Mental health is a topic that sometimes isn't spoken about during pregnancy. But it should be—especially when it comes to depression.
Studies suggest that around 14 to 23 percent of pregnant women experience depression during their pregnancy (also known as antepartum depression). Left untreated, antepartum depression can have negative effects on both mother and baby.
Pregnant women who are depressed might not seek the prenatal care they and their babies need. And they may not have the energy to care for themselves, including eating the right foods and getting enough exercise.
A Neuroscience article in Feb. 2017 reported that untreated depression during pregnancy could affect the fetus—causing hyperactivity and irregular fetal heart rate. It’s also noted that untreated depression during pregnancy can have effects on newborns, including stress/depressive-like behaviors.
Screening is key
All pregnant women should be screened for depression and treated appropriately. In fact, the U.S. Preventive Services Task Force “recommends that clinicians provide or refer pregnant and postpartum women who are at increased risk of perinatal depression to counseling interventions.”
According to the latest edition of the Diagnostic and Statistical Manual of Mental Disorders (the authoritative guide to the diagnosis of mental disorders), also referred to as DSM-5, the diagnostic criteria for a major depressive disorder includes five or more of the following over at least a two-week period (at least one of the symptoms must be either a depressed mood or loss of interest or pleasure):
- Depressed mood most of the day, nearly every day, as indicated by either subjective report or observation made by others
- Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day
- Significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day (of course, pregnancy can affect appetite and weight)
- Insomnia or hypersomnia nearly every day
- Psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down)
- Fatigue or loss of energy nearly every day
- Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick)
- Diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others)
- Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan or a suicide attempt or a specific plan for committing suicide
There's also a specifier in the DSM-5 for peripartum onset. This includes major depression onset mood symptoms occurring during pregnancy to four weeks after delivery (postpartum depression).
Women with peripartum onset often have severe anxiety and even panic attacks. Studies have shown mood and anxiety symptoms during pregnancy increase the risk for postpartum major depressive episode.
How to get help
If you're depressed and pregnant—or if you're depressed and thinking of becoming pregnant—speaking with a mental health professional about potential treatment options may be of benefit to you.
To schedule an appointment with Psychiatric Associates in Iowa City or North Liberty, call 319-356-6352 or use our Request an Appointment form.
-Depression and Postartum Depression: Resource Review. American College of Obstetrics and Gynecology. https://www.acog.org/Womens-Health/Depression-and-Postpartum-Depression?IsMobileSet=false.
-Untreated Depression During Pregnancy: Short- and long-term effects in offspring. A systematic review. Neuroscience. Volume 342, 7 February 2017, Pages 154-166.
-Perinatal Depression: Preventive interventions.US Preventive Services Task Force. https://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/perinatal-depression-preventive-interventions
-Depressive disorders/Specifiers for depressive disorders. Desk Reference to the Diagnostic Criteria From the DSM-5. American Psychiatric Association. Pages 94-95; 111-112
Francis Giuliani, MD
Dr. Giuliani is board-certified by the American Board of Psychiatry and Neurology in Adult Psychiatry. He is also trained in Cognitive Behavioral Therapy and is a Diplomat and certified member of the Academy of Cognitive Therapy. Dr. Giuliani takes an individualized approach to treating patients and is happy to discuss treatment options using medications, therapy, or a combination of medications and therapy. He served on the faculty at the University of Iowa Hospitals and Clinics prior to joining Psychiatric Associates. With his experience comes knowledge of treating a wide variety of conditions in people ages 18 and older.