Checkup on health: Watch out for pregnancy-related depression

Mother and newborn infant © iStockphoto
Mother and newborn infant

by Richard Graves, M.D.

Pregnancy-related psychiatric disorders have been recognized since at least the time of Hippocrates, who described the phenomenon. It’s well known that women are prone to mood disturbances during rapid shifts in reproductive hormones, such as occurs just before every period and at menopause. During pregnancy, estrogen and progesterone levels rise ten-fold, then plunge back to pre-pregnancy levels within three days of delivery.

Other factors during pregnancy and the first months after a baby are born also make a woman prone to depression. Chronic sleep disruption, not feeling well physically, and the inevitable tensions that arise when a couple takes on the new role of parenthood add to the stress of this time. In addition, our culture increases a sense of isolation. So many peers of new mothers are busy in the workplace, and extended families are far away. It’s no wonder that the “baby blues,” as well as other mood disorders, are so common.

Four mood disorders are recognized to be pregnancy-related:

Prepartum depression, which occurs in the months before childbirth. This condition is less often recognized because many of the symptoms are identical to the physical effects of pregnancy. Lethargy, change in appetite (too much or too little), loss of energy, and sleep disturbances (again, either too much or too little), are both classic symptoms of depression and common problems of late pregnancy. Profound mood disturbances, however, are not normal, and depression at this time is a strong predictor of depression following childbirth.

“Baby blues,” which is characterized by mood swings, tearfulness and confusion in the early weeks after childbirth. The baby blues are so common that some studies estimate that it occurs in some 80 percent of new mothers. It usually subsides without any treatment after about two weeks.

Postpartum depression, which afflicts about one out of 10 women, is more intense and continuous than the baby blues. Without treatment, symptoms can continue for many months. 

Postpartum psychosis, which is a rare phenomenon, occurs in about one or two women out of 1,000. It is associated with hallucinations and delusional beliefs about the baby and usually comes on suddenly and severely. The mother may be lethargic or have excessive, frantic energy. Such a condition must be regarded as an emergency and treated at once to protect the mother and baby. She may need to be hospitalized until stable.

Women with mood disorders are at risk for losing interest in their baby and becoming socially withdrawn. They may neglect their health and turn to drugs or alcohol. The baby and older children will probably be affected, and at worst, suffer from abuse or neglect.

Unfortunately, pregnant women are often reluctant to seek professional help or reveal their feelings to their family, friends or even husbands. They know it is a time that they are supposed to feel joyous, and many feel ashamed or guilty to feel the opposite.

The treatment of depression during pregnancy and childbirth is highly individualized. Some women can be helped with increased social support and counseling. Others may need medications. Many drugs are considered safe during pregnancy and while breastfeeding. For severe depression, electro-convulsive therapy is a valid option that enables many women to rapidly return to a normal life without the use of medications.

Dr. Graves is an obstetrician and gynecologist with the Women’s Center for Health at UC Davis Medical Center in Sacramento.

Since depression is so common, pregnant women should be aware of the symptoms and take actions to prevent it. They should develop a strong social network by making friends with other women who are pregnant or have babies. They should take care to get plenty of rest and nap whenever possible. Accept help and support from others, and if possible, arrange for help with housecleaning and taking care of other children.

Despite their best efforts, many women who suffer from depression usually feel that it comes on without any reason and beyond personal control. Many worry that admitting it will make others think they are a bad mother, or risk being separated from their baby. It is especially important for husbands and close friends and family of new mothers to watch out for signs of depression (again, it could manifest itself as prolonged tearfulness, confusion, apathy, or lethargy) and help a woman seek the care she needs.