Depression In Pregnancy: Facts To Know For Men And Women

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— By Dr. Sandip Roy.

Depression in pregnancy can last for a long time. It can start before pregnancy and can continue up to two years after childbirth.

For women between 18 and 45 years of age, the two most common mental health issues are depression and anxiety. So, the risk of having those two psychiatric conditions is highest during their fertile years.

Moreover, women with a history of depression are more likely to relapse into depression during their pregnancy.

Depression Is More Than Sadness

Depression is not sadness. In fact, sadness is just one part of depression.

Sadness, negative mood, and related feelings are intense and constant in depression. “Cheer up!” messages do not help the depressed; they need help and therapy.

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) says to diagnose Major Depressive Disorder (MDD):

Depression In Pregnancy

A study in Obstetrics & Gynecology found 4.8% of women aged 20 to 44 (reproductive years) had major depression and 4.3% had minor depression.

Pregnancy is also the time when women are more vulnerable to depression. A CDC analysis found depression diagnoses increased during delivery visits.

Changes in a pregnant woman happen week by week. The hormonal changes during this period can make the condition worse. Inadequate treatment of depression carries a high risk of self-harm in the postpartum period.

There can be two specific types of depression during pregnancy:

1. Antepartum depression
2. Postpartum depression

1. Antepartum Depression (APD)

The depression that occurs just before or during pregnancy is antepartum depression (APD). The 2001 Avon study verified that depression during pregnancy is more common than depression occurring after childbirth.

The negative mood in the mother can directly affect the brain development of the fetus. The risk to the fetus is very high if the pregnant woman uses alcohol, tobacco, or psychoactive drugs.

The US Agency for Healthcare Research and Quality considers the following two simple questions to be enough to detect depression during pregnancy:

Early detection is the key to treating it. The earlier the obstetrician or the gynecologist screens for depression as a routine in any pregnancy-related consultation, the better the chance of preventing and controlling it.

Antidepressants In Antepartum Depression

Antidepressants are the mainstay for treating moderate depression to severe depression.

However, the treatment of pregnancy-related depression with antidepressant medications comes with the risk of harm to the unborn child. Drug-related birth defects are most likely to occur during the initial 12 weeks (3 months) of pregnancy.

Antidepressants during the final three months of pregnancy may also cause serious problems for neonates, resulting in prolonged hospitalization, breathing support, and tube feeding.

Another effect of antidepressants is a higher stress level in the mother, which further affects fetal growth negatively.

In 2005, the FDA issued warnings that the use of the drug paroxetine in early pregnancy may cause major congenital malformations.

Non-Drug Treatment In Antepartum Depression

The Policy Statement of the American Academy of Pediatrics considers psychotherapy as the first option for antenatal depression, and drugs are only indicated if psychotherapy is inadequate or inappropriate.

Psychotherapy can be given as a group or individually. The caregivers should encourage the woman to obtain social and family support.

Some recent studies consider the following to be effective:

• morning light or phototherapy,
• dietary changes and/or supplements,
• increase of physical activity (but criticized),
• chiromassage.

2. Postpartum Depression (PPD)

Postpartum depression occurs in 10 to 15% of mothers. It is often caused by the mother feeling that she is unable to properly carry out her motherly duties.

Women can get postpartum depression (PPD) at any time up to a year after giving birth. There is a higher risk during the first 5 weeks after childbirth.

Its symptoms are similar to depression in other settings, except that the mother’s feelings of inadequacy and guilt over her lack of coping erode her relationship with her baby.

Depression after pregnancy strains marriage, wears away the mother’s confidence, and limits her social functioning. In serious cases, it may lead to infant abuse, and even suicidal or infanticidal behavior.

“Baby Blues”

PPD is different from baby blues (maternity blues or postnatal blues). Baby blues is diagnosed as a commonly occurring self-limiting state of dysphoria. It rarely requires treatment unless it persists for over 10 days. It is a normal reaction to the hormonal changes and stress after delivery.

Antidepressants In Postpartum Depression

First-line treatment for severe or prolonged postpartum depression includes starting an SSRI with possible addition of a benzodiazepine when extreme anxiety or insomnia is a presenting feature.

Two-thirds of women with postpartum depression recover by the end of the first year, and 90% by the end of the second year.

Breastfeeding: To minimize neonatal exposure to antidepressants in breast milk, the drug should be prescribed at the lowest effective dose, if possible.

Non-Drug Treatment In Postpartum Depression

Psychological counseling and social interventions can treat mild depression. Cognitive-behavioral therapy (CBT) and interpersonal therapy (IPT) are useful in treating postpartum depression.

The major goal of CBT is to modify patients’ beliefs, which helps mothers change their thinking and behavior patterns. Additionally, increased family assistance and support improve mild forms of postpartum depression.

Effects Of Depression On Newborns

Studies show newborns of women with postpartum depression are more likely to have an impairment in terms of socio-emotional and cognitive development. Postnatal depression symptoms are also a consistent predictor of negative parenting behavior.

On a more practical note, PPD may lead to simple things as infant undernutrition and suboptimal childcare.

Four-year-old boys, whose mothers had been through depression after childbirth, lagged 15 points behind on IQ scales, and were still behind at 11 years old. They were also more emotionally and behaviorally disturbed.

Girls were not affected in the same way. At the age of 11, boys, but not girls, with low IQ saw themselves as having attention, emotional, and behavioral problems.

Postnatal Depression In Fathers

Mothers do not suffer a monopoly on pregnancy-related depression. It is Paternal Postnatal Depression when it happens in fathers.

Between 5-24% of fathers suffer from depression in the early postnatal period. In addition, what we know from studies is that paternal postnatal depression is closely related to maternal depression. Fathers will likely have it if mothers suffer from it.

Other than the mother’s depression, some causes of paternal postnatal depression could be:

1. unemployment
2. low socioeconomic status
3. psychiatric history
4. marital discord
5. neuroticism (excessive tendency to have negative emotions)
6. younger paternal age
7. first-time fatherhood

Paternal depression at 8 weeks doubles the risk of behavioral issues in the child at 3½ years of age. The effects are dominantly on boys. Paternal depression is less likely to affect a daughter’s behavior.

Final Words

Women with psychiatric disorders can bear and rear children as well as any other woman. All they need is adequate care, support, and treatment.

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Source: Psychiatric Disorders in Pregnancy in the textbook Selected Topics in Obstetrics and Gynaecology-5 For Postgraduates and Practitioners, by the same author, Dr. Sandip Roy.

√ Also Read: 10 Depression Myths (And The Straight Facts)

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