A significant percentage of pregnant women and new mothers experience mild symptoms of depression and anxiety, often referred to as “baby blues,” according to the World Health Organization.
Others experience persistent sadness, anxiety, fatigue, trouble functioning and even difficulty bonding with their babies.
Dr. Kristina Deligiannidis, director of Women’s Behavioral Health for Northwell Health in New York, joined Here & Now to talk about the growing awareness and evolving understanding of pregnancy-related depression.
8 questions with Dr. Kristina Deligiannidis
Tell us what you’ve learned about women who experience depression during pregnancy.
“Yes, postpartum depression is increasingly known as peripartum or perinatal depression. And that’s really to acknowledge that half of the onsets of depression start during pregnancy. In the past, depression screening was only recommended after delivery, but not in pregnancy. That has changed, and now screening is recommended twice in pregnancy and once after delivery so that women are diagnosed sooner than later. And it’s such an important point, because many women used to think that all those mood changes and the symptoms you just noted and that impairment that they experience during pregnancy couldn’t be postpartum depression because they hadn’t delivered their baby. So now we must screen women during pregnancy so that we identify those who may need more support or treatment.”
What causes this type of depression? Are the symptoms the same in pregnant women and new mothers?
“Peripartum depression has multiple causes. The research suggests that it may be in part due to the hormonal changes, either when the hormones are high during pregnancy or after that rapid drop in the hormones after delivery. And those hormones might be changing or triggering changes in how the brain networks communicate. We know that stress can really impair brain networks and that those hormonal shifts make the brain even more susceptible to stress. And, you know, there are other causes of stress, too, in this transition to motherhood. So, stresses from relationship changes, physical body changes and recovery, isolation, lack of support, so many different things can be causing stress and the brain seems to be more sensitive to stress at that time. The symptoms are fairly similar. Whether they happen in pregnancy or after delivery, they just might present a little bit differently. So the things that women are anxious about are different. The things that they are guilty around can be different, whether it’s in pregnancy or after their baby’s born.”
What symptoms should a woman or her family watch for that may indicate something more serious than “baby blues” is going on?
“It’s a really important question. Women will tell me that they are experiencing significant, severe sadness or loss of interest in their relationships, the people around them, the activities that they usually enjoy. I mentioned significant guilt often about not being a good enough mother or partner. And I would say, you know, different from depression at other times in a woman, a person’s life, anxiety, irritability and feeling overwhelmed are real key features. You know, what can this look like? A woman may start to have little interest in being around her family, withdraw socially, may not want to get out of bed or go outside the house. They actually have to push through that low energy and that low motivation to get things done and care for their baby. And they tell me that it’s exhausting, exhausting to live with these symptoms. They’re often not eating. They’re not sleeping at night, which makes them even more exhausted. And this impacts their health in so many different ways. In severe cases, the worthlessness and feelings of hopelessness can lead some women to have thoughts that their family would just be better off with them if they weren’t around.”
How often do the symptoms get so serious that women might become suicidal or have suicidal ideation?
“Peripartum depression, clinical depression occurs about one in seven women. So it’s about 14%. We know that about 10% to 15% of those cases are in that severe range. And the rest of the cases can be more mild or moderate in the severity of their symptoms.”
Are women who experience pregnancy loss and miscarriages also particularly vulnerable to depression?
“Perinatal loss can be a traumatic and unexpected outcome for families, and there is a range of emotional reactions after loss that can range from bereavement, depression, acute stress, post-traumatic stress or depression. And so we know that the rates are higher, as you mentioned. Rates can be about 20 to 30% after miscarriage and 30 to 40% after a stillbirth loss.”
What misconceptions are out there that you think need to be dispelled about pregnancy-related depression?
“There are still misperceptions, even with increased education and information to the public and especially to perinatal individuals. There’s still some thought that, you know, motherhood should just always be joyful or that depression is due to being weak and women are still dismissed being told, ‘Oh, it’s just the baby blues’ or ‘Oh, you’ll be fine. All mothers are tired.’ And my favorite is ‘Your hormones will settle down’ and the hormones are important, but you can’t just blame the hormones. You know, these are stigmatizing messages that can lead to delayed diagnosis and treatment and worse outcomes for women. Those misperceptions and misconceptions are just unfortunately still out there.”
What questions do you urge women to ask their doctor?
“I let women know that they’re not alone. I reiterate that 1 in 7 women can develop peripartum depression. It’s a medical condition. It’s not a character flaw. It’s not due to weakness. It’s not being a bad mother. It’s biological, hormonal there are social factors. And I encourage them to seek help and taking care of their health benefits, them, their baby and their family. Ask about what are my risk factors for peripartum depression? Will you screen me for peripartum depression? Whether that’s their midwife, their obstetrician. What symptoms should I watch out for? And if I develop peripartum depression, are there treatments and will you refer me to a mental health specialist? We encourage women who are feeling afraid to do so, to have the courage and strength to tell one person you trust, take one small action like talking to your health care provider. Or there is a national maternal mental health hotline, the 1 833 TLC MAMA line that is available 24/7 by call or text. We just asked women to take one small step to talk it out with somebody they trust.”
Leave us with some good advice on how families and friends of pregnant and postpartum women can help support them better. What should we be looking out for?
“Families can support women in their lives by validating their experience. They can offer specific support, such as I’m here to listen. Sometimes just listening. It’s not always solving the problem, but listening. But also, how can I best support you? Can I help with baby care? Can I help with household tasks? And encouraging treatment. The terrifying statistic is that 50% of women with peripartum depression never receive treatment. And this leads to unnecessary suffering for mothers, babies and families despite depression being highly treatable.”
This interview has been edited for clarity.
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Jenna Griffiths produced and edited this interview for broadcast with Catherine Welch. Griffiths also adapted it for the web.
This article was originally published on WBUR.org.
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