As practicing OB/GYNs, we are constantly learning about how our health and bodies are impacted by the world around us. The focus on our mental health is rapidly growing, and it is about time – considering perinatal mental health conditions affect more than one in five people. Poor mental health may have serious consequences for pregnant people and babies alike.
The good news is that postpartum depression is treatable, and according to a 2022 Centers for Disease Control report, all cases of maternal mortality associated with mental health conditions are preventable. Screening for perinatal mental health conditions has become an important aspect of comprehensive care. It is crucial that providers invite pregnant and postpartum people to engage in open conversations about changes in mood and other symptoms they are experiencing and initiate timely interventions when indicated.
What is postpartum depression and what are the symptoms?
The criteria for diagnosis of postpartum depression is the same criteria for diagnosing depression outside of pregnancy. An individual must report five or more of the following symptoms representing a change from their norm and lasting for at least two weeks:
- Depressed mood
- Decreased interest or pleasure in normal activities
- Significant unintentional changes in weight (gain or loss of at least 5 percent in a month) or appetite (decrease or increase)
- Alterations in sleep (too much or not enough)
- Feeling like you are reacting slower or more agitated than normal
- Fatigue
- Feelings of worthlessness or inappropriate guilt
- Difficulty concentrating
- Disruptive and recurrent thoughts of wanting to hurt yourself or others
In addition to these symptoms which make up the diagnostic criteria, other signs of postpartum depression include withdrawal from friends and family as well as difficulty bonding with your baby.
Postpartum depression is diagnosed using a screening tool administered by your provider. One of the most commonly used tools is the Edinburgh Postnatal Depression Scale. This ten-question survey assesses the presence and degree of significance of depressive or anxiety-related symptoms within the previous seven days.
Postpartum depression is different from the baby blues, which is usually characterized by mild symptoms that start within a few days after delivery and resolve by two weeks postpartum. If you are experiencing moderate to severe symptoms or any symptoms that extend beyond two weeks after your baby is born, you may have postpartum depression.
What are the main causes and risk factors?
Expected fluctuations in important hormones, which are active in normal pregnancy and lactation, can lead to emotional or behavioral changes. When these fluctuations are combined with a lack of sleep, feelings of isolation, and other environmental stressors of having a newborn, we may feel like we are pushed to our emotional limits.
If you have a pre-existing mental health condition, you may be at higher risk of developing postpartum depression. A diagnosis of postpartum depression in any prior pregnancies also predisposes you to having symptoms in your current or future pregnancies. Similarly, individuals who may be coping with a history of substance abuse or current addictions are also at particularly high risk for developing postpartum depression. External stressors from work or school, food or housing instability, or interpersonal relationships can all contribute to depressive emotions or thoughts as well. Mental health conditions may even run in families.
What are some ways postpartum depression is treated?
Despite the high prevalence of postpartum depression, perinatal mental health conditions are still largely under-treated – or not treated at all. Talk therapy and medications are both safe and effective to use during pregnancy and while breastfeeding, but it is well known that when combined they can lead to the best possible outcomes. In addition to medical or psychological treatments, eating well, staying active, getting outside, and maintaining sleep hygiene are also vital factors that support overall physical and emotional wellness.
Don’t be afraid to reach out for help.
There is a lot of pressure on parents to be able to juggle all of the real challenges that come with welcoming a new baby. It’s important to remember that postpartum depression – or any lack of ability to manage what is going on around you – is not your fault. We encourage you to feel empowered and advocate for your mental health by speaking with your provider about any concerns. The sooner symptoms are recognized and treated, the better.
