Postpartum, Peripartum Depression. Treatment
In the updated DSM-5, the diagnosis “peripartum depression” has taken the place of the previous diagnosis “postpartum depression.” The older diagnosis “postpartum depression” referred specifically to depression after childbirth. According to the new classification, peripartum (perinatal) depression occurs during pregnancy and up to one year after childbirth.
The symptoms of peripartum depression are essentially the same as those of depression in other life phases. Peripartum depression, especially those with more severe symptoms, is a serious but well treatable illness.
In this text, we will use both terms, postpartum and peripartum depression, interchangeable.
Symptoms of Postpartum Depression
The signs of peripartum depression vary from person to person. Common symptoms include:
Low mood
Even if pregnancy fulfils a long-held wish, mood can suddenly hit rock bottom. Mood swings and uncertainties also occur in a normal pregnancy but usually pass on their own. The persistence of negative feelings can indicate depression.
Loss of interest and joylessness
Hobbies and social contacts lose importance. Things that once brought joy feel irrelevant. Social withdrawal and lack of motivation are warning signs that should be taken seriously.
Self-doubt and guilt
Pregnant women with depression often experience self-doubt, fearing they won’t bond with their baby or be a good mother. External expectations can add pressure, as people often expect pregnant women to feel overwhelming joy. When this isn’t the case, affected women may feel inadequate and guilty.
Sleep disturbances
Anxiety and worries often lead to poor sleep. Once the body relaxes, thoughts start racing, and people dwell on their worries. Mornings are filled with tiredness from sleepless nights. Long-term lack of sleep affects both physical and mental health.
Physical signs
Depression affects not only the mind but can also manifest physically. Symptoms like nausea and stomach pain are often mistaken for pregnancy-related changes rather than depression. Shortness of breath and sexual problems, which occur in most pregnancies, may also signal depression.
Baby Blues or Depression?
Every expectant mother experiences mood swings, driven by pregnancy hormones. Hormones flood the body, leading to emotional ups and downs. One day, a pregnant woman feels overjoyed and confident; the next, she’s filled with anxiety and fears. But negative emotions usually fade, leaving a mostly positive mood. In depression, however, sadness and low mood persist.
Up to 85% of new mothers experience the “baby blues,” a brief, mild condition that doesn’t interfere with daily life and doesn’t need medical attention. Symptoms of the “baby blues” include unexplained crying, irritability, restlessness, and anxiety. These typically last a week or two and resolve without treatment.
Perinatal depression, however, is emotionally and physically debilitating, lasting for months or longer. An estimated 10-15% of women experience postpartum depression. Factors like socioeconomic status, residence, healthcare discrimination, and immigrant status contribute to this risk.
Postpartum Depression
If depressive symptoms appear within the child’s first twelve months, it’s called postpartum depression. Postpartum is the period between delivery and the body’s recovery from pregnancy and birth changes. The uterus contracts, birth injuries heal, and the mother’s hormones return to a “non-pregnant” state. This delicate phase involves major changes, and everyday life with a newborn is a new challenge.
When depression symptoms occur, either right after birth or weeks later, they might be overlooked. Physical symptoms like headaches, sleep issues, or appetite loss are often attributed to the stress of the new life situation. Therefore, close monitoring of the mothers after birth by their gynecologists is essential.
Treatment of postpartum depression
If the mother cannot overcome her emotional low with the help of loved ones, seeing a doctor is advised. The first consultation can be with a gynecologist, who will assess whether it’s a temporary mood dip or depression. They’ll ask about emotional well-being and any physical symptoms. Diagnostic questionnaires can help identify pregnancy depression. The gynecologist will also check for physical causes of the symptoms.
In case of depression, the pregnant woman is referred to a psychiatrist, who specializes in treating mental illnesses.
Depression is nothing to be ashamed of; it’s an illness with a good prognosis. There are effective treatments for postpartum depression.
Treatment of Postpartum Depression with Psychotherapy
For mild depression, psychotherapy is the most suitable treatment, conducted by an experienced therapist. This type of therapy focuses on open conversations. The therapist works with the affected individual to develop strategies for coping with the situation and helps alleviate self-doubt and fears. Results aren’t immediate, requiring patience.
Treatment of Postpartum Depression with Medication
If psychotherapy alone is ineffective, the patient should see a psychiatrist, who will prescribe appropriate medications for treating pregnancy depression. The choice of medication depends on the severity of symptoms and the stage of pregnancy. Antidepressants are typically used for depression, lifting mood and reducing anxiety. However, they can take up to 4 weeks to be fully effective. In some cases, anxiety-relieving medications like benzodiazepines may be temporarily prescribed. The psychiatrist must closely monitor the medication.
Alternative Treatments of Postpartum Depression
In addition to traditional treatments, alternative therapies like light therapy, acupuncture, and hypnosis are possible for alleviating symptoms. However, there is no scientific proof of their effectiveness in treating pregnancy depression. Consult your doctor to see if these treatments are suitable for you.
Mother’s self-doubts: Questions to ask
Have you been crying more lately?
Are you more easily irritated?
Do you struggle to bond with your baby?
Are you mostly sad and feeling little joy?
Do you doubt being a good mother?
Uncertainty is part of life, but if negative feelings persist beyond two weeks, seeking help is advisable. The first point of contact for emotional issues after birth is the gynecologist. They can recommend further therapy options. Postpartum depression is highly treatable. Like pregnancy depression, psychotherapy shows promising results.
Self-help for Postpartum Depression
In addition to medical and psychotherapeutic treatment, there are steps the patient can take to feel better:
- Openly talk with close ones (partner, family, midwife) about your fears and concerns. Sharing the burden with loved ones makes the crisis easier to manage.
- Accept offers of support from family and friends (like help with household tasks).
- No one is perfect: Struggling with depression during pregnancy doesn’t make you a bad mother.
- Stay physically active; exercise contributes to mental well-being.
- Accept your imperfections. Be patient with yourself—uncertainties from the new life situation are normal.
- Pregnancy depression is an illness beyond the mother’s control, but it’s treatable and will pass.
- Conversations with other affected pregnant women can help overcome the crisis. Your doctor can advise where to find a suitable support group.
- Be patient: Treating depression takes time.
Course of Postpartum Depression
Women who experienced depression during a previous pregnancy have a 60% risk of recurrence in subsequent pregnancies. In such cases, it’s wise to consult a doctor or therapist before symptoms appear. The symptoms of peripartum depression can start during the pregnancy and if untreated, it may persist beyond childbirth. Since postpartum depression is well treatable, the prognosis is favorable but it’s important to start treatment early.
Causes of Postpartum Depression
Why around twelve out of 100 women develop depression during pregnancy isn’t fully understood. Depression can occur in any life phase, even during times typically associated with happiness. It is among the most common mental health issues during pregnancy.
Changed life situation
Pregnancy brings a rollercoaster of emotions for most women. Along with the anticipation of the baby, worries and fears often arise: “Will I be a good mother? Can I provide a good future for my child?” Most expectant mothers view the future positively, but sometimes sadness and anxiety can take over, dominating everyday life. Possible causes include:
Problems with the partner
Women who have relationship issues before pregnancy are at higher risk for pregnancy depression. Uncertainty in the personal sphere can intensify negative thoughts about pregnancy.
Complications during the pregnancy
Women who’ve experienced miscarriages or complications in previous pregnancies are generally more prone to depression in subsequent pregnancies.
Pre-existing mental health conditions
Women who have had depression or other mental health conditions, independent of pregnancy, are more likely to develop pregnancy depression.
Social environment
Financial worries, limited family support, or stressful past experiences can increase the likelihood of pregnancy depression.
Effects of Postpartum Depression on the Child
Depression during pregnancy and after delivery (peripartum depression) affects not only the mother’s mental health but can also impact the baby. Children of women affected by depression during pregnancy or after delivery are more likely to develop mental health disorders in the future.
Untreated perinatal depression affects both the mother’s health and the baby’s well-being. Babies may be born prematurely or with a low birth weight. If the depression continues after birth, the mother may struggle to provide the emotional support the child needs. In long-term, children of mothers with perinatal depression face higher risks of cognitive, emotional, and developmental delays. They may also struggle with verbal deficits and social skills. Such children often develop behavioral issues during childhood and have an increased risk of depression or anxiety disorders as adults.
Postpartum depression (peripartum depression). Summary
Pregnancy and postpartum are for the mother and her partner vulnerable periods with emotional, financial, and social changes. Some mothers become depressed during or after pregnancy. The new term “peripartum depression” replaced the old and still used term “postpartum depression.”
During pregnancy and after the delivery most women experience various emotions, from overwhelming joy to sadness and fears. These mood swings are hormonally driven and usually not a cause for concern. They are a normal part of pregnancy and typically resolve on their own.
However, if negative emotions such as sadness, indifference, anxiety, fatigue, and sleep depravation dominate daily life and persist for longer than two weeks, it is considered peripartum depression.