Perinatal Depression
By Dr. Randi Fredricks, Ph.D.
Depression that occurs during pregnancy is called perinatal depression.
Historically, pregnancy was considered protective for depression; now, however, studies indicate that the rates of major
depression during pregnancy (10%-15%) are similar to rates in nonchildbearing women.
A recent study reported that
although rates of major depression do not rise during pregnancy, symptoms of psychological distress often increase
during the second and third trimesters.
Perinatal depression has substantial personal consequences and interferes with quality of child-rearing, adversely
affecting parent-child interactions, maternal responsiveness to infant vocalizations and gestures and other stimulation
essential for optimal child development.
Early detection is disturbingly uncommon even though it is known to improve
maternal well-being and child outcomes.
The following factors may increase a woman’s
chance of depression during this time:
History of depression, mental illness or substance abuse
Lack of support from family or friends
Problems with a previous pregnancy or birth
Marital or financial problems
Young age
Depression during pregnancy can affect the weight of the baby and cause the baby to be delivered prematurely. Limited
research suggests that women with perinatal depression improve when treated with therapy and/or medication prior to
delivery.
Many women may be concerned that treatment of depression with medication may be harmful to the fetus if
taken during pregnancy, or that the baby may have symptoms from medication exposure after delivery.
The most recent reviews of medical treatment of depression have shown that the risks to the mother and baby from not
receiving adequate antidepressant treatment outweigh the risks of harmful effects on the infant from medication.
Depression that is not treated can lead to risks to the mother and baby.
Untreated depression in pregnant women can lead to poor nutrition, missed prenatal appointments, drinking and smoking.
These behaviors can cause premature birth, low birth weight and other problems. A woman who develops depression while
she is pregnant is three times as likely to be depressed after giving birth.
Mothers with depression may find it hard to deal with daily life and stress. Women who are depressed often do not feel
like taking care of themselves or their babies. Their babies may develop learning or behavior problems. Women with
depression are also at risk for suicide.
Medications used to treat depression work very well. It is natural for mothers to be concerned about the effects of
medication on the fetus and breast milk. It is important to consider the risks. It is also important to consider the
risks to the mother, the fetus and the baby if the mother does not receive treatment for depression.
Going off antidepressant medication may make depression return. If you are taking an antidepressant medication, talk
to your health care provider if you are planning a pregnancy and as soon as you learn that you are pregnant. Only you
and your doctor can decide what medicine, if any, is best for you.
Counseling also helps. For some women, it may be all that is needed. For others, it can be used along with the medication
the doctor prescribes. Family, friends, helplines and support groups can also help.
References (To view, roll mouse over the "References" heading; to hide, click on the heading)
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Beck, C. T. (1992). The lived experience of postpartum depression: A phenomenological study. Nurs Res, 41, 166-170.
Cooper, P. J., & Murray, L. (1998). Postnatal depression (Fortnightly Review). BMJ, 316, 1884-1886.
Eisenberg, D. M., Davis, R. B., Ettner, S. L., Appel, S., Wilkey, S., Van Rompay, M., Kessler, R. C. (1998). Trends in alternative medicine use in the United States, 1990-1997: Results of a follow-up national survey. JAMA, 280, 1569-1575.
Fredricks, R. (2008). Healing & wholeness: Complementary and alternative therapies for mental health. Bloomington, IN: Author House.
Hale, T. W. (2002). Medications and mothers' milk: A manual of lactational pharmacology. Amarillo, TX: Pharmasoft Publishing.
Hay, D. F., Pawlby, S., Sharp, D., Asten, P., Mills, A., & Kumar, R. (2001). Intellectual problems shown by 11-year-old children whose mothers had postnatal depression. J Child Psychol Psychiatry, 42(7), 871-889.
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Kennedy, H. P., Beck, C. T., & Driscoll, J. W. (2002). A light in the fog: Caring for women with postpartum depression. J Midwifery Womens Health, 47, 318-327.
Kleiman, K., & Raskin, V. (1994). This isn't what I expected: Overcoming postpartum sepression. New York: Bantam Books.
Sabastian, L. (1998). Overcoming postpartum depression and anxiety. Omaha, NE: Addicus Books.
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