Perinatal Depression and Anxiety: Symptoms, Causes, and Effective Treatments

Introduction:

During pregnancy and childbirth, numerous physical and emotional changes occur in the body. More often, perinatal mood and anxiety disorders are commonly prevalent and associated with pregnancy or in the first year after the birth of the child. This condition is often a missed diagnosis and significantly affects the health of the mother and infant. It is very important to identify the signs and help in the management of perinatal depression and anxiety. This article aims to understand perinatal depression, identify its various signs and symptoms, and briefly explain the management aspect of it.

What Is Perinatal Depression and Anxiety?

Feeling persistently sad or hopeless during or after your pregnancy? It might be more than just the 'baby blues.' Perinatal depression is a real mood disorder that needs attention and care. It occurs during pregnancy or the time after the birth of a child. The mother feels majorly sad, hopeless, and lacking interest in everything.

How Is Perinatal Depression Different from Postpartum Depression?

Perinatal Depression vs Postpartum Depression: Perinatal depression occurs during pregnancy and after childbirth, whereas postpartum depression occurs after the birth of a baby. Postpartum depression is of three types namely baby blues, postpartum psychosis, and postpartum depression.

Perinatal Anxiety vs Postpartum Anxiety: Perinatal anxiety occurs during pregnancy and after childbirth, whereas postpartum anxiety occurs after childbirth for the first year. Mindfulness-based interventions are effective in treating perinatal anxiety.

What Are Baby Blues and How Different It Is From Perinatal Depression?

Baby blues is the period after childbirth wherein the new mother suddenly feels sad and anxious and experiences extreme mood swings. Usually, it resolves without any treatment on its own. Compared to this, perinatal depression is usually severe and lasts longer. Also, it interferes with the mother's ability to care for the child and may not resolve without any interventions.

What Are the Causes of Perinatal Depression and Anxiety?

You may experience perinatal depression if you fit into any of the following-

• Lack of Support: A difficult relationship with the partner, lack of help at home or workspace, and limited social life can all lead to stress and feeling alone. Young single mothers are more likely to get anxiety and depression.

• Stressful Life: If you lead a stressful and tension-filled life during pregnancy due to life events, work stress, and personal life events, it will increase the feelings of being upset and lonely. This tends to make the person more anxious and fearful.

• Hormonal Changes: During pregnancy, your hormones, like progesterone and estrogen, go on a rollercoaster. These shifts can significantly impact your mood and feelings.

• Family History: If you have a family history of mental health issues, you stand at higher risk of developing perinatal and postpartum depression along with anxiety.

• Previous Traumatic Labor Experience: If you have a previous history of a difficult pregnancy or traumatic childbirth experience, it will make you fearful and anxious about the future, making you more depressed.

What Are the Signs and Symptoms Of Perinatal Depression and Anxiety?

Perinatal depression symptoms include -

• Constant sadness.

• No interest in otherwise favorite hobbies.

• Tiredness.

• Decreased bond with baby.

• Decrease in appetite.

• Self-harm.

• Suicidal thoughts.

• Panic attacks.

• Sleepless nights.

• Headaches, body aches.

What Are the Risk Factors of Perinatal Depression?

You are at risk of developing perinatal depression if you have the following risk factors -

• History of depression.

• Poor educational status.

• Low financial status.

• Absence of family support.

• Traumatic life events.

• Domestic violence.

• Perinatal smoking.

• Perinatal drinking.

• Difficulty in getting pregnant (infertility).

• Pregnant with a special child.

• Carrying twins or triplets.

• Anxiety disorders.

How Does Perinatal Depression Affect Mother and Baby?

It is no surprise that perinatal depression impacts both mother and baby. Below is the list of how it impacts them:

• Effects of Perinatal Depression on Baby: Children born to mothers with perinatal depression will have developmental delays, poor growth, poor cognitive development, less energy, and will always be irritable. Perinatal depression disturbs the effective bonding of the mother with the child, and due to the condition, the mother will fail to provide the required care to the child.

• Impact on Pregnancy and Childbirth: Perinatal depression, if left untreated, not only affects the mother but also affects the child, resulting in preterm birth and low birth weight.

• Effects on Infant Development and Bonding: Perinatal depression in mothers causes mental, emotional, and behavioral delays in infants. They would also have insecure attachment due to less bonding with their mothers.

• Long-Term Effects on Maternal Mental Health: Women with perinatal depression will have anxiety or depression disorders, inflict self-harm, and cause harm to infants.

Diagnosing Perinatal Depression: Screening and Tests

Have no clue on how to diagnose perinatal depression. Then, you are at the right place. Here are several tools utilized for diagnosing the condition -

• Edinburgh Postnatal Depression Scale: This is a 10-question-based screening method, where every answer is scored from one to three. The scores generally fall between zero and 30, with above 13 indicating depression.

• Patient Health Questionnaire-9: This screening tool has nine questions and scores ranging from zero to 27. An increased score indicates severity.

• Perinatal Anxiety Screening Scale (PASS): This test is designed to identify signs of anxiety in pregnant and postpartum women. It contains 31 self-questions. Each answer is scored zero to three based on the symptom frequency. The total scores in this test range from zero to 93, with 61 to 93 being the score grade for severe anxiety.

How Is Perinatal Depression and Anxiety Managed?

Perinatal depression is a curable condition. Yes, you read it right. If diagnosed and treated promptly, it is a curable condition.

Perinatal Depression Treatment:

Despite a large number of expecting mothers experiencing depression, only a few are diagnosed and opt for treatment. Multiple reasons like time crunch, fear of being labeled as a mental health patient, or difficulty in managing a house and children or childcare issues are all obstacles in seeking treatment.

For those who do come for treatment, the available treatment modalities are :

For Mild to Moderate Cases

Psychotherapy:

• Counseling and Therapy:

  • Cognitive Behavioral Therapy: The treatment involves altering thoughts to make them more focused and functional. It also aims to alter behavior.

  • Interpersonal Therapy: The treatment aspect deals with interpersonal roles and how the woman can transition smoothly into motherhood. The therapy helps the mother understand and develop better relationships.

• Support Groups: If you join support groups of people facing similar situation, it will help to find a solution to the problems. Also, a strong family support system is very beneficial in helping the new mother understand the changes and accept them sooner.

• Healthy Lifestyle: Consuming balanced nutritious meals, regularly engaging in light exercise or physical activity, and getting enough sleep and rest are all ways to lead a healthy lifestyle and significantly decrease depression.

• Prioritize Self-care: Are you aware that prioritizing self-care can do more good to the body? New mothers must be encouraged to take time off their day and improve their mood. Any hobby or activity that alleviates stress and builds a happy mood must be undertaken; this can positively affect their mental health.

• Alternative Therapies: The use of acupuncture and herbal remedies exist, but they need to be used with caution as there are not many studies studying their safety for the baby during pregnancy and breastfeeding.

Medications:

If you have severe perinatal depression, then medications are essential to manage the condition. Medications may be taken in combination with other approaches. Caution must be exercised at certain times. At the beginning of pharmacotherapy, the patient may get suicidal thoughts and must be closely monitored.

Medications Used Are:

• Antidepressants: They act on the stress chemicals produced by the brain. Generally, after initiating treatment, you will feel better in four to eight weeks.

• GABA Receptor Modulators: Brexanolone is an intravenous medicine used specifically in postpartum depression patients. Zuranolone is the first oral medication approved by the FDA (Food and Drug Administration) for these types of cases, providing a more convenient mode of therapy and not requiring hospital visits.

• SSRIs (Selective Serotonin Reuptake Inhibitors): Selective Serotonin Reuptake Inhibitors, or SSRIs, like Fluoxetine and Citalopram, are often considered safer options during pregnancy and breastfeeding for treating depression. However, there have been some concerns about neonatal adaptation syndrome, where newborns might experience jitteriness or breathing issues. Discuss the benefits and risks of SSRIs with your doctor.

What Are the Prevention Strategies for Perinatal Depression?

It is not possible to prevent the occurrence of perinatal depression. You are at risk of developing perinatal depression if you have any other mental health disorders and a family history of depression. Discuss with the physician to learn about the signs of perinatal depression so that you can get it treated earlier.

Several studies have reported that women with a risk of developing perinatal depression will benefit from therapies like cognitive behavioral therapy and interpersonal therapy.

Conclusion

Perinatal depression and anxiety require prompt diagnosis and treatment. Women with risk factors should be aware of causes, symptoms, diagnosis, and treatment. Healthcare providers, family members, and community members must collaborate and support the expecting mother in taking the best care of herself and the newborn child during this phase of life.

Key Takeaway/ Note From iCliniq:

Perinatal depression occurs during pregnancy and after childbirth. It has an impact on both the mother and the child. Being aware of the risk factors and symptoms helps you in reaching out for assistance early. The condition can be managed with medications and therapies. Take support from your family members, relatives, and friends to help you with this difficult phase of life.

If you are still not sure about your symptoms, you can visit icliniq.com for an online consultation with our expert team of doctors.