Navigating Perinatal Depression: Understanding, Challenges, and Treatment Options

Perinatal depression (PND) is a type of major depressive episode that occurs during pregnancy or within four weeks after childbirth ¹. It is different from the common and temporary “postpartum blues” or “baby blues”, which are characterized by fluctuating moods, fatigue, and anxiety and usually resolve within two weeks after delivery ¹. There are several risk factors for developing PND, including stressful life events, a history of depression, poor social support, and individuals or families with limited financial resources ¹.

In the United States, around 8.5% to 11% of pregnant women and 6.5% to 12.9% of women in the first postpartum year experience this condition ¹. Postnatal depression (PND) can have severe consequences for both the mother and the baby; it can lead to negative birth outcomes, hinder maternal-infant bonding, and increase the likelihood of developing mental disorders during childhood ¹.

Perinatal depression is a common issue that has significant implications. Unfortunately, it often remains unnoticed and untreated. Shockingly, only 15% of pregnant and postpartum women who suffer from PND receive adequate help and support ¹. Recognizing the signs and symptoms of PND is essential, as seeking help and support can significantly improve outcomes for those affected.

Understanding Perinatal Depression

Perinatal depression, a mood disorder affecting women during and after pregnancy, comprises both prenatal depression during pregnancy and postpartum depression after childbirth ⁶. While perinatal mental illnesses occur during pregnancy and up to one year after childbirth, postpartum mental illnesses specifically manifest after delivery, encompassing postpartum depression, anxiety disorders, and postpartum psychosis ⁸. Notably, perinatal depression might not be more prevalent during the postpartum period compared to other stages in a woman’s life ⁸.

Challenges and Impact

Perinatal depression is characterized by intense feelings of sadness, anxiety, and exhaustion, hindering a woman’s ability to fulfill regular responsibilities, including self-care and caregiving ⁶. Postpartum depression (PPD), a type of perinatal depression occurring after childbirth, affects about one in seven women, often leading to prolonged impairment and significant impacts on a mother’s relationship with her infant ⁵.

Signs and Symptoms of Perinatal Depression

Perinatal depression can be challenging to identify due to overlapping symptoms that are common during pregnancy and the postpartum period. Recognizing the signs and symptoms of perinatal depression is crucial for timely intervention and support.

Perinatal depression may show the following symptoms ¹⁰:

• Persistent feelings of sadness
• Decreased energy levels
• Frequent crying
• Changes in appetite, either increased or decreased.
• Disturbances in sleep patterns, such as excessive sleep or insomnia
• Feelings of low self-worth
• Heightened anxiety levels
• Episodes of panic attacks
• Persistent worries about the well-being of the baby leading to obsessive or ritualistic behaviors
• Avoidance of leaving the house due to fear
• Emotional numbness and a sense of detachment
• Lack of emotional response, neither experiencing joy nor sadness
• Reduced attachment or interest in the baby
• A sense of inertia or feeling stuck
• Feelings of hopelessness or thoughts of self-harm or harming the baby
• Physical complaints such as headaches, body pains, rapid heartbeat, and ongoing fatigue
• Active expressions of anger and resentment towards the baby
• Persistent irritability and a generally negative mood.

If you or someone you know is in crisis:

• Dial 911 in an emergency.
• Call the toll-free National Suicide Prevention Lifeline at 1-800-273-TALK (8255), 24 hours a day, 7 days a week. All calls are confidential. To use the Lifeline Chat, visit the National Suicide Prevention Lifeline website.

Differentiating Perinatal and Postpartum Depression

It can be challenging to distinguish between perinatal and postpartum depression, as their symptoms often overlap. Perinatal depression can occur during pregnancy or after childbirth, while postpartum depression specifically occurs after childbirth ^5,6. While perinatal depression can last for varying lengths of time, postpartum depression typically lasts for at least two weeks ^5,6. Both perinatal depression and postpartum depression share similar risk factors, including a history of depression, anxiety, or bipolar disorder, as well as psychosocial factors, such as ongoing conflicts with a partner, poor social support, and ongoing stressful life events ⁸.

Importance of Early Recognition and Support

Recognizing the significance of early identification and support for perinatal depression is fundamental in protecting the well-being of mothers and their families. Prompt recognition of the signs and symptoms of perinatal depression plays a pivotal role in facilitating timely intervention and comprehensive support (take our free depression quiz). Encouraging affected women to seek the necessary help and support is essential in mitigating the potentially detrimental effects of perinatal depression on both the mother and the child. If left unaddressed, perinatal depression can lead to complications such as low birth weight, impacting the child’s cognitive and social development ¹⁰.

Taking proactive steps to identify and address perinatal depression not only ensures the health and happiness of the entire family but also creates a nurturing and supportive environment for the healthy growth and development of the newborn. The U.S. Preventive Services Task Force highlights the importance of counseling interventions for perinatal depression for women who are at higher risk due to a history of depression. Additionally, resources like the Edinburgh Postnatal Depression Scale can provide valuable insight into the severity and overall prevalence of depression among new mothers. This is a patient health questionnaire and should not be used to diagnose postpartum depression.

Challenges of Perinatal and Postpartum Depression

Perinatal Depression and Postpartum Depression are two conditions that can be difficult to identify and address. The symptoms of both conditions can be mistaken for common experiences during pregnancy and the postpartum period, which can lead to delays in diagnosis. Additionally, the stigma surrounding mental health issues often prevents women from seeking help, which further complicates the situation.

Both women and healthcare providers may lack awareness about the signs and symptoms of these conditions, which can also lead to a delay in diagnosis and treatment. Furthermore, the limited availability of resources, including mental health professionals and support groups, can pose an additional obstacle for women who are struggling with these conditions. In the case of Postpartum Depression, concerns about the effects of medication on breastfeeding infants may create additional barriers to accessing appropriate treatment.

Treatment and Management for Perinatal Depression

In addressing perinatal depression, a range of treatment options can be considered to effectively manage the condition and promote well-being, including psychotherapy, medications, and holistic and alternative treatments. Reaching out to health care providers is a great step to take and can reduce the risk factors associated with untreated depression.

Psychotherapy

Many types of therapy may be used alone or in conjunction with other treatments for perinatal or postpartum depression; these may include:

• Group Interpersonal Psychotherapy (IPT): A therapy that involves addressing interpersonal issues to improve relationships and decrease depressive symptoms. Studies have suggested that group interpersonal therapy may provide increased social and emotional support, minimizing the stigma associated with postpartum depression [3].
• Cognitive Behavioral Therapy (CBT): This therapy aims to modify distorted patterns of negative thinking and behavior, enhancing coping strategies and reducing distress. Some trials have shown the effectiveness of CBT in reducing depressive symptoms, either alone or in combination with pharmacotherapy ³.
• Nondirective Counseling: This empathetic and nonjudgmental approach focuses on listening and providing support without directing the client. Studies have shown that this approach can significantly aid in the remission of depression ³.
• Peer and Partner Support: Programs involving support from peers and partners have shown promising results in reducing postpartum depression. Telephone-based peer support and partner involvement in therapy sessions are effective in decreasing depressive symptoms ³.

Medications

Medications are commonly used to treat depression, with antidepressants being the go-to option. They work by balancing certain chemicals in the brain that affect mood. However, pregnant, or breastfeeding women should talk to their health care provider before starting these medications to ensure their baby’s safety ⁷.

New research suggests that some medications are safer during pregnancy and breastfeeding than previously thought, changing the old practice of stopping all psychiatric medications during these times ¹⁰. Brexanolone (Zulresso), a recently approved drug, can provide quick relief for severe depression and reduce suicidal thoughts. While it’s currently given as an injection, researchers are working on making it available as a pill or an oral formulation ¹⁰.

When it comes to specific antidepressants during pregnancy and postpartum, some are considered safer than others. Paroxetine (Paxil) is generally discouraged due to potential heart issues in newborns. On the other hand, sertraline is often preferred for breastfeeding mothers as it has minimal impact on infants. Citalopram (Celexa) is also viewed as a good option for managing postpartum depression, given its low risk during breastfeeding. It’s crucial for women to get personalized advice from a mental health professional, as their individual circumstances and medical history can affect which treatment is best for them.

Transcranial Magnetic Stimulation

Repetitive Transcranial Magnetic Stimulation (rTMS) is a non-invasive and advanced therapeutic procedure that uses magnetic fields to target specific brain regions. It offers an alternative to traditional medication for women experiencing Postpartum Depression (PPD) ⁴. Unlike Electroconvulsive Therapy (ECT), which requires anesthesia and might induce seizures, rTMS allows patients to remain awake during treatment without affecting their cognitive function ⁴. Studies have demonstrated that rTMS is an effective way to reduce depressive symptoms over time for women with PPD, making it a viable treatment option ⁴. However, its effectiveness in severe or treatment-resistant depression is still under exploration, emphasizing the need for further investigation into alternative treatments, such as ECT, in such cases ⁴.

Various studies have indicated that rTMS has positive outcomes for perinatal and postpartum depression, particularly during the postpartum period. Minimal side effects were observed for mothers, and no adverse effects on newborns through breastfeeding ⁹.

Although generally considered safe and well-tolerated, rTMS might lead to mild and short-term side effects such as discomfort at the application site, muscle contractions, tingling sensations, headaches, and occasional lightheadedness ⁶.

Alternative and Complementary Medicine

There are many complementary and holistic options that can be used alongside other treatments. Some examples include:

• Folate: This vitamin, found in forms like L-methylfolate, has shown promise as an additional therapy for perinatal depression, especially for women with low folate levels ².
• Bright Light Therapy: Bright light therapy is known to treat perinatal depression effectively, but careful monitoring is needed to prevent hypomania or mania ².
• Exercise: Several studies have explored the role of exercise in alleviating postpartum depressive symptoms. While results have been varied, exercise, particularly moderate-intensity activities, has been recommended as a management strategy for mild-to-moderate depression ^2,3.
• Massage: Regular massage therapy has been shown to reduce depressive symptoms and balance hormones ^2,3.
• Yoga and mindfulness: Complementary health approaches, such as yoga and mindfulness, can potentially reduce symptoms of perinatal depression ¹.

Help and Support for Perinatal Mental Health

 In summary, perinatal depression, which includes both prenatal depression during pregnancy and postpartum depression after childbirth, significantly impacts the well-being of mothers and infants. Despite its widespread occurrence and potentially serious consequences, the challenges in recognizing and addressing perinatal depression, such as lack of awareness and stigma, persist. Early identification of the signs and symptoms of perinatal depression, along with accessible and comprehensive support systems, is crucial to minimize its effects. Various treatment options, including therapy, medication, and innovative techniques like transcranial magnetic stimulation and complementary approaches, provide hope for affected individuals.

If you or someone you know is struggling with perinatal or postpartum depression, it’s important to seek the help and support you need. Neuro Wellness Spa is here to assist you on your journey towards mental wellness. Our experienced team of professionals specializes in providing innovative and effective treatments for depression. Our in-person and online psychiatrists can provide psychiatric medication management and find a medication that works for you. Transcranial Magnetic Stimulation (TMS therapy) treats specific parts of the brain responsible for mood regulation. Talk therapy will give you an opportunity to identify and work through the underlying causes of perinatal depression and teach you effective coping skills. Don’t suffer in silence. Take the first step towards healing by contacting Neuro Wellness Spa today. Your well-being matters, and we are here to help.

References

1. Dagher, R. K., Bruckheim, H. E., Colpe, L. J., Edwards, E., & White, D. B. (2021). Perinatal Depression: Challenges and Opportunities. Journal of women’s health (2002), 30(2), 154–159. https://doi.org/10.1089/jwh.2020.8862

2. Deligiannidis, K. M., & Freeman, M. P. (2014). Complementary and alternative medicine therapies for perinatal depression. Best practice & research. Clinical obstetrics & gynecology, 28(1), 85–95. https://doi.org/10.1016/j.bpobgyn.2013.08.007

3. Fitelson, E., Kim, S., Baker, A. S., & Leight, K. (2010). Treatment of postpartum depression: clinical, psychological and pharmacological options. International journal of women’s health, 3, 1–14. https://doi.org/10.2147/IJWH.S6938

4. MGH Center for Women’s Health (2020, March 18). Is Transcranial Magnetic Stimulation Effective for Postpartum Depression? https://womensmentalhealth.org/posts/tms-for-ppd/

5. Mughal S, Azhar Y, Siddiqui W. Postpartum Depression. [Updated 2022 Oct 7]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK519070/

6. National Institute of Mental Health (n.d.). Perinatal Depression. https://www.nimh.nih.gov/health/publications/perinatal-depression

7. National Institute of Mental Health (n.d.). What is Depression? https://www.nimh.nih.gov/health/topics/depression

8. O’Hara, M. W., & Wisner, K. L. (2014). Perinatal mental illness: definition, description, and aetiology. Best practice & research. Clinical obstetrics & gynaecology, 28(1), 3–12. https://doi.org/10.1016/j.bpobgyn.2013.09.002

9. Pacheco, F., Guiomar, R., Brunoni, A. R., Buhagiar, R., Evagorou, O., Roca-Lecumberri, A., Poleszczyk, A., Lambregtse-van den Berg, M., Caparros-Gonzalez, R. A., Fonseca, A., Osório, A., Soliman, M., & Ganho-Ávila, A. (2021). Efficacy of non-invasive brain stimulation in decreasing depression symptoms during the peripartum period: A systematic review. Journal of psychiatric research, 140, 443–460. https://doi.org/10.1016/j.jpsychires.2021.06.005

10. Van Niel, M. S., & Payne, J. L. (2020). Perinatal depression: A review. Cleveland Clinic journal of medicine, 87(5), 273–277. https://doi.org/10.3949/ccjm.87a.19054