Pregnancy and depression are heavy issues on their own, but when they occur together it can be even more challenging for women who are pregnant.
Pregnancy causes all sorts of hormone imbalances, so it’s common to chalk up feelings of sadness and fear to these changes. However, for 10-20% of women, they will be diagnosed with depression during this time, which is something that must be taken very seriously. The good news is women who are properly diagnosed and treated go on to have very normal pregnancies.
What’s the Difference Between Prenatal & Postpartum Depression?
So what distinguishes “regular” depression from prenatal depression, which is also known as antepartum depression (i.e., during pregnancy)? Depression involves changes in brain chemistry and so does pregnancy to some extent. The hormones produced during pregnancy can throw off the balance of chemicals in the brain, which can impact mood. This imbalance can be further exacerbated by difficult life situations like a death or starting a new job, or a preexisting mood disorder.
BLOG: You’re Pregnant! Now What?
What about postpartum depression? There is not much difference here, with the exception of it occurring after pregnancy as opposed to during pregnancy like prenatal depression. Experts say most women will experience what’s called the “baby blues” a week or two after birth. But these blues are supposed to melt away within days. However, it might be postpartum depression if these “blues” last for more than two weeks.
Further, as noted in a Psychology Today blog post: This juxtaposition of one of life’s greatest gifts and one of life’s most unkind illnesses is what makes postpartum depression different from “regular” depression.
Postpartum depression occurs in about 10% of new mothers, with some estimates as high as 20%. But they’re not the only ones! Apparently, dads can experience this too. In fact, it is more common than you might think — affecting up to 25% of new fathers. And this percentage can skyrocket to 50% when the mother is also struggling prenatal or postpartum depression, according to the American Academy of Pediatrics (AAP).
The AAP recommends that all mothers be routinely screened for depression during pregnancy, as well as at 1, 2, 4, and 6 months after childbirth using screening tools, such as the Edinburgh Postnatal Depression Scale (EPDS).
As for what effects depression might have on the baby, if not treated it could prompt dangerous behaviors from mom like drinking, smoking, not eating right, and suicidal behavior. These can cause issues like low birth weight, premature birth, and developmental problems.\
What Are the Warning Signs?
Maternal depression is one of the most common – and costly – obstetric complications in the U.S. when left undiagnosed and untreated, says a December 2018 report released by the AAP.
In its updated policy statement, “Incorporating Recognition and Management of Perinatal Depression Into Pediatric Practice,” the AAP renews its call for physicians to screen women for depression during and after pregnancy and details the health implications for children.
The policy statement and an accompanying technical report, which was published in the January 2019 issue of Pediatrics, updates guidance offered in a 2010 clinical report by AAP.
“When we are able to help a mother deal with her mental health, we are essentially reaching the whole family,” said Marian Earls, MD, FAAP, a lead author of the report, which was developed by the AAP Committee on Psychosocial Aspects of Child and Family Health. “We hope to create a protective buffer for the baby while strengthening family relationships and wellbeing.”
An estimated 50% of women who are depressed during and after pregnancy are undiagnosed and untreated, according to research cited in the report. When left untreated, perinatal depression can hinder bonding and healthy attachment, distort the perception of the infant’s behavior, and impair the mother’s attention to and judgment concerning safety.
In order to diagnose depression, doctors often look for pregnant women to have at least two of the following symptoms during a two-week period, according to the American Pregnancy Association.
- Persistent sadness
- Difficulty concentrating
- Sleeping too little or too much
- Loss of interest in activities that you usually enjoy
- Recurring thoughts of death, suicide, or hopelessness
- Feelings of guilt or worthlessness
- Change in eating habits
Steps You Can Take To Manage Depression
If you are pregnant or just gave birth, it is important to talk to your doctor if you are having any of the feelings described earlier in this blog post. Asking for help is the first step. Besides medications, there are support groups that embrace women who are going through these issues. Many often feel better participating in these groups and to know they are not alone.
In terms of using antidepressant medications, there is currently no consensus about their use during or even after pregnancy, especially as it relates to long-term effects. Because medications cross the placenta to the baby and end up in breastmilk, weighing the risks and benefits of taking antidepressants during pregnancy is very important, especially for those suffering from severe depression. Because of this, most doctors will address the use of these medications with their patients on a case by case basis.
BLOG: How Can Omega-3s Help Depression?
Some experts also recommend tactics like light therapy for depression in lieu of medications. According to the Mayo Clinic, light therapy is used to treat those who have seasonal affective disorder (SAD). But it can also be useful during pregnancy because it is easy to do, relatively affordable, and low risk. The main reason people like light therapy is because there are virtually no side effects. And even if there are, they tend to go away shortly after exposure. One thing to keep in mind is if you are taking medications such as certain antibiotics or herbs like St. John’s Wort, they could increase your sensitivity to light.
Perhaps the best part about light therapy is that you do not need a prescription. They are available at various internet retailers and drugstores. The trick to using one is to make sure you sit near the light box but don’t stare directly into it. You can do other things while it is running like working, watching TV or talking on the phone.
It is also important to be consistent with light therapy. In other words, try to use the light box at the same time(s) every day. Depending on the intensity of the light box you buy, sessions usually run about 20-30 minutes.
Some other ways you can manage depression during pregnancy is to make sure you are getting enough rest, exercise and the right nutrients. Some of the most prominent recommendations include getting enough vitamins and minerals, as well as other nutrients like omega-3 fatty acids, especially DHA.
BLOG: 5 Ways Pregnant Women Can Get More DHA in Their Diet
Start Taking Omega-3s Before You Even Become Pregnant
A study published in April thrust omega-3s into the spotlight as a potential preventative solution to postpartum depression.
According to the study authors, interest in the connection between omega-3s and postpartum depression has been building for more than a decade, triggered by research showing an association between both lower seafood consumption and lower docosahexaenoic acid (DHA) content in mothers’ milk and higher rates of postpartum depression.
The combination of low omega-3 intake as well as the depletion of maternal DHA stores and lack of recovery after birth could make the road to postpartum depression more likely for some women.
“Therefore, an omega-3 index (erythrocyte eicosapentaenoic acid (EPA) plus DHA expressed as weight percentage of total fatty acids) lower than 5% in late pregnancy was suggested as a biological risk factor for postpartum depression,” the study authors said.
VIDEO: The Target Level for the Prenatal DHA Test is 5%
For this study, researchers wanted to get a better look at maternal omega-3 blood levels to see if they have anything to do with developing postpartum depression, so they screened 72 Belgian women and assessed their blood levels of omega-3s. Postpartum depression was determined using the Bromley Postnatal Depression Scale by phone interview one year after delivery.
Women with an omega-3 index <5% had a 5-fold increased risk of depressive episode than did those with an omega-3 index ≥5%. A low omega-3 status, alone and combined with high omega-6 status, in early pregnancy was associated with a greater risk of postpartum depression. In summary, these researchers believe correcting maternal omega-3 deficiency could be a simple, safe, and cost-effective strategy for the prevention of this major public health issue.
INFOGRAPHIC: 10 Reasons Every Pregnant Woman Should Know Her DHA Level