during pregnancy and the postpartum period is critical to managing the symptoms of depression and the health of your baby. Insufficient sleep can make coping with the stressors of life more challenging. While waking up during the night is common, try to get seven or more hours of sleep each night, which is the recommended amount for adults. 
  • Healthy diet and nutrition. Your body needs additional calories and nutrients when pregnant and breastfeeding. To support overall health, focus on a diet full of fresh fruit, vegetables, healthy fats, complex carbohydrates, and lean protein. 
  • Support groups. One way to help ease some of the stress and feelings of loneliness is to find your community. Whether it’s friends, other women going through the same thing, family members, or a support group run by a therapist, sharing this experience with others can help you feel supported and find new ways to cope. 

    A Word From Verywell

    Pregnancy and motherhood can produce a range of feelings from sheer excitement and joyful celebration to sadness, loneliness, and emptiness. For some women, these ups and downs are temporary, but for others, these feelings persist or increase in intensity as time goes on.

    If you’re experiencing any symptoms of perinatal depression, the most important thing to remember is that you are not alone. There are safe and effective ways to treat and manage the symptoms of depression. That’s why it’s important to talk to your doctor right away. Asking for help is the first step in finding ways to feel better so you can begin to enjoy this incredible time in your life. 

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    Article Sources

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