Psychiatric Associates

Depression During and After Pregnancy

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         Many women experience changes in mood while pregnant or after they’ve given birth. They can be happy one minute and sad the next; may have difficulty sleeping and eating, even while their babies are asleep; and may feel depressed part or all of the time. These symptoms can begin anywhere from early pregnancy to a year after giving birth. Depending on when they start, how long they last, and how severe they get, these symptoms could result from Depression, the Baby Blues, Postpartum Depression, or Postpartum Psychosis.

What is Major Depressive Disorder (commonly referred to as Depression)?

       Major Depressive Disorder (commonly referred to as Depression) is more than just feeling sad, blue, or down in the dumps for a few days. It can last weeks, months, or years and, without treatment, can seriously interfere with your ability to function properly. Someone who’s depressed experiences one or both of the following symptoms most of the day, nearly every day:
  • depressed mood (feeling sad, blue, down in the dumps, empty, helpless, or hopeless);
  • anhedonia, (an inability to experience pleasure, enjoyment, or happiness).
       He or she also experiences at least three of the following symptoms nearly every day:
  • decreased or increased appetite or significant weight loss or gain;
  • difficulty falling asleep or staying asleep, or waking up too early;
  • sleeping much longer at night, napping during the day, or fighting off falling asleep during the day;
  • mental and physical excitation, racing thoughts, flight of ideas, or restlessness;
  • thinking and moving as if you’re in slow motion;
  • fatigue or loss of energy;
  • feelings of worthlessness or guilt;
  • difficulty thinking, concentrating, or deciding;
  • and/or recurrent thoughts of death or suicide, a suicide plan, or a suicide attempt.
What are the Baby Blues?

       The Baby Blues are a short-lasting condition experienced by 50% to 80% of women who’ve given birth. It begins within a few days of giving birth and goes away within a couple of weeks. Women with the Baby Blues might experience any or all of the symptoms of Depression, but also might:
  • feel angry with their babies, partners, or other children;
  • and/or question whether or not they can adequately care for themselves or their babies, partners, or other children.
       The Baby Blues aren’t severe, don’t significantly interfere with a new mother’s ablity to care for herself or her newborn, don’t last long, and therefore don’t really need treatment.

What is Major Depressive Disorder with Peripartum Onset (commonly referred to as Postpartum Depression)?

       MDD with Peripartum Onset (commonly referred to as Postpartum Depression) is a longer-lasting condition experienced by 10% to 15% of women who’ve given birth. It begins anywhere between two weeks and a year after giving birth and, without treatment, can last for years. Women with MDD with Peripartum Onset might experience any or all of the symptoms of Depression and the Baby Blues, but also might:
  • lose interest in caring for themselves or their babies, partners, or other children;
  • become excessively and/or inappropriately anxious or worried about their babies, partners, or other children;
  • and/or have thoughts of harming or killing themselves or their babies, partners, or other children or plan how to do so or try to do so.
What is Major Depressive Disorder with Peripartum Onset and Psychotic Features (commonly referred to as Postpartum Psychosis)?

       MDD with Peripartum Onset and Psychotic Features (commonly referred to as Postpartum Psychosis) is a rare but serious condition experienced by anywhere from 0.1% to 0.4% of women who’ve given birth. It begins within a few weeks of giving birth and, without treatment, can last for years and have very serious consequences. Women with
MDD with Peripartum Onset and Psychotic Features might experience any or all of the symptoms of MDD with Peripartum Onset, but also might:
  • refuse to eat;
  • sleep little or not at all;
  • exhibit frantic energy;
  • have rapid mood swings;
  • see, hear, feel, taste, or smell things that aren’t really there;        
  • hear voices telling them to harm or kill themselves or their babies, partners, or other children;
  • and/or believe that people, even family members, are out to get them or their babies, partners, or other children.
What can I do if I experience any of these?

       If you experience the Baby Blues or mild
MDD with Peripartum Onset, you can help yourself feel better by doing some or all of the following :
  • rest as much as you can, including sleeping whenever your baby is sleeping;
  • don’t try to do everything or to be perfect;
  • ask your partner, family, and friends for help or help if it’s offered;
  • make time for yourself to go out and visit friends family or to just enjoy being alone;
  • make time to be alone with your partner;
  • discuss your thoughts and feelings with your partner, family, or friends;
  • talk with other more experienced mothers;
  • join a support group for mothers;
  • and/or don’t make any major life changes while pregnant or too quickly after having given birth.
       If you experience moderate or severe MDD with Peripartum Onset you can also help yourself feel better by doing some or all of the above but, in addition, you should seek professional help immediately. Call your Obstetrician/Gynecologist (OB/GYN ), your Primary Care Provider (PCP), or a Psychologist. Your OB/GYN or PCP may either treat you by prescribing an appropriate medication or refer you to a Psychologist experienced in treating MDD with Peripartum Onset.
 
IF YOU FIND YOURSELF THINKING ABOUT
HARMING OR KILLING YOURSELF OR YOUR
BABY, PARTNER, OR OTHER CHILDREN CALL
911 OR GO TO AN EMERGENCY ROOM IMMEDIATELY.

What happens if I experience Major Depressive Disorder while I’m pregnant, or MDD with Peripartum Onset or
MDD with Peripartum Onset and Psychotic Features after I've given birth, and don’t seek treatment?

       During pregnancy a depressed woman may not care for herself properly. This may result in:
  • poor nutrition;
  • failure to gain enough weight or excessive weight gain;
  • trouble sleeping;
  • missed prenatal visits;
  • failure to follow medical recommendations;
  • and/or the use of alcohol, tobacco, or recreational drugs.
       Any of the above may result in problems during the pregnancy or delivery or afterward, such as:
  • gestational diabetes, hypertension, or preeclampsia;
  • fetal distress necessitating an emergency c-section;
  • premature birth:
  • low birth weight;
  • birth defects such as fetal alcohol syndrome;
  • and/or low IQ, delayed language acquisition, learning difficulties, behavior problems, or medical disorders.
       After delivery a depressed woman may not be able to parent her new baby properly. This may result in:
  • impaired mother/child bonding;
  • increased infant crying or fussiness;
  • feeding problems, including an inability to breast feed;
  • and/or failure-to-thrive syndrome.
How are Major Depressive Disorder and MDD with Peripartum Onset treated?

       The two prevalent treatments for Depression, including Postpartum Depression, are:
 
       Prescription medication: Your OB/GYN or PCP can prescribe an antidepressant medication or anti-anxiety medication or both, depending upon your symptoms and history. Such medications have the advantage of requiring little effort on your part except taking the medication as prescribed. However, they may not begin to relieve your symptoms for up to eight weeks after you begin taking them, may not work at all, and come with sometimes significant side-effects, such as decreased interest in sex, drowsiness, dry mouth, fatigue, headache, impaired memory, insomnia, nausea, sleepiness, and weight loss or gain.

       Psychotherapy: A Psychologist can’t prescribe medication, but can help you think and talk about being depressed and suggest things that you can do to change your thoughts and feelings so that your depression lifts. Psychotherapy can begin to relieve your symptoms immediately, has a high rate of success, and comes with few if any side-effects.
 
       These two treatments can be employed either individually or together. Research indicates that the combination of the two tends to work better and faster than either alone.

How do I find a Psychologist?

       You can find a Psychologist by talking to your OB/GYN or PCP about a referral; by getting recommendations from friends or family; by calling the Customer Service number on the back of your insurance card; or by using a Psychologist referral service. These include:
  • The American Psychological Association’s Psychologist Locator on the Internet at http://locator.apa.org/ or by phone at 1-800-964-2000.
 
© 2010
Thomas E. Hranilovich, Ed.D.
Licensed Psychologist

Psychiatric Associates / 4084 Okemos Rd. / Suite A / Okemos, MI 48864
Phone: (517) 347-4848 / Fax: (517) 347-4844