Depression Related to Pregnancy and Childbirth

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KEY POINTS

• You may have depression during pregnancy or within a few days to a few weeks after giving birth or having a miscarriage. You may feel sad, afraid, or angry.
• Postpartum depression can be successfully treated with therapy, medicines, or both.
• If you are depressed and feel that you could hurt yourself or your baby, call your healthcare provider or therapist right away.

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What is depression related to pregnancy and childbirth?

During pregnancy or after childbirth, you may feel more emotional. You may feel sad, afraid, or angry. This is often called baby blues. For most women these baby blues are mild and go away within a few weeks. Depression related to pregnancy and childbirth lasts longer, is more severe, and makes it hard to manage your daily tasks. It may be called postpartum depression or depression with peripartum onset.

In most cases depression related to pregnancy and childbirth goes away in the 9 to 12 months after birth. Treatment helps speed your recovery.

What is the cause?

You may have depression anytime during pregnancy or within a few days to a few weeks after giving birth or having a miscarriage. While hormone changes during pregnancy and after giving birth seem to play a part, the exact cause is not known. Risk factors that increase your chances for depression are:

• Having been depressed sometime before you got pregnant
• Having been depressed after a previous pregnancy
• Having family members who were depressed, especially after a pregnancy
• Having little support during your pregnancy and bringing your baby home to a very stressful place or relationship
• Having had many recent stresses such as pregnancy complications, conflict with your partner, job loss, or financial problems
• Having a baby with health problems or a baby who cries a lot
• Having a miscarriage late in pregnancy or a stillbirth

If your pregnancy was unplanned or unwanted you are also at risk for depression.

What are the symptoms?

Besides feeling sad and uninterested in activities, symptoms may include:

• Feeling unable or unwilling to care for your baby
• Thinking often about bad things that could happen to your baby or feeling like you want to hurt yourself or your baby
• Trouble bonding with your baby
• Being irritable
• Having trouble falling asleep, waking up very early, or sleeping more than usual
• Feeling overwhelmed by everyday activities such as taking a shower or doing laundry
• Having little appetite or eating too much
• Feeling very tired or low energy
• Losing interest in sex
• Feeling worthless and guilty
• Feeling fearful or panicked
• Not being able to concentrate or remember things
• Feeling hopeless or just not caring about anything
• Having unexplained pain or getting headaches
• Worrying that you’re a bad mother and you will never feel better

If you have any of these symptoms and they don’t go away within a couple weeks, it’s important to get treatment as soon as possible.

Some women also hear voices, see things that are not there, or cannot tell what is real from what is imagined. If you have these symptoms, it is a medical emergency. Get help right away.

How is it diagnosed?

Your healthcare provider or therapist will ask about your symptoms. He will make sure you do not have a medical illness or drug or alcohol problem that could cause the symptoms. You may be tested to rule out medical problems such as hormone imbalances.

How is it treated?

Depression related to pregnancy or childbirth can be successfully treated with therapy, medicines, or both.

Medicine

Several types of medicines can help. Your healthcare provider will work with you to select the best medicine. It is important to check with your healthcare provider before you take any new prescription or nonprescription medicines when you are pregnant or breast-feeding.

Therapy

Seeing a mental health therapist is helpful. Cognitive behavioral therapy (CBT) is a form of therapy that helps you identify and change thought processes and learn ways to better cope. Learning ways to replace negative thoughts with more positive ones can help your depression. Family or relationship therapy may be helpful.

Other treatments

Diets rich in fruits and vegetables are recommended. A multivitamin and mineral supplement may also be recommended. Learning ways to relax may help. Yoga and meditation may also be helpful. You may want to talk with your healthcare provider about using these methods along with medicines and therapy.

Claims have been made that certain herbal and dietary products help control depression symptoms. Omega-3 fatty acids may help to reduce symptoms of depression. No known herbal or natural remedies are effective in treating postpartum depression. Supplements are not tested or standardized and may vary in strengths and effects. They may have side effects and are not always safe. Talk with your healthcare provider before you use any of these products, especially when pregnant or breastfeeding.

How can I take care of myself?

To help prevent postpartum depression:

• Get support. Talk with family and friends. Consider joining a support group in your area. Ask for help with night time feedings so that you can sleep. You may also find it useful to get help with household chores. Take time for yourself. Hire a sitter, leave your baby with a close friend or your spouse, and do something you enjoy. Spend time with support groups and friends, and don't be afraid to share both your fears and your joys.
• Learn to manage stress. Don’t pressure yourself to do everything. Ask for help at home and work when the load is too great to handle. Find ways to relax. For example take up a hobby, listen to music, watch movies, or take walks. Try yoga, meditation, or deep breathing exercises when you feel stressed.
• Take care of your physical health. Since you will need to be up during the night with your baby during the first few months, it is important to take naps to keep your energy up. Eat a healthy diet. Limit caffeine. If you smoke, try to quit. Avoid alcohol and drugs, because they can make your symptoms worse. Exercise according to your provider’s instructions after giving birth.
• Check your medicines. Some medicines can add to the symptoms of depression. To help prevent problems, tell your healthcare provider and pharmacist about all the medicines, natural remedies, vitamins, and other supplements that you take.
• Contact your healthcare provider or therapist if you have any questions or your symptoms seem to be getting worse.

Get emergency care if you or a loved one have serious thoughts of suicide, harming your child, or harming others.

For more information, contact:

• National Institute of Mental Health
  866-615-6464
  http://www.nimh.nih.gov/
• Mental Health America
  800-969-6642
  http://www.mentalhealthamerica.net/