Along with all the physical changes women go through during pregnancy and childbirth, their mental health may also be impacted. And there are several different reasons for this. Women who've had psychosis, severe depression, or bipolar affective disorder are more likely to relapse during pregnancy or after giving birth, especially if they stop taking medication due to the fear that it may harm the baby. Hormonal changes and the added stresses of pregnancy and taking care of a baby can also set off depression. In some cases, women may also experience postpartum psychosis or anxiety disorders. Pregnancy can also affect women with eating disorders since their body is going through such extreme changes – this can worsen their condition or lead to a relapse. However, some women may actually show an improvement in symptoms due to concerns about harming the baby. No matter what the cause, if you’re an expectant or new mother concerned about your mental health, don't hesitate to ask for help and discuss your condition with your doctor.
While everyone will naturally have some anxieties about bringing a new baby home, the typical image of the “glowing” mother-to-be has us all believing that pregnancy should be an incredible time of joy and excitement for a woman. This, however, is not always the case. With all of the extreme physical and lifestyle changes that come with pregnancy and childbirth, many women become more vulnerable to mental health issues. In fact, about 13% of pregnant women may experience depression during pregnancy.1 If this may be you, know that you’re not alone and that help is available. Here’s a closer look at the connection between pregnancy and mental health.
Prenatal and Postpartum Depression
A few factors can trigger depression, including having a family history of depression or overcoming a stressful or traumatic event like the passing of a loved one. Hormones, which influence our moods and emotions by acting on our brain chemistry, also play a large role, especially among women, who have a greater risk of depression during puberty and pregnancy, after giving birth (postpartum), and throughout perimenopause.
Depression during pregnancy is often hard to detect because many of its symptoms – things like anxiety, mood swings, or dips in energy level and appetite – are often brushed off as typical pregnancy woes. A certain amount of worry about the health of the baby and your own condition is quite normal during pregnancy. But if you’re experiencing a persistent feeling of sadness, anxiety, or hopelessness, especially for more than a week or two, it’s time to seek help. Prenatal depression that is overlooked can lead to poor nutrition or even suicidal behavior in the mother, and may increase the risk of premature birth, low weight, and developmental problems in the baby.2
Most women experience symptoms such as moodiness, sadness, and loss of energy or appetite immediately after giving birth. These “baby blues” usually pass in about a week and don’t require medical attention. However, postpartum depression can last longer, be more severe, and inhibit you from functioning normally in your day-to-day life. It is important to get treatment for postpartum depression, and to understand the factors that may be causing it, including:
- Levels of female hormones estrogen and progesterone go up significantly during pregnancy and return to normal within a day after childbirth. This sudden and severe fluctuation in hormone levels can cause depression.
- Thyroid hormones, which play a role in how the body stores and uses energy, also reduce after childbirth and may lead to depression. Your doctor can assess this with a blood test and may prescribe medication to help.
- Feeling overwhelmed with doubts about your capacity to care for a baby, lack of sleep, and feeling unattractive and uncomfortable in your post-baby body can also contribute to the development of postpartum depression.
The US Preventive Services Task Force advises all women to get screened for depression during pregnancy and after giving birth. If a woman is dealing with depression, talk therapy (talking to a therapist or social worker) and medication will often be prescribed.3
Pregnancy may trigger anxiety disorders like panic disorder (in which you feel overwhelmed by fear) and obsessive-compulsive disorder (OCD, in which you can’t control certain thoughts or repetitive behaviors). In one study, about 39% of participants who had OCD stated that their condition began during pregnancy or after childbirth.4 Women who experience a panic attack for the first time during pregnancy should get their thyroid tested, since this may be linked to an issue in the thyroid glands. Your doctor may recommend cognitive behavioral therapy or medication to treat an anxiety disorder.5
A Rise (And Fall) in Eating Disorders
Pregnancy can be an especially challenging time for women with eating disorders since their body is going through such extreme changes – this can worsen their condition or lead to a relapse. However, some women may actually show an improvement in symptoms due to concerns about harming the baby. Some studies have found that women with bulimia nervosa (which includes binge eating followed by purging) actually show an improvement during pregnancy.6 However, they may be more prone to postnatal depression, with about 33% of them affected versus 3–12% for those without an eating disorder.7
A Risk For Relapse
Women who’ve had serious mental health conditions like psychosis, severe depression, or bipolar affective disorder are more likely to relapse during pregnancy or after giving birth.8 A study found that 43% of participating women with depression relapsed during pregnancy, with those who stopped taking medication showing higher chances of being depressed (68%) than those who continued with their medication (26%).9 Another study that looked at the health of women who stopped medication for bipolar disorder found that episodes of mental illness were 2.9 times more frequent in women who had just given birth than in women who weren’t pregnant.10 Because of this, it is important for pregnant women with a history of mental illness to share their concerns with a doctor, check that their medications are safe to take while pregnant, and discuss others ways they can manage their condition.
A Trigger For Psychosis
In very rare cases, women may experience psychosis after giving birth (postpartum psychosis). Those who are affected may feel confused, see things that are not real, experience extreme mood swings, or even try to harm themselves or their baby. It generally starts in the first 14 days after childbirth and one to four cases are seen in 1000 births.11
If you are experiencing overwhelming feelings of depression or anxiety during pregnancy or after your baby is born, don’t be afraid to ask for help. Reach out to family, join support groups, and discuss your concerns with a doctor, all of whom can help you manage your condition and keep you and your baby strong, healthy, and happy.
References [ + ]
|1.||↑||Depression during and after pregnancy fact sheet, U.S Department of Health and Human Services. 2016.|
|2.||↑||Depression in Pregnancy, American Pregnancy Association.|
|3.||↑||Depression during and after pregnancy fact sheet, US Department of Health and Human Services.|
|4.||↑||Neziroglu, Fugen, Richard Anemone, and Jose A. Yaryura-Tobias. “Onset of obsessive-compulsive disorder in pregnancy.” Am J Psychiatry 149, no. 7 (1992): 947-950.|
|5.||↑||Carter, Diana, and Xanthoula Kostaras. “Psychiatric disorders in pregnancy.” British Columbia Medical Journal 47, no. 2 (2005): 96.|
|6.||↑||Rocco, Pier Luigi, Barbara Orbitello, Laura Perini, Valentina Pera, Rossana P. Ciano, and Matteo Balestrieri. “Effects of pregnancy on eating attitudes and disorders: a prospective study.” Journal of psychosomatic research 59, no. 3 (2005): 175-179.|
|7.||↑||Morgan, John F., J. Hubert Lacey, and Elaine Chung. “Risk of postnatal depression, miscarriage, and preterm birth in bulimia nervosa: retrospective controlled study.” Psychosomatic medicine 68, no. 3 (2006): 487-492.|
|8.||↑||Mental health problems and pregnancy, National Health Service.|
|9.||↑||Cohen, Lee S., Lori L. Altshuler, Bernard L. Harlow, Ruta Nonacs, D. Jeffrey Newport, Adele C. Viguera, Rita Suri et al. “Relapse of major depression during pregnancy in women who maintain or discontinue antidepressant treatment.” Jama 295, no. 5 (2006): 499-507.|
|10.||↑||Viguera, Adele C., Ruta Nonacs, Lee S. Cohen, Leonardo Tondo, Aoife Murray, and Ross J. Baldessarini. “Risk of recurrence of bipolar disorder in pregnant and nonpregnant women after discontinuing lithium maintenance.” American Journal of Psychiatry 157, no. 2 (2000): 179-184.|
|11.||↑||Depression during and after pregnancy fact sheet, Office on Women’s Health, US Department of Health and Human Services.|