Historically, it has been wrongfully believed that pregnancy and the puerperal period, also known as the postpartum period, serve as protective factors against mental health issues in women (Kerr, 2017). In recent years, this myth has been largely disproven as more women and mental health professionals are sharing their experiences and expertise on the matter of how pregnancy and the puerperal period are two areas of high concern where increased risk of developing mental health issues has been observed. One such critical mental health concern is perinatal, formally postpartum, depression which refers to the onset of depression or related symptoms beginning in pregnancy and/or following childbirth. The former term, postpartum depression, is limited to the period when the body is returning to its nonpregnant state, however it fails to acknowledge that depression during this time often begins during pregnancy (National Institute of Mental Health, 2022). Individuals with perinatal depression may experience extreme sadness, indifference, anxiety, and fatigue which makes it more difficult to care for oneself and the child (National Institute of Mental Health, 2022).
Oftentimes, pregnancy and the time period following delivery can be a vulnerable and sensitive experience, as there is a multitude of changes occurring in one’s body to prepare for pregnancy and delivery. Physiological changes relating to the high and rapid variation in reproductive hormones, estrogen, and progesterone both during pregnancy and after delivery may lead to potential mood changes and emotional distress (Torres, 2020). Emotional stress may be heightened due to financial and social changes, such as the high expenses associated with keeping up with physician visits, medications, and postpartum care. Considering the range of potential triggers which may interfere with a new mother’s well-being, approximately 70% of women experience a short onset of emotional anguish following the delivery of their child (Torres, 2020). Colloquially referred to as the “baby blues”, this period of emotional stress is characterized by negative feelings of anxiety, sadness, or irritability, with the added responsibility of caring for a baby, sleep deprivation, and lifestyle changes. While “baby blues” may appear to be similar to perinatal depression, it is important to acknowledge that these are two very different conditions in their severity and duration. “Baby blues” are defined to be short-term and do not disrupt or impair an individual’s ability to carry out their daily activities. After a couple of days, patients will see an improvement in their mood without needing medication attention or treatment. However, perinatal depression is usually a longer-lasting condition paired with intense symptoms that can be emotionally and physically debilitating to an individual (Torres, 2020).
Perinatal depression must be diagnosed by healthcare professionals, and although it is not a separate illness classification in the DSM-5 manual, patients must meet the provisions for a major depressive episode with the criteria of a peripartum-onset specifier (American Psychiatric Association, 2022). For a depressive episode to be classified as such, patients must experience at least five out of nine symptoms nearly every day for a two–week period: depressed mood, loss of interest or pleasure, change in appetite or weight, insomnia or hypersomnia, psychomotor retardation or agitation, fatigue, worthlessness or guilt, reduced concentration or indecisiveness, or suicidal ideation or attempt (American Psychiatric Association, 2022). These symptoms may increase or decrease in severity throughout the depressive episode and may result in additional shame or guilt concerning motherhood.
Evidently, perinatal depression can have dire consequences for the pregnant individual in question by hampering their quality of life. However, these consequences can also impact the baby’s well-being and sense of attachment and bonding with the mother. This can induce sleeping and feeding issues, which can introduce a host of new concerns for the child and mother (Van Niel & Payne, 2020). With the severity of perinatal depression, treatment is usually needed to resolve the depressive episode. Treatment options include cognitive behavioral therapy (CBT), interpersonal therapy (IPT), and the use of medications such as antidepressants. CBT and IPT are two evidence-based psychotherapy approaches that revolve around improving one’s ability to challenge negative situations (National Institute of Mental Health, 2022). CBT is a more structured therapy approach in which an individual may work to identify and tackle harmful thought patterns, behaviors, and emotional responses by substituting them with realistic and positive ways of thinking about one’s challenges and situations (Cleveland Clinic, 2022). IPT allows one to better their communication and relationship skills to develop stronger support networks and realistic expectations and outlooks on their respective situations. This allows an individual to have more resources and control over their circumstances to deal with their issue (National Institute of Mental Health, 2022). Whether an individual chooses to use therapy, medications, or both, it is no doubt that these options should be available to any individual undergoing a pregnancy. While pregnancy is commonly viewed as a time to rejoice, we, as a society, need to acknowledge the social and biological difficulties that pregnancy may introduce to the individual.
American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 5th ed., text rev (DSM-5-TR). Washington, DC: American Psychiatric Publishing; 2022.
Cleveland Clinic. (2022, August 4). Cognitive behavioral therapy (CBT). https://my.clevelandclinic.org/health/treatments/21208-cognitive-behavioral-therapy-cbt
Kerr, M. (2017, June 26). Perinatal depression. Healthline. https://www.healthline.com/health/depression/perinatal-depression#causes
National Institute of Mental Health. (2022). Perinatal depression. https://www.nimh.nih.gov/health/publications/perinatal-depression
Torres, F. (2020, October). What is Peripartum Depression (formerly Postpartum)? American Psychiatric Association. https://psychiatry.org/patients-families/peripartum-depression/what-is-peripartum-depression
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