Perinatal depression is the new label for ‘Post-Partum’ Depression; i.e.: Depression occurring during and after pregnancy. It occurs in 5 to 25 percent of pregnant women and leads to problems for the mother, the infant and the family, because depression leads to emotional distress and difficulty in carrying out daily activities. Let alone care taking responsibilities.

What is Perinatal depression? It is a collection of symptoms including sadness, eating and sleeping problems, crying spells, lack of enjoyment in previously pleasurable activities, feelings of inadequacy, and contemplation of suicide.

How to identify it? Medical Professionals are familiar with the disorder and many are equipped to treat it. It generally involves symptoms that have persisted for at least 2 weeks.  Screening scales, like the Edinburgh Post-Natal Depression Scale [ it is also reliable in pregnancy] are used because they have severity ratings and can track progress with treatment.

What is it confused with? It can be confused with depression due to Bipolar Disorder [ Manic-Depressive disorder] which has the same symptoms, the Baby Blues which occurs and lasts a few days shortly after delivery, and post-partum Psychosis which occurs in about 1 in 500 live births, happens within 1-2 weeks of birth, usually begins as critical voices telling the mother to harm herself and the infant, and is therefore a psychiatric emergency that usually leads to immediate psychiatric hospitalization to prevent suicide and infanticide.

How do I treat Perinatal Depression?

Probably the preferred treatment is psychological, with Cognitive Behavioral Therapy [CBT] having the most evidence of benefit. It is usually delivered in person in 10-12 weeks with a face to face contact between the patient and therapist. There have also been on-line CBT formats, which have been shown to be effective as well. Other depression therapies, like Interpersonal Therapy and Commitment Therapy have also been beneficial.

Medications: The most common anti-depressants are the SSRI serotonin reuptake inhibitors. There is concern about fetal risk with them, but data except for Paroxetine, which has been associated with fetal cardiac issues, has shown that the risk of fetal effect of these drugs is much lower than the risks of untreated depression, which can endanger the life of the infant and the mother and other children in the family. In fact, studies of maternal depression show it to be a risk factor for conduct problems in boy, and substance use in girls. The risk of autism from SSRI’s leading to autism has been a subject of ongoing debate, but the consensus appears to be that the risk is low and maybe complicated by  parental genetics  and environmental factors, but not vaccines.

Some studies have looked at complementary medications to treat Perinatal Depression, and have focused on L-Methyl folate [ Deplin] and S-Adenosyl Methionine, both of which can be precursors to antidepressant amino acid synthesis in the brain and body. We need more data to assess efficacy.

Perinatal depression screening should also include fathers, because there is evidence that they too can develop depressive symptoms and withdraw from their roles of parental support.

Warnings for Perinatal Depression

Warning 1:

Suicide is the most dangerous effect of depression and self-injury a close second. Being aware of these risks is important so that patients can tell their loved ones and their doctors, because it can be stopped and treated. Screening scales like the Columbia Suicide Severity Scale is adapted for use by healthcare professionals and lay individuals. Training on it use is freely available on the internet.

Warning 2:

Pregnancy also increases the risk for life threatening events for a mother and infant. This situation, although rare, occurs mostly in situations of domestic violence, spousal abuse, human trafficking, especially where substances like alcohol are abused. The assaults often occur when the mother is trying to leave the abusive situation. About one third of abusers who contemplate violent actions towards their spouses and children, also contemplate killing themselves. This is in marked contrast to only 1% of depressed persons who have thoughts of harming others. Signs include the wearing of sun glasses to hide bruises, and lack of freedom of the mothers to talk privately to friends or doctors, without the presence of the abuser.

Take Home Message

Peri-Partum depression is a disabling and potential fatal illness. However, we can prevent it, and we can treat it into remission and restore a person to health. We are, all of us, obliged to recognize it and help those with it to seek treatment.