What Are Some Causes Of Depression During Pregnancy
Some women who experience antepartum depression have a history of major depression prior to pregnancy. However, many women have their first experience of depression while they’re pregnant. Antepartum depression is thought to be caused by a combination of hormonal changes and psychological disturbances associated with pregnancy. Physical changes, such as changes in body and changes in sleep and eating habits, while normal aspects of pregnancy, can also contribute to the development of antepartum depression. Risk factors for antepartum depression include:
- Personal or family history of depression
- Stressful life events, like the death or illness of a loved one
- Lack of a partner or social support during pregnancy
- Relationship problems, including domestic violence
- History of abuse or trauma
- Financial stress, including poverty
- Unplanned pregnancy
Frequently Asked Questions Expand All
- What is depression?
Depression is a common illness that can be mild or very serious. It is more than feeling sad or upset for a short time or feeling grief after a loss. Depression changes your thoughts, feelings, behavior, and physical health. It affects how you function in your daily life. It also can affect how you relate to your family, friends, and coworkers. Depression can occur at different times of life or in different situations.
- How common is depression during pregnancy?
Depression is common during pregnancy, affecting about 1 in 10 pregnant women. Some women have depression and anxiety for the first time in their lives during pregnancy or after delivery.
- What are the signs of depression during pregnancy?
The signs of depression can seem like the normal ups and downs of pregnancy. A blue mood now and then is normal. But its important to know the signs of depression. Talk with your obstetriciangynecologist if you have any of these signs for at least 2 weeks:
Depressed mood most of the day, nearly every day
Loss of interest in work or other activities
Feeling guilty, hopeless, or worthless
Sleeping more than normal or having trouble sleeping
Loss of appetite, losing weight, or eating much more than normal and gaining weight
Feeling very tired or without energy
Having trouble paying attention, concentrating, or making decisions
Being restless or slowed down in a way that others notice
Thinking about death or suicide
What Advice Should Be Given About Family Planning
Family planning should be discussed with all women who have an affective disorder and could become pregnant, regardless of reproductive plans. Women should be referred to specialist psychiatric services, if possible, for advice before they plan a pregnancy.w31 Women who are not at high risk of relapse should try to reduce their medication gradually before they embark on a pregnancy.w32 Explain the evidence and evaluate the risk on an individual basis so that women can make an informed choice about whether or not to take medication.
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Take Care Of Yourself
Preparing for a new baby is a lot of hard work, but your health should come first. So resist the urge to get everything done: Cut down on your chores, and do things that will help you to relax. Taking care of yourself is a key part of taking care of your unborn child.
Open up to your partner, your family, or your friends about what concerns you. If you ask for support, you’ll find that you often get it.
Your OB-GYN or regular doctor may screen you for depression at a routine office visit. They can ask you a series of questions to check your risk for depression and can offer treatment if necessary.
What Are The Signs Of Depression
Depression can come on slowly. The symptoms are different for everyone. They can be mild, moderate or severe. Some of the more common signs are:
- changes in appetite, like eating too much or having little interest in food,
- changes in sleep, such as trouble sleeping or sleeping too much,
- lack of energy,
- feeling sad, hopeless or worthless,
- crying for no reason, and
- loss of interest or pleasure in activities you normally enjoy.
New moms with depression may have trouble caring for their baby. They might not want to spend time with their baby, which can lead to a baby who cries a lot.
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Are Antidepressant Medications Safe During Pregnancy
Growing evidence suggests that many of the currently available antidepressant medicines are relatively safe for treating depression during pregnancy, at least in terms of short-term effects on the baby. Long-term effects have not been fully studied. You should discuss the possible risks and benefits with your doctor.
What Causes Perinatal Depression
Perinatal depression is a real medical illness and can affect any motherregardless of age, race, income, culture, or education. Women are not to blame or at fault for having perinatal depression: it is not brought on by anything a mother has or has not done. Perinatal depression does not have a single cause. Research suggests that perinatal depression is caused by a combination of genetic and environmental factors. Life stress , the physical and emotional demands of childbearing and caring for a new baby, and changes in hormones that occur during and after pregnancy can contribute to the development of perinatal depression. In addition, women are at greater risk for developing perinatal depression if they have a personal or family history of depression or bipolar disorder or if they have experienced perinatal depression with a previous pregnancy.
Postpartum Psychosis Postpartum psychosis is a severe mental illness that occurs after childbirth. PP is a medical emergency, and it is important to seek help immediately by calling 911 or going to the nearest emergency room. Women who have PP can have delusions , hallucinations , mania , paranoia, and confusion. Women who have PP also may be at risk for harming themselves or their child and should receive help as soon as possible. Recovery is possible with professional help.
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How Does Depression Affect The Outcome Of Pregnancy
Studies examining obstetric complications in women who are depressed during pregnancy are difficult to interpret because the possible consequences of untreated depression are difficult to separate from the possible consequences of taking psychotropic medication. Some findings suggest that depressed pregnant women have an increased risk of complicated deliveriesw15 or miscarriage,w16 but the latter tends to be associated with exposure to antidepressants during pregnancy.w17 There is more convincing, but inconsistent,w18 evidence of an association between antenatal stress and preterm delivery or low birth weight, or both,67w19 w20 w21 as in the case report presented here where the baby was born after 35 weeks’ gestation. Most of these studies used various measures of psychosocial stress, but the associations with poorer birth outcomes were more evident when measures of depression were used.7w21 The effects of depression on birth outcome are more evident in poorer countries2w3 and among relatively deprived social groups in the economically developed world.w6 w10 w19 One of the most replicated findings is the poorer birth outcomes for African-American women compared with non-Hispanic white women.w6 w7 A study from Pakistan has shown that the negative effects of maternal antenatal depression on infant growth continue for at least a year after birth.2
Weighing Benefits And Risks
“Have a discussion with your doctor about the risk and benefits about being on an antidepressant if you are pregnant,” says Epperson. “If you can be off a medication, of course you should be, but if you can’t — and a lot of women can’t — then antidepressants can help.”
With both psychotherapy and antidepressants, a pregnant woman can overcome depression and enjoy the birth of their child, and be assured that the risk that antidepressants pose to their child is small.
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Should Antidepressants Be Continued Postpartum
If a woman has chosen to utilize an antidepressant medication throughout pregnancy, it is typically recommended that she continue it postpartum. The postpartum period is a time of increased risk of affective illness therefore, continuation of an antidepressant medication may be beneficial in maintenance of euthymia.
Many providers are concerned about the risk of postpartum psychosis and recommend continuation of antidepressants to prevent its onset. Postpartum psychosis is a rare, severe psychiatric illness occurring at a rate of 12 per thousand births onset is typically within the first 12 weeks postdelivery. Postpartum psychosis has a strong bidirectional link with bipolar disorder major depressive disorder is not thought to increase the risk of postpartum psychosis. Patients may experience psychotic symptoms in the context of a major depressive episode however, this is vastly different than the rapid onset of psychotic symptoms that are seen in an episode of postpartum psychosis.
Talking To Your Health Care Provider About Your Mental Health
Communicating well with your doctor health care provider can improve your care and help you both make good choices about your health. Read our Tips for Talking With Your Health Care Provider to help prepare for and get the most out of your visit. For additional resources, including questions to ask your doctor, visit the Agency for Healthcare Research and Quality.
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Can Depression During Pregnancy Affect Your Baby
Some women dont seek treatment for their pregnancy depression out of embarrassment, shame or guilt, or simply because they think their depression symptoms are just normal pregnancy symptoms that will go away on their own.
But studies show that untreated or undertreated depression can lead to preterm delivery, low birth weight, possibly gestational diabetes and, in severe cases, developmental delays in baby.
Over time, these problems can snowball as your baby gets older. Babies and children of mothers who experienced depression during pregnancy are at greater risk for learning delays and emotional issues, including aggression.
Theres also the fact that depression may not end when your pregnancy does. Being depressed when youre pregnant also puts you at a higher risk of postpartum depression. In fact, research estimates that around a quarter of women with PPD first became depressed while they were pregnant.
So if you think theres any chance youre suffering from pregnancy depression, ask for help for yourself, but also because your baby needs a mother who’s healthy both physically and mentally.
How Depression Affects Fathers
According to a 2010 studyexternal icon using data from 1993 to 2007, approximately 4% of fathers experience depression in the first year after their childs birth. By a childs 12th birthday, about 1 out of 5 fathers will have experienced one or more episodes of depression. Younger fathers, those with a history of depression, and those experiencing difficulties affording items such as a home or car were most likely to experience depression.
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What Should I Do If I Have Symptoms Of Depression During Or After Pregnancy
- Your baby blues don’t go away after 2 weeks
- Symptoms of depression get more and more intense
- Symptoms of depression begin any time after delivery, even many months later
- It is hard for you to perform tasks at work or at home
- You cannot care for yourself or your baby
- You have thoughts of harming yourself or your baby
Your doctor can ask you questions to test for depression. Your doctor can also refer you to a mental health professional who specializes in treating depression.
Some women don’t tell anyone about their symptoms. They feel embarrassed, ashamed, or guilty about feeling depressed when they are supposed to be happy. They worry they will be viewed as unfit parents.
Any woman may become depressed during pregnancy or after having a baby. It doesn’t mean you are a bad or “not together” mom. You and your baby don’t have to suffer. There is help.
Here are some other helpful tips:
What Can Happen If Depression Is Not Treated
Untreated depression can hurt you and your baby. Some women with depression have a hard time caring for themselves during pregnancy. They may:
- Eat poorly
- Use harmful substances, like tobacco, alcohol, or illegal drugs
Depression during pregnancy can raise the risk of:
- Problems during pregnancy or delivery
- Having a low-birth-weight baby
Untreated postpartum depression can affect your ability to parent. You may:
- Lack energy
- Feel moody
- Not be able to meet your child’s needs
As a result, you may feel guilty and lose confidence in yourself as a mother. These feelings can make your depression worse.
Researchers believe postpartum depression in a mother can affect her baby. It can cause the baby to have:
- Delays in language development
- Behavior problems
- Increased crying
It helps if your partner or another caregiver can help meet the baby’s needs while you are depressed.
All children deserve the chance to have a healthy mom. And all moms deserve the chance to enjoy their life and their children. If you are feeling depressed during pregnancy or after having a baby, don’t suffer alone. Please tell a loved one and call your doctor right away.
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Can You Take Antidepressants During Pregnancy
Many pregnant women are wary of taking medications during pregnancy.
Theres the concern, that the doctor will automatically place them on an antidepressant, Clark said. But thats not always the case. Sometimes just following up and counseling will help.
If a doctor does determine a patient needs to be on medication, or refers a patient to a psychologist who makes that call, there are many options.
While some antidepressants and anti-anxiety medications may be associated with minor risks of birth defects or other developmental issues, many others are safe for pregnant women to take. And in most cases, if a woman needs to be on a medication, the risks of taking that medication are far less than the risks of the mom-to-be going untreated.
Theres definitely still stigma behind pregnant women who need to take medications for any kind of mental health disorder, Clark said. But the fact remains that we need to have a healthy mom to have a healthy baby, and if that means she needs to take medication, that is perfectly fine.
What Factors Increase My Risk Of Being Depressed During Pregnancy
There are many different factors that can add to your risk of developing depression during your pregnancy. These risks can include:
- Having a history of depression or premenstrual dysphoric disorder .
- Your age at time of your pregnancy the younger you are, the higher the risk.
- Living alone.
- Feeling ambivalent about your pregnancy.
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How Can Family And Friends Help
It is important to understand that depression is a medical condition that impacts the mother, the child, and the family. Spouses, partners, family members, and friends may be the first to recognize symptoms of perinatal depression in a new mother. Treatment is central to recovery. Family members can encourage the mother to talk with a health care provider, offer emotional support, and assist with daily tasks such as caring for the baby or the home.
Support or advocacy groups can offer a good source of support and information. One example of this type of group is Postpartum Support International others can be found through online searches.
How Does Pregnancy Affect Depression
There are many reasons for the increased prevalence of depression during pregnancy. Most women welcome pregnancy but it is also a major physiological and psychological life event. Women who are coping with other more chronic life stressors may find the additional stress of pregnancy unmanageable. Pregnancy also carries specific demands that individual women may have difficulties with, such as impending motherhood if she has had poor parenting herself or if she has been sexually abused as a child.w9
The biological changes during pregnancy also have a direct effect on mood state. Concentrations of female specific sex steroids are raised during gestation and modify parts of the brain involved in mood regulation.w11 There are also gradual increases in hormone concentrations within the cortisol stress systemthe hypothalamic-pituitary-adrenal axis4overactivity of which has been found in people with depression.w12
Although women are at a low risk of suicide during pregnancy,w14 it is the most common cause of maternal death in the year after the birth.5
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What Are The Risks Of Using Non
Bupropion has been relatively well-studied in pregnancy, in part, thanks to the manufacturers pregnancy registry. An increased risk of major malformations has not been identified however, a recent study demonstrated a slightly increased risk of cardiac defects when bupropion was used during pregnancy. An increased risk of spontaneous abortion has also been identified, as has decreased birth weight in association with use of higher dosages.
A study of mirtazapine use in pregnancy demonstrated no increased risk of major malformations, although a higher rate of preterm birth was noted. The same study demonstrated a nonstatistically significant and increased risk of spontaneous abortion .
Who Is At Risk
Across cultures poverty, lack of education, and sex inequality predispose women to depression in pregnancy.2w3 w6 w7 This is reflected in the high rates seen in low income countries, varying from 19-25% in Pakistan,2 Goa,w8 and Rio de Janeiro.w3 Exposure to domestic violence also increases the risk of developing antenatal depression.2w3 w9 Similar effects of social adversity have been found among women living in relative poverty in Europe and America.w6 w7 Women with poor social support, with an unplanned pregnancy, and who are single or adolescent are also more vulnerable to depression during pregnancy.w10
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