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

Most 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:

• Postpartum Support International
• Postpartum Progress
• 2020 Mom Project
• Inland Empire Perinatal Mental Health Collaborative
• Postpartum Health Alliance

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.

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