Perinatal Depression: What It Is and What It Probably Isn’t

Pregnant woman, mid sectionMost estimates fall somewhere in the middle, but it is widely accepted that between 8% and 23% of all childbearing women will develop depression and/or anxiety during their pregnancies or during the first year after delivering their babies. Perinatal depression/anxiety is the clinical term for this condition, believed to be the most common complication of childbirth.

Medical personnel are getting better at screening women during pregnancy and postpartum, but much more needs to be done to improve access to screening, treatment, and training providers—and, of course, to reduce stigma, which likely leads to under-reporting of the condition.

Perinatal depression does not discriminate. Women of all ethnicities, cultures, socioeconomic statuses, and sexual orientations are at risk. No woman is to blame for developing perinatal depression/anxiety. Thought to be a perfect storm of genetics, fluctuating reproductive hormones, sleep deprivation, and other environmental factors (which may include grief, loss, trauma, complicated birth, etc.), perinatal depression is very treatable with swift access to care. A combination of psychotherapy (cognitive behavioral therapy and interpersonal modalities are evidence-based approaches), strengthening of social supports, self-care (attention to nutrition, exercise, sleep hygiene, breaks from baby care), and, in some cases, medication management has been shown to be effective and expeditious in bringing about recovery.

Women should not attempt to diagnose themselves with perinatal depression, but if a woman or her loved ones suspect she may be experiencing depression or anxiety, it is critical to link her with a trained perinatal psychotherapist who can provide an assessment and develop a comprehensive treatment plan. Such plans typically coordinate care with ob/gyns, pediatricians, psychiatrists, support groups, lactation consultants, the family support network, doulas, etc.

Symptoms of perinatal depression may include not only a depressed mood but also unbearable anxiety often occurring with panic attacks, intrusive thoughts, and insomnia. A woman with perinatal depression may feel extremely exhausted, hopeless, and terribly guilty that she is experiencing such a biochemical upheaval during a time when she anticipated the joy of a new life.

Symptoms of perinatal depression may include not only a depressed mood but also unbearable anxiety often occurring with panic attacks, intrusive thoughts, and insomnia. A woman with perinatal depression may feel extremely exhausted, hopeless, and terribly guilty that she is experiencing such a biochemical upheaval during a time when she anticipated the joy of a new life. Guilt and shame may exacerbate her symptoms and contribute to a spiraling of the depression and any anxiety. With treatment, though, she will recover.

Perinatal depression is sometimes confused for postpartum psychosis, which contributes to the stigma many women experience. The two conditions are very different. Only in very rare circumstances—one to two women in 1,000 births—do women present with postpartum psychosis, a condition in which there may be hallucinations and delusional thought processes resulting in a medical emergency. (If you experience these symptoms, call 911 or go to your nearest emergency room right away.) However, women with bipolar are at elevated risk for developing postpartum psychosis and should be monitored carefully by their medical practitioners during pregnancy and the postpartum period.

Fortunately, an increasing number of psychotherapists are specializing in providing therapy for women during reproductive life events such as pregnancy, postpartum, during fertility treatments, PMDD (premenstrual dysphoric disorder), and perimenopause (the 10 years approximately preceding menopause). Please see the following list of resources for women and their families.

May is National Maternal Depression Awareness Month. Please seek help if you or someone you love may be experiencing perinatal depression/anxiety.

Recommended resources:

References:

  1. Gaynes, B.N., Gavin, N., Meltzer-Brody, S., Lohr, K.N., Swinson, T., and Gartlehner, G. Perinatal depression: Prevalence, screening accuracy, and screening outcomes. Rockville, MD: Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services; 2005, February. Evidence Report/Technology Assessment No. 119. AHRQ Publication No. 05-E006-2.
  2. Harlow, B.L., Vitonis, A.F., Sparen, P., Cnattingius, S., Joffe, H., and Hultman, C.M. Incidence of hospitalization for postpartum psychotic and bipolar episodes in women with and without prior prepregnancy or prenatal psychiatric hospitalizations. Arch Gen Psychiatry. 2007 Jan;64(1):42-8.
  3. Stuart, S., Couser, G., Schilder, K., et al. Postpartum anxiety and depression: onset and comorbidity in a community sample. J Nerv Ment Dis. 1998;186:420–424.

© Copyright 2015 GoodTherapy.org. All rights reserved. Permission to publish granted by Andrea Schneider, LCSW, therapist in Benicia, California

The preceding article was solely written by the author named above. Any views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the preceding article can be directed to the author or posted as a comment below.

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  • Andrea Schneider

    Andrea Schneider

    May 4th, 2015 at 9:32 AM

    also, for residents of L.A. County, please see maternalmentalhealthla.org for an interactive map of perinatal providers in this county…the Los Angeles Perinatal Mental Health Task Force has set this up online for easy access to quality care in L.A. County.

  • Cynthia

    Cynthia

    May 4th, 2015 at 10:25 AM

    You have to understand that this is not going to be something that will be easy for most women to accept and talk about. I think that pregnant women will feel that there is real shame attached to this. Who wants to speak about being depressed when they are having a baby and there are so many people who want to have children and can’t? This did not happen to me but I can look back on that time and remember how happy everyone was telling me that I must be and there are those days when you don’t even feel that way, but who wants to speak up and say that out loud?

  • Andrea Schneider

    Andrea Schneider

    May 5th, 2015 at 2:08 PM

    exactly Cynthia…thus the stigma and shame associated with this situation that doesn’t need to be there…it’s the most common complication of childbirth, and it’s no one’s fault….

  • Serai

    Serai

    May 5th, 2015 at 2:18 PM

    It does make things so much easier when you have someone in your life that you feel you can depend on and trust to help you through it

  • April C.

    April C.

    May 6th, 2015 at 1:31 PM

    I remember all of those feelings of being afraid that I was going to do something wrong and that I was never going to be able to live up to the example of the strong women that I have in my family and in some ways this terrified me so much that I became convinced that I could never be a good mom to my kids.

    I think that there was a part of me that knew that all of this was wrong, but there are so many hormonal things going on that you sort of think that feeling like this is unavoidable.

  • trinie

    trinie

    May 9th, 2015 at 5:12 PM

    There may be more providers but how many women do you think will be lining up to seek treatment when there is still so much stigma that surrounds the issue?

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