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Understanding Perinatal Depression

What is Perinatal Depression?

Perinatal Depression is a term used to refer to depression occurring during pregnancy and/or the first year post-birth. Recent estimates indicate that up to 1 in 10 women and 1 in 20 men experience antenatal depression (depression occurring during pregnancy), while more than 1 in 7 new mums and 1 in 10 new dads experience postnatal depression (depression occurring after the birth of the baby). Anxiety can also be just as common, if not more so, with many expecting and new parents experiencing both anxiety and depression at the same time (Perinatal Anxiety will be further discussed in a separate upcoming article).

Perinatal depression differs from the ‘baby blues’ where women may feel teary, irritable, anxious, and/or experience fluctuating moods due to dramatic hormonal changes. The baby blues usually occur approximately 3 to 10 days after giving birth and typically last for 2 to 3 days. Support from one’s partner, family and friends is usually all the assistance that’s needed during this time. If the baby blues last for more than two weeks, this may be a sign that postnatal depression is developing; speaking to someone about this and seeking professional support early on is strongly encouraged.

Symptoms of Perinatal Depression

The symptoms of depression during the perinatal period are the same as those at any other time of life. For a clinical diagnosis to be made an individual must be experiencing five or more symptoms from the list below, one of which must be symptom (1) or symptom (2). Furthermore, the symptoms need to occur during the same 2-week period and represent a change from previous functioning.

  1. Depressed mood/irritability
  2. Diminished interest in activities
  3. Significant weight or appetite change
  4. Sleeping problems (e.g. insomnia or hypersomnia)
  5. Psychomotor agitation and/or retardation
  6. Fatigue
  7. Feelings of worthlessness/guilt
  8. Inability to think clearly or concentrate
  9. Recurrent thoughts of death and/or suicide.

As can be seen from the list of symptoms above, some of the experiences and changes that typically occur during pregnancy and after having a baby, overlap with symptoms of depression (e.g., changes in sleep patterns, weight, appetite and concentration). This can make it challenging to distinguish between what is part of the ‘usual’ perinatal experience, as opposed to the experience of depression. The severity of these symptoms can also be different from one person to the next.

A diagnosis of perinatal depression can also at times be complicated by the presence of other conditions that may be occurring at the same time, such as other mental health disorders (e.g., eating disorders, post-traumatic stress disorder, personality disorders), or other physical conditions (e.g., diabetes, thyroid dysregulation). In light of this, careful assessment is needed to differentiate between these experiences. It is strongly encouraged that individuals speak with a health professional if some of these symptoms are present and impacting on their daily life.

Risk factors for Perinatal Depression

As with depression occurring at any time in one’s life, there is no one single cause. Instead, it is a combination of different factors that are known to increase the likelihood of perinatal depression developing.  Currently, the most consistent factors include:

  • a past history of depression and/or anxiety
  • a family history of depression and/or other mental health difficulties
  • lack of practical, financial, social and/or emotional support
  • lack of support from partner or the presence of marital/relationship problems
  • the presence of significant life events and stressors, particularly in the preceding 12 months (e.g., death of a loved one, unemployment, moving house, major illness)

Other risk factors that can play a role in the development and/or maintenance of perinatal depression include:

  • Domestic violence
  • Past or current physical, sexual and/or psychological abuse
  • Low self-esteem
  • Past or present drug and/or alcohol abuse
  • Having unrealistic/unmet expectations about parenthood
  • Having a poor attachment with one’s own mother
  • Previous miscarriage/stillbirth
  • Complications in labour and/or delivery
  • Problems with the baby’s health
  • Difficulty breastfeeding
  • Having an unsettled baby (e.g., difficulty with feeding or sleeping)

It is important to remember that experiencing one or more of the above mentioned risk factors does not mean that an individual will experience perinatal depression. Instead, if you can identify with some of the above experiences/events, it is likely that some additional support or assistance will be helpful in managing the complex demands of parenthood.

Treatment and Support Options

Pregnancy and the postnatal period are both characterised by a significant number of physical, emotional, and psychosocial changes. When one considers all the changes that occur in a relatively short period of time, it is not surprising that a considerable number of individuals find this period of time in their lives increasingly challenging. For some people, prioritising some time for their own self-care, and drawing on support from partners, family and friends (where available), may be all the support that’s needed. In other cases, formal assistance from a health professional may be needed. The good news is that depression during the perinatal period is very responsive to treatment. A sense of relief is often experienced by a lot of individuals, as they realise that the symptoms and challenges that they are experiencing, ‘have a name’ and are treatable. A range of different treatments options are available; the decision on which one to undertake should be done in consultation with an appropriately trained health professional (e.g., GP, child and family health nurse, psychologist, psychiatrist). Some of the most effective treatment options are summarised below:

Psychological treatments:

  • Cognitive behaviour therapy (CBT) for depression: CBT aims to help an individual to identify and adjust unhelpful patterns related to their thoughts, feelings and behaviours. CBT currently has the strongest evidence-base for use in the perinatal period. CBT based treatment programs that have been specifically designed for the perinatal period are available, which often include a combination of individual and partner sessions. CBT continues to evolve, with therapies such as mindfulness based cognitive therapy (MBCT), acceptance and commitment therapy (ACT), and schema therapy increasingly being used, however evidence regarding their effectiveness during the perinatal period is still limited compared to traditional approaches.
  • Interpersonal psychotherapy (IPT) for depression: IPT is a form of psychotherapy based on the premise that personal relationships are at the core of psychological problems or disorders such as depression, and thus focuses on an individuals’ relationships with other people. IPT has been increasingly used in the treatment for perinatal depression, with a growing evidence base demonstrating its effectiveness.
  • Psychodynamic therapy: Psychodynamic therapy focuses on unconscious processes and how they manifest in an individual’s present behaviour. This form of therapy aims to increase one’s self-awareness and understanding about the influence that the past is having on present experiences. Various adaptations of this therapy have been successfully used with a range of psychological disorders, including depression.
  • Specialised therapy: At times the symptoms of depression, particularly when severe, and/or when other mental health disorders are present, can make it difficult to engage in joyful, positive interactions, which in turn may influence key relationships. In cases where there is a considerable disconnect between a mother and her infant, specialist mother-infant treatment focusing on this attachment relationship may be warranted. In other cases, couples counselling may be beneficial, given that difficulties within the partner relationship are very common during this time.

Pharmacological treatments:

  • Medication: Various medications can be beneficial in helping individuals manage their depression and/or anxiety. During the perinatal period, it is particularly important that medication is only prescribed after careful consideration and discussion with each woman and how it may affect her pregnancy, infant, or desire to breastfeed. Most women tend to prefer psychotherapy to medication during pregnancy because of such concerns; however medication may need to be considered either as a stand-alone treatment, or in combination with psychotherapy, in cases where symptoms of depression are severe. In such instances, involving a psychiatrist is recommended.

Summary:

Perinatal depression is a condition that occurs far more frequently than what a lot of people realise. It is not a sign of failure, or of not being a ‘good enough’ parent. Instead, it often occurs because a number of factors, changes and life events have resulted in increased demands, which puts our usual coping resources under pressure. Given the impact that depression during the perinatal period can have not only on the mother herself, but also her infant, other children, partner, family and friends, early identification and treatment is needed. If you or someone you care about is struggling, don’t be afraid to reach out and speak up. Remember, effective treatment and support is available!

References and sources for additional information:

  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders(5th ed.). Washington, DC: Author.
  • Australian Psychological Society: EQIP (2015). Perinatal Depression Guide for Practitioners
  • Austin M-P., Highet N., and the Expert Working Group (2017). Mental Health Care in the Perinatal Period: Australian Clinical Practice Guideline. Melbourne: Centre of Perinatal Excellence.
  • (2011). Clinical practice guidelines for depression and related disorders – anxiety, bipolar disorder and puerperal psychosis – in the perinatal period. A guideline for primary care health professionals. Melbourne: beyondblue: The national depression initiative.
  • Beyondblue (2012).Managing mental health conditions during pregnancy and early parenthood: A guide for women and their families

Disclaimer:

Please note that the information provided in this article, and any associated references, is general and is not intended to be therapeutic in nature. If you feel that you would benefit from additional support and/or require urgent assistance please contact your GP, or one of the following services in your state.

Crisis and Support Services

National Services:

Lifeline
13 11 14 (24 hours a day, 7 days a week)
www.lifeline.org.au

Perinatal Anxiety and Depression Australia (PANDA)
1300 726 306 (Monday-Friday 9am – 7.30pm (AEST / ADST)
www.panda.org.au

Pregnancy, Birth and Baby Helpline
1800 882 436
https://www.pregnancybirthbaby.org.au

MensLine
1300 78 99 78
www.mensline.org.au

Suicide Call Back Service
1300 659 467 (24 hours a day, 7 days a week)
www.suicidecallbackservice.org.au

Additional State Based Services:

Victoria:
Maternal and Child Health Line 24 hours a day, 7 days a week 13 22 29
Parentline VIC 8am to 12am Monday to Friday, 10am to 10pm weekends 13 22 89

NEW SOUTH WALES:
Karitane Careline 24 hours a day, 7 days a week 1300 227 464
Parentline NSW 24 hours a day, 7 days a week 1300 130 052

ACT:
healthdirect Australia 24 hours a day, 7 days a week 1800 022 222
Parentline ACT 9am – 9om Monday to Friday (except public holidays) (02) 6287 3833

QUEENSLAND:
Child Health Line 24 hours a day, 7 days a week 13 43 25 84
Parentline QLD & NT 8am to 10pm, seven days a week 1300 30 1300

SOUTH AUSTRALIA:
Child and Youth Health Service 9am – 4.30pm Monday to Friday 1300 733 606
Parent Helpline SA 24 hours a day, seven days a week 1300 364 100

WESTERN AUSTRALIA:
healthdirect Australia 24 hours a day, 7 days a week 1800 022 222
Parent Help Centre WA 24 hours a day, 7 days a week 1800 654 432

NORTHERN TERRITORY:
healthdirect Australia 24 hours a day, 7 days a week 1800 022 222
Parentline QLD & NT 8am to 10pm, seven days a week 1300 30 1300

TASMANIA:
Parenting Line TAS 24 hours a day, 7 days a week 1300 808 178