Antepartum and postpartum depression: Mental illness during and after pregnancy

Posted by Stephani Monhollon on May 24, 2022 7:00:00 AM
7 minute read

If you’ve been around women who have given birth, you’ve probably heard about postpartum depression (PPD), a mental illness that presents after childbirth. While women have suffered from various forms of childbirth-related mood disorders for centuries, it wasn’t until the late 1980s that awareness of PPD surfaced. The American Psychological Association estimates that one in seven women suffer from this condition, stating that half of them had not experienced an episode of depression previously. Half were also found to have had symptoms during pregnancy.

Pregnancy-related depression, called antepartum depression, hasn’t received the same recognition as PPD. Still, it’s very real for about 7% of women who struggle with symptoms of depression during pregnancy, according to Mayo Clinic. In addition, a study published by Obstetrics & Gynecology suggests that one in three women hospitalized because of obstetric complications (high-risk pregnancies) experience clinical levels of depression or anxiety symptoms. That’s more than double the prevalence of antenatal depression in women with routine, low-risk pregnancies.

Because antepartum and postpartum depression can affect anyone — even those least susceptible to mental illness — it’s important to understand the types, signs and symptoms of pregnancy- and childbirth-related depression and when, where and how to get help. Equally important is the long-term impact prenatal and postnatal depression has on developing babies, infants and children.

Antepartum depression

Antepartum depression, also known as maternal depression, prenatal depression or perinatal depression, occurs during pregnancy and can affect anyone whether they’ve experienced depressive episodes previously or not. Common symptoms include:

  • Depressed mood daily or most days.
  • Disinterested in work or other activities.
  • Feelings of guilt, despair or insignificance.
  • Sleeping issues (sleeping too much or not enough).
  • Loss of appetite and weight loss or overeating and weight gain.
  • Severe fatigue.
  • Problems concentrating or making decisions.
  • Restlessness
  • Thinking about death or suicide.

Risk factors

There is no rhyme or reason why some pregnant women develop antepartum depression, and others don’t. However, certain risk factors are believed to increase the chances of acquiring depression while pregnant, such as:

  • Lack of support from family, friends and spouse/partner.
  • Anxiety or depression before pregnancy.
  • Stressful life events.
  • Insomnia (poor quality of sleep).
  • Poor nutrition, specifically low levels of specific vitamins (e.g., B and D) and minerals (e.g., iron and zinc).

Impact on fetuses, babies and children

If left untreated, depression during pregnancy can have numerous effects on developing babies, infants and children, such as:

  • Miscarriage
  • Restricted fetal growth.
  • Premature labor.
  • Low birth weight.
  • Excessive crying in newborns.
  • Inability to comfort infants.
  • Cognitive and developmental delays.
  • Emotional and behavioral problems.

Additionally, untreated antepartum depression increases the risk of postpartum depression. More than 70% of expectant moms who are depressed during pregnancy will experience postpartum depression, compared to less than 40% of women who develop PPD but were not showing depressive symptoms during pregnancy.

Postpartum depression

 The most common form of postpartum depression, affecting up to 80% of new moms, is the “baby blues.” It is often the culprit of various symptoms, such as fear, anxiety, loneliness, mood swings, insomnia, crying, sadness and irritability and typically subsides within a couple of weeks after delivery.

When these symptoms become more severe and ongoing, a new mother may be suffering from a more severe type of depression, simply referred to as postpartum depression.

PPD may pose many risks for the mom and her baby due to the severity of symptoms that may last several months or longer if left untreated. Common symptoms include:

  • Excessive crying.
  • Problems bonding with the baby.
  • Withdrawing from friends and family.
  • Difficulties sleeping or sleeping too much.
  • Extreme irritability and anger.
  • Severe mood swings.
  • Acute fatigue.
  • Intense anxiety and panic attacks.
  • Thoughts of causing harm to herself or her baby.
  • Recurrent thoughts of death or suicide.

Symptoms, such as difficulties sleeping, appetite changes, fatigue, exhaustion and frequent mood changes, are often present after childbirth. Therefore, it can be difficult to detect PPD. Mothers experiencing these symptoms and those listed above should contact their physician immediately.

The most severe and detrimental type of PPD, affecting one to two in 1,000 women, is postpartum psychosis, typically occurring during the first three months after childbirth. It is a severe mental illness with symptoms such as:

  • Losing touch with reality.
  • Becoming delusional.
  • Experiencing auditory and/or visual hallucinations.
  • Suffering from insomnia.
  • Feeling overly angry or agitated.
  • Violent thoughts or behaviors.
  • Exhibiting unusual behaviors.
  • Thoughts of self-harm or causing harm to the baby or others.

Women experiencing postpartum psychosis are at greater risk of harming themselves or their babies and are often hospitalized and treated with medications called antipsychotics. Mothers exhibiting any of these behaviors should seek immediate evaluation and medical treatment.

Fathers and PPD

PPD isn’t exclusive to mothers. Studies have found that one in 10 new dads experience postpartum depression and anxiety. Many of their symptoms are the same as those in women, including anger, irritability, withdrawal from relationships, fatigue and thoughts of suicide.

Expectant fathers are at the highest risk of becoming depressed during the first trimester of pregnancy and when their baby is between 3 months and 6 months old.

As with moms, fathers should seek evaluation and treatment as soon as possible.

PPD causes

While there is no single cause of PPD, several factors for women and/or men may contribute, such as:

  • Significant declines in estrogen, progesterone and other hormones produced by the thyroid for women and extreme drops in testosterone for men.
  • Family or personal history of depression.
  • Stress and anxiety of caring for a new baby.
  • Sleep deprivation.
  • Low self-esteem resulting from body changes during and after pregnancy.
  • Marital/couples troubles.
  • Single parenting/living alone.
  • Having a baby with health problems.
  • Being a teenage parent.
  • Lack of support from family and friends.
  • Delivering multiples (twins, triplets, etc.).

Additionally, PPD doesn’t only happen after the first child is born. It can present after subsequent births.

Treating antepartum and postpartum depression

Properly treating antepartum and postpartum depression is dependent on the types and severity of the symptoms. Promptly scheduling an appointment with the obstetrician at the onset of symptoms during pregnancy is essential. For new moms and dads, PPD screenings are available to help diagnose and determine the best treatment options.

For years, obstetricians have carried the responsibility of screening mothers for postpartum depression. Three years ago, the American Academy of Pediatrics recommended that PPD screenings for both mothers and fathers occur during well-child visits. The Academy also urged pediatricians to partake in referring parents with PPD to appropriate health care professionals for treatment.

However, parents with persisting moderate to severe depressive symptoms should immediately schedule an appointment with their health care provider rather than wait for their baby’s well-child visit.

There are several treatment options for pregnancy- and childbirth-related depression, such as: 

  • Medications for anxiety and depression that balance chemicals in the brain and help improve emotions and mood.
  • Psychotherapy (also known as talk therapy).
  • Self-care (quality sleep, healthy eating, exercise).
  • Couples therapy.
  • Alternative therapies (massage, acupuncture, exercise).
  • Intravenous drug therapy administered in a hospital.
  • Hospitalization and antipsychotics for postpartum psychosis. 

The role of family, friends and medical professionals

While an expectant mother or a new mom or dad may recognize that something is wrong, they may not realize their symptoms result from depression. They may feel like they can overcome them on their own or even feel embarrassed and not want to admit they need help. They may also be too tired or overwhelmed to address the problems they’re experiencing. Therefore, family, friends and health care professionals must watch for signs of depression and help the struggling mother-to-be or new parents seek immediate medical attention.

 


If you or anyone you know is struggling with depression or having suicidal thoughts, please call the National Suicide Prevention Lifeline immediately at 800-273-8255. They are available 24/7 and provide free, confidential support to anyone in distress. Effective July 16, 2022, you can connect to the Lifeline by dialing 988 from anywhere in the United States.

 

Topics: Education, Maternal-Fetal Medicine, Neonatology, Prenatal