Pregnancy-related Depression and Anxiety

 

If there is one article that has resonated very deeply with our audience, it was Casey’s confession of when she intentionally overdosed on prescription medication when she was seven months pregnant.
Pregnancy is supposed to be a wonderful time in a woman’s life as she prepares for the joys of motherhood. However, pregnancy-related depression and anxiety are the most common complications of pregnancy, affecting about one in 10 Colorado women. At Mile High Mamas, we are proud to partner with the Colorado Department of Public Health and Environment (CDPHE) on their new awareness campaign to help women recognize the symptoms and get help with the important message:
You are not alone.
Pregnancy-related depression (PRD) and anxiety can occur any time during pregnancy through the baby’s first birthday. It may also happen after a miscarriage, pregnancy loss or after adopting a baby. Many women feel uncomfortable talking about their symptoms with family, friends or health care providers and we want to help break down those barriers.

Symptoms of PRD

Pregnancy-related depression and anxiety are serious conditions that affect a woman’s physical and mental health. Pregnancy-related mood disorders include anxiety, obsessive-compulsive disorder (OCD), depression, post-traumatic stress disorder (PTSD), and psychosis. Symptoms differ for everyone and might include the following:

• Feelings of anger or irritability.
• Lack of interest in the baby.
• Loss of appetite and trouble sleeping.
• Crying and sadness.
• Feelings of guilt, shame or hopelessness.

Why is this happening?

Just remember: you are not at fault and you are not to blame! There is no one cause for pregnancy-related depression and anxiety. Women who develop depression or anxiety around childbearing have symptoms that are caused by a combination of psychological, social and biological factors that can include a personal or family history of mood or anxiety disorders such as depression, anxiety, bipolar disorder (manic-depressive) and sensitivity to hormonal changes.

How is PRD different from the “baby blues”?

Pregnancy-related depression and anxiety can look like the “baby blues” because they share similar symptoms such as worry, crying and fatigue.
The difference is that with the “baby blues,” the feelings are somewhat mild, last a week or two and go away on their own.

How do I get help?

Here’s the good news: With support and resources, pregnancy-related depression and anxiety is highly treatable. Treatment plans are different for each woman but might include increased self-care, social support, therapy or counseling, and treatment of symptoms with medication when necessary. Here are some suggestions for mothers:
○ Get support from family and friends so you can keep active, eat healthy and get enough rest and time for yourself.
○ Talk to a professional.
○ Learn as much as you can about pregnancy-related depression and anxiety.
○ Ask for help when you need it.
○ Join a support group in your area or online.
○ Don’t give up! It may take more than one try to get the right help you need.

Where do I get help?

Feelings of guilt, frustration and withdrawal are common among new moms but you don’t have to feel this way. Having a baby is hard but help is available.
Go to www.postpartum.net to ​get information about pregnancy-related depression and anxiety and find Colorado coordinators who can give you support and resources in your area. You may also call 1.800.944.4773 (English and Spanish) to​ get confidential, free and immediate support. They also offer free, live phone chats with experts every week including chats and resources for dads.
And always remember: You are not alone. You are not to blame.  It’s okay to ask for help.

Everyone experiences feelings of sadness. They are a natural response to life's difficult times and events, and they usually lessen with time.
Clinical depression goes beyond feelings of sadness and is a real illness with potentially serious consequences. It is a mood disorder and impacts people's quality of life. People with depression struggle with daily life because it affects the way they function.
Relationships, self-esteem, work, motivation, sleep, appetite, and more are all affected by depression. It is not a weakness and is a condition that requires treatment from a healthcare professional.

Contents of this article:

1. Depression during pregnancy
2. Signs and symptoms of depression
3. Treatment for depression during and after pregnancy
4. Depression after pregnancy
5. Tips for preventing depression during and after pregnancy

Depression during pregnancy

Depression can affect women both during and after pregnancy.

It was once believed that pregnancy hormones could protect a mother-to-be from depression, but this is no longer the case. Changes in hormones during pregnancy can make a woman highly emotional, and this makes it harder to cope with depression.
Some women experience depression after the birth of a child, known as postpartum depression. It is not to be confused with the "baby blues," which is mild depression that usually goes away within 2 weeks of the baby's birth.
Women can also start to feel depressed while they are pregnant. This is known as perinatal depression.
Perinatal depression is a major depression with extreme feelings of sadness, anxiety, and tiredness. This illness can make it difficult for a new mother to take care of herself and her baby once it is born.

Risk factors

Perinatal depression may result from a combination of emotional, physical, and environmental factors. Some of the risk factors are:

• Previously having depression
• A family history of depression
• An unplanned pregnancy
• A problematic pregnancy or birth experience
• Giving birth to twins or more
• Financial worries
• Relationship difficulties
• Not having a support network of family or friends
• Smoking, drinking alcohol, using drugs

Signs and symptoms of depression

Some of the signs and symptoms of depression are:

Depression can make it difficult for people to concentrate and complete routine tasks.

• Feeling extremely sad, angry, or overwhelmed
• Having a sense of hopelessness or a lack of interest
• Feeling anxious or irritable
• Being tearful
• Feeling worthless, guilty, or like a failure
• Having no energy and finding it difficult to complete tasks
• Not sleeping or sleeping too much
• Eating more or less than usual
• Having difficulty concentrating, remembering things, or making decisions
• Avoiding contact with friends and family
• Thoughts of suicide
• Body aches and pains

Effects of depression on a baby

Depression can affect a mother's relationship with her baby. Early bonding is important for the baby's development, but perinatal depression makes it difficult for a mother to feel close to her baby. It can also make it hard for her to respond to what her baby needs.
Depression, when left untreated, can potentially cause:

• A premature birth that takes place before 37 weeks of pregnancy
• An underweight baby, weighing less than 5 pounds 8 ounces
• A more irritable baby who is not very attentive or expressive

A mother-to-be with depression can have trouble taking care of herself during pregnancy. She might not eat healthily or put on sufficient weight, and she might miss prenatal appointments. Treatment for depression during pregnancy can help prevent these problems.
 

Treatment for depression during and after pregnancy

Treating depression before, during, and after pregnancy is crucial to the health of the mother and baby. There are several treatment options. Most often, a combined treatment plan works best. The treatments include:

• Medication
• Counseling or talk therapies
• Support groups
• Electroconvulsive therapy (ECT)

Alternative treatments such as light therapy and acupuncture are another option. It's also important to have a healthy diet, regular exercise, and enough sleep.

Medication for depression

A common treatment option is antidepressant medication.
Antidepressants that may be prescribed during pregnancy include:

• Some SSRIs (selective serotonin reuptake inhibitors), such as citalopram, fluoxetine, and sertraline
• SNRIs (serotonin and norepinephrine reuptake inhibitors), such as duloxetine and venlafaxine
• Bupropion, which is used for both depression and to help stop smoking

Possible risks

Doctors caring for women before, during, and after pregnancy carefully weigh the benefits and risks of taking antidepressant medication. If someone is taking antidepressant medication, they should not stop taking it without a doctor's advice.
Some medications may carry a low risk of birth defects.
Symptoms such as irritability and jitters may occur in a newborn whose mother took antidepressant medication during pregnancy.

Depression after pregnancy

Depression after pregnancy, or postpartum depression, is a mood disorder. The woman experiences feelings of sadness, anxiety, and tiredness following the birth of her baby.

According to the Centers for Disease Control and Prevention (CDC), postpartum depression affects around 1 in 8 women.

Postpartum depression occurs in around 12 percent of births. It can begin any time after delivery, but it is most common between a week and a month after childbirth.
There isn't a single cause of postpartum depression. Most likely, it is the result of several physical and emotional factors, including sleep deprivation, exhaustion, and hormonal changes.
The symptoms of postpartum depression are similar to those of perinatal depression. The mother may also have trouble bonding with her baby, or thoughts of harming herself or her baby.
Postpartum depression usually requires medical treatment. As with perinatal depression, some women have a greater chance of developing postpartum depression because they have one or more of the risk factors.
Treatment for postpartum depression is usually medication, counseling, or both.

Tips for preventing depression during and after pregnancy

There is no known way to prevent depression from happening. Knowing what symptoms to look for can help reduce the effects on both mother and baby.
To help prevent depression during and after pregnancy, people should:

• Learn the signs and symptoms
• Get as much information on parenting, pregnancy, and childbirth as possible
• Plan ahead and identify the people who can offer support
• Talk openly with a healthcare provider about depression symptoms

Once the baby arrives, a new mother can benefit from:

• Spending time with other new mothers
• Taking a bit of time each day to do something enjoyable like having a bath, reading a book, or listening to music
• Being realistic about how much it is possible to get done with a newborn baby
• Asking for help from family and friends
• Resting when the baby rests

It is always important to remember that depression during or after pregnancy is a real medical condition that requires medical attention.

Written by Silvana Montoya

 Pregnant women face a number of choices. Most are pretty noncontroversial: Don’t smoke or use drugs; avoid raw fish and eggs; get lots of rest. But one dilemma some pregnant women face is less intuitive: whether and how to treat their minds and bodies if they are depressed.
Much attention has focused on postpartum depression (that is, the occurrence of depression in the mother after giving birth), which occurs in about one in 8-10 women. But depression during the nine months of pregnancy occurs as frequently, yet has received less spotlight.
Diagnosing depression in pregnancy can be tricky, as women may initially disregard some of the symptoms, such as changes in mood, appetite or sleep, as normal or to be expected. But here’s what’s critical to know: Identifying and treating maternal depression during pregnancy is particularly important as it impacts not only the mom, but baby as well.
This concept – that maternal mood can be passed on to offspring – is hardly new. It has existed since the days of Hippocrates, and even Shakespeare understood it: In “Henry VI,” a pregnant and despondent Queen Elizabeth laments:

 "Ay, ay, for this I draw in many a tear, 
 And stop the rising of blood-sucking sighs,
 Lest with my sighs or tears I blast or drown, 
 King Edward's fruit, true heir to the English crown." 

 

Shakespeare’s Queen Elizabeth in ‘Henry VI’ understood the perils of depression in pregnancy.

Shakespearean insights aside, we now know that chronic depression in pregnancy can alter levels of stress hormones, divert blood (and with it, oxygen and key nutrients) away from the fetus and suppress the immune systems of mother and child, leaving both more vulnerable to infection.

Sadness not always the tell-tale symptom

So, what might a pregnant woman who thinks she might be depressed do? The first step is to become aware of signs and symptoms. And feeling sad or blue may not be the first or the main one. Others can include excessive fatigue, loss of concentration or interest, change in appetite, either too little or too much sleep, feelings of worthlessness and recurrent thoughts of death.
Note that a sad day here or a stressed one there does not a depressive episode make. But if you have been experiencing several of the above symptoms chronically over a two-week period or more, and they’re not the result of another medication you’re on, you could be suffering from clinical depression. Speaking to your health professional proactively and openly can help distinguish the normal ups and downs of pregnancy from symptoms that need medical attention. And if your OB-GYN is not well-versed in mental health issues (which may be the case), ask for a referral to see someone who is. Or, if you know someone who has been through a similar experience, get her opinion: Nothing beats a word-of-mouth referral.
If clinical depression is identified, treating it is important for both mother and the baby (remember, it’s a twofer). As a neuroscientist and epidemiologist who studies the long-term effects of various prenatal exposures, I have seen that, even though the choices are not always easy, there are a number of effective options for treatment.

Treatment options

The first is antidepressant medications. Several are on the market, with the most common being the “selective serotonin reuptake inhibitor (SSRI)” class that includes familiar names such as Prozac, Zoloft, Paxil and Lexapro.
These medications are, by and large, safe for adult use, and many are approved for use by pregnant women too. However, because these medications cross the placenta, the long-term effects on the baby, when they’re used in pregnancy, are not entirely clear. Some studies have suggested increased cognitive, language and emotional problems among children gestationally exposed to antidepressant medications, but it’s unclear how much of these effects are due to the medications versus the underlying depression itself.
Given the uncertainty, some pregnant women may want to be treated, but, understandably, not to be medicated. For them, there is another viable route, and one that a number of pregnant women fail to seriously consider: psychotherapy.
Many psychotherapeutic treatments reduce symptoms of depression and anxiety as well as their medication counterparts, but without unwanted pharmacological side effects. Although the term psychotherapy has occasionally been misappropriated by some questionable forms of treatment or self-help, there are a number of structured therapies such as Cognitive Behavioral Therapy (CBT) and Interpersonal Therapy (IPT) that have been developed by clinicians, are based on solid scientific evidence and (here’s the important bit) have been adapted to treat symptoms in pregnancy.
Clinical trials, including here at Columbia University Medical Center where some of these treatments were developed, show psychotherapy to be an effective treatment alternative for many pregnant women. And for women already on an antidepressant who might be contemplating a pregnancy, switching to psychotherapy for the span of pregnancy may be an option as well.
And finally, there’s always the option to not do anything. It is indeed true that some depressions are short-lived and will go away on their own. But ignoring what your body tells you is rarely a good idea (would we ignore chest pains, for example, just hoping they will go away?). Plus, it’s impossible to predict ahead of time how long a depressive episode might last, and the “let’s wait and see” approach risks prolonging the baby’s exposure to maternal stress. Remember, stress is bad for baby too.

Not all depressions are treated equally

To be sure, these are not simple choices. Risks of treatment have to be balanced against the risks of remaining untreated. For some women (e.g., those with severe depression, or with other psychiatric or medical complications), medication may be necessary. For others, psychotherapy may be the preferred option. But even when it is, psychotherapy requires time, a commodity that many pregnant women simply do not have. Costs could play a role too, although many health plans cover a certain number of psychotherapy sessions.

 

While this sliding scale of options may sound unsatisfying, it simply reflects the underlying reality that there’s no one size fits all for depressed, pregnant woman. But here’s the good news: What the options do offer an expecting woman is the opportunity to explore – with herself, her family and friends, and her doctor – what the best road to travel may be for her. The only ill-advised thing a mother-to-be who thinks she might be depressed can do is to not do anything at all.

Although many people consider pregnancy a time of happiness, about 10% to 20% of moms-to-be struggle with symptoms of depression.

Causes

• Having a history of depression or PMDD (premenstrual dysphoric disorder, a severe type of PMS)
• Age at time of pregnancy; the younger you are, the higher the risk.
• Living alone or having limited familial support
• Limited social support
• Marital conflict or domestic violence
• Uncertainty about the pregnancy

Effects

Stress related to pregnancy can contribute to the return or worsening of depression symptoms.
Depression can get in the way of being able to care for yourself during your pregnancy. You may be less able to follow medical recommendations, as well as sleep and eat properly.
The condition can also make you more likely to use tobacco, alcohol, and illegal drugs that can harm you and your developing baby.
Some studies suggest that depression during pregnancy may increase the risk for pre-term delivery and low infant birth weight. However, there are experts who debate the connection between these outcomes and untreated depression.

Depression may interfere with your ability to bond with your growing baby, too. Being depressed during pregnancy can place you at greater risk for having an episode of depression after delivery (postpartum depression).

Take Care of Yourself

Preparing for a new baby is a lot of hard work, but your health should come first. So resist the urge to get everything done: Cut down on your chores, and do things that will help you to relax. Taking care of yourself is a key part of taking care of your unborn child.
Open up to your partner, your family, or your friends about what concerns you. If you ask for support, you'll find that you often get it.
If you're still feeling down and anxious, consider therapy with a mental health specialist.

Medication and Treatment

Evidence suggests that many antidepressant medicines are safe for treating depression during pregnancy, and will not harm your growing baby -- at least according to the results from short-term studies. Long-term effects have not been as fully studied.
Talk to your doctor about the possible risks and benefits of antidepressants. He can work with you to manage your symptoms and develop a treatment plan. He can also to refer you to a mental health specialist, if you need it.

What is depression?

Depression is more than just feeling "blue" or "down in the dumps" for a few days. It's a serious illness that involves the brain. With depression, sad, anxious, or "empty" feelings don't go away and interfere with day-to-day life and routines. These feelings can be mild to severe. The good news is that most people with depression get better with treatment.

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How common is depression during and after pregnancy?

Depression is a common problem during and after pregnancy. About 13 percent of pregnant women and new mothers have depression.

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How do I know if I have depression?

When you are pregnant or after you have a baby, you may be depressed and not know it. Some normal changes during and after pregnancy can cause symptoms similar to those of depression. But if you have any of the following symptoms of depression for more than 2 weeks, call your doctor:

• Feeling restless or moody
• Feeling sad, hopeless, and overwhelmed
• Crying a lot
• Having no energy or motivation
• Eating too little or too much
• Sleeping too little or too much
• Having trouble focusing or making decisions
• Having memory problems
• Feeling worthless and guilty
• Losing interest or pleasure in activities you used to enjoy
• Withdrawing from friends and family
• Having headaches, aches and pains, or stomach problems that don't go away

Your doctor can figure out if your symptoms are caused by depression or something else.

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What causes depression? What about postpartum depression?

There is no single cause. Rather, depression likely results from a combination of factors:

• Depression is a mental illness that tends to run in families. Women with a family history of depression are more likely to have depression.
• Changes in brain chemistry or structure are believed to play a big role in depression.
• Stressful life events, such as death of a loved one, caring for an aging family member, abuse, and poverty, can trigger depression.
• Hormonal factors unique to women may contribute to depression in some women. We know that hormones directly affect the brain chemistry that controls emotions and mood. We also know that women are at greater risk of depression at certain times in their lives, such as puberty, during and after pregnancy, and during perimenopause. Some women also have depressive symptoms right before their period.

Depression after childbirth is called postpartum depression. Hormonal changes may trigger symptoms of postpartum depression. When you are pregnant, levels of the female hormones estrogen (ESS-truh-jen) and progesterone (proh-JESS-tur-ohn) increase greatly. In the first 24 hours after childbirth, hormone levels quickly return to normal. Researchers think the big change in hormone levels may lead to depression. This is much like the way smaller hormone changes can affect a woman's moods before she gets her period.
Levels of thyroid hormones may also drop after giving birth. The thyroid is a small gland in the neck that helps regulate how your body uses and stores energy from food. Low levels of thyroid hormones can cause symptoms of depression. A simple blood test can tell if this condition is causing your symptoms. If so, your doctor can prescribe thyroid medicine.
Other factors may play a role in postpartum depression. You may feel:

• Tired after delivery
• Tired from a lack of sleep or broken sleep
• Overwhelmed with a new baby
• Doubts about your ability to be a good mother
• Stress from changes in work and home routines
• An unrealistic need to be a perfect mom
• Loss of who you were before having the baby
• Less attractive
• A lack of free time

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Are some women more at risk for depression during and after pregnancy?

Certain factors may increase your risk of depression during and after pregnancy:

Did you know?

If you take medicine for depression, stopping your medicine when you become pregnant can cause your depression to come back. Do not stop any prescribed medicines without first talking to your doctor. Not using medicine that you need may be harmful to you or your baby.

• A personal history of depression or another mental illness
• A family history of depression or another mental illness
• A lack of support from family and friends
• Anxiety or negative feelings about the pregnancy
• Problems with a previous pregnancy or birth
• Marriage or money problems
• Stressful life events
• Young age
• Substance abuse

Women who are depressed during pregnancy have a greater risk of depression after giving birth. The U.S. Preventive Services Task Force recommends screening for depression during and after pregnancy, regardless of a woman's risk factors for depression.

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What is the difference between "baby blues," postpartum depression, and postpartum psychosis?

Many women have the baby blues in the days 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 baby blues most often go away within a few days or a week. The symptoms are not severe and do not need treatment.
The symptoms of postpartum depression last longer and are more severe. Postpartum depression can begin anytime within the first year after childbirth. If you have postpartum depression, you may have any of the symptoms of depression listed above. Symptoms may also include:

• Thoughts of hurting the baby
• Thoughts of hurting yourself
• Not having any interest in the baby

Postpartum depression needs to be treated by a doctor.
Postpartum psychosis (seye-KOH-suhss) is rare. It occurs in about 1 to 4 out of every 1,000 births. It usually begins in the first 2 weeks after childbirth. Women who have bipolar disorder or another mental health problem called schizoaffective (SKIT-soh-uh-FEK-tiv) disorder have a higher risk for postpartum psychosis. Symptoms may include:

• Seeing things that aren't there
• Feeling confused
• Having rapid mood swings
• Trying to hurt yourself or your baby

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What should I do if I have symptoms of depression during or after pregnancy?

Call your doctor if:

• Your baby blues don't go away after 2 weeks
• Symptoms of depression get more and more intense
• Symptoms of depression begin any time after delivery, even many months later
• It is hard for you to perform tasks at work or at home
• You cannot care for yourself or your baby
• You have thoughts of harming yourself or your baby

Your doctor can ask you questions to test for depression. Your doctor can also refer you to a mental health professional who specializes in treating depression.
Some women don't tell anyone about their symptoms. They feel embarrassed, ashamed, or guilty about feeling depressed when they are supposed to be happy. They worry they will be viewed as unfit parents.
Any woman may become depressed during pregnancy or after having a baby. It doesn't mean you are a bad or "not together" mom. You and your baby don't have to suffer. There is help.
Here are some other helpful tips:

• Rest as much as you can. Sleep when the baby is sleeping.
• Don't try to do too much or try to be perfect.
• Ask your partner, family, and friends for help.
• Make time to go out, visit friends, or spend time alone with your partner.
• Discuss your feelings with your partner, family, and friends.
• Talk with other mothers so you can learn from their experiences.
• Join a support group. Ask your doctor about groups in your area.
• Don't make any major life changes during pregnancy or right after giving birth. Major changes can cause unneeded stress. Sometimes big changes can't be avoided. When that happens, try to arrange support and help in your new situation ahead of time.

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How is depression treated?

The two common types of treatment for depression are:

• Talk therapy. This involves talking to a therapist, psychologist, or social worker to learn to change how depression makes you think, feel, and act.
• Medicine. Your doctor can prescribe an antidepressant medicine. These medicines can help relieve symptoms of depression.

These treatment methods can be used alone or together. If you are depressed, your depression can affect your baby. Getting treatment is important for you and your baby. Talk with your doctor about the benefits and risks of taking medicine to treat depression when you are pregnant or breastfeeding.

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What can happen if depression is not treated?

Untreated depression can hurt you and your baby. Some women with depression have a hard time caring for themselves during pregnancy. They may:

• Eat poorly
• Not gain enough weight
• Have trouble sleeping
• Miss prenatal visits
• Not follow medical instructions
• Use harmful substances, like tobacco, alcohol, or illegal drugs

Depression during pregnancy can raise the risk of:

• Problems during pregnancy or delivery
• Having a low-birth-weight baby
• Premature birth

Untreated postpartum depression can affect your ability to parent. You may:

• Lack energy
• Have trouble focusing
• Feel moody
• Not be able to meet your child's needs

As a result, you may feel guilty and lose confidence in yourself as a mother. These feelings can make your depression worse.
Researchers believe postpartum depression in a mother can affect her baby. It can cause the baby to have:

• Delays in language development
• Problems with mother-child bonding
• Behavior problems
• Increased crying

It helps if your partner or another caregiver can help meet the baby's needs while you are depressed.
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.