By Anna Glezer, MD
Many of my patients are surprised to hear how common it is to experience depression in pregnancy. Perhaps this is because pregnancy in today's society is often viewed as a magical time for a woman, full of glowing happiness. However, for many women, this is not the case.
Depression during pregnancy—called antenatal, prenatal or perinatal depression—happens to 10 percent to 15 percent of women. Depression after delivery, called postpartum depression, happens to 15 percent to 20 percent of women. There has been more public awareness recently about this postpartum condition, though depression during pregnancy is often overlooked and underdiagnosed.
A recent recommendation from the U.S. Preventive Services Task Force may improve awareness and diagnosis. This recommendation says that primary care providers should screen all adults, including pregnant and postpartum women, for depression and should have systems in place for diagnosis, treatment and follow-up.
Why are pregnant and postpartum women vulnerable to depression?
The short answer is: hormones. There are significant hormone fluctuations during pregnancy, with large increases in estrogen and progesterone, and then a rapid drop-off immediately after giving birth.
Pregnancy is also a time of increased stress due to changing life circumstances. It might be your first time as a parent. It might be navigating a new relationship with your partner when it used to be just two of you. It might be trying to be productive on much less sleep. It might be this is an unplanned pregnancy or there is a lack of a good support system. Maybe you had depression in the past or it runs in your family. Your risk is also increased if the pregnancy was medically difficult or the delivery was complicated.
One strong predictor of relapse of depressive symptoms during pregnancy is discontinuation of medication. Many women have told me that upon learning they are pregnant they quickly stop taking their antidepressant medication—sometimes on their own, other times on the advice of their psychiatrist or obstetrician. Abruptly stopping medication can lead to a relapse of symptoms in pregnancy in over two-thirds of women, a rate much higher than if a woman continues in treatment.
Why is it important to recognize depression during and after pregnancy?
The consequences of untreated depression in pregnancy and postpartum can be far-reaching, affecting labor, delivery, infancy, and beyond. There are more medical complications (like preeclampsia or severe nausea) and higher rates of smaller babies and preterm deliveries. And for the mom and baby, depression postpartum affects the ability to bond and develop a positive attachment, which is essential for the child's well-being.
How do we to screen for and diagnose depression during and after pregnancy?
The reason depression is more challenging to recognize and diagnose during this time is that the symptoms we normally use to make this diagnosis—sleep appetite, energy, concentration—are almost always altered during pregnancy and postpartum. This is one reason almost two-thirds of women experiencing an episode of depression in pregnancy are missed or misdiagnosed.
One screening tool I use daily in my clinic is the Edinburgh Postnatal Depression Scale. It is a 10-item questionnaire that was developed for postpartum women, but the questions apply to pregnant women as well. One of the best features of this screen is the focus on anxiety symptoms. Many women are surprised to hear that anxiety is often a primary symptom of depression during and after pregnancy.
The good news is that depression and anxiety during pregnancy and postpartum is very treatable! Treatment options include psychotherapy, medications and many others that are effective and safe. To begin the process of healing, please reach out to your primary care doctor, your obstetrician, a counselor or any trusted provider if you or a loved one is struggling with symptoms.
About Dr. Glezer:
Dr. Anna Glezer is a Harvard-trained clinician with current appointments in the reproductive psychiatry and OB/GYN departments at University of California, San Francisco Medical Center. She is the founder of Mind Body Pregnancy, a new educational site providing mental health articles, resources and advice that help women have a healthier pregnancy, delivery and postpartum.