Depression and Pregnancy
One in five pregnant women experiences postpartum depression
Major depressive disorder is not uncommon during pregnancy, and certainly occurs as well during the postpartum phase. In a large systematic review, prevalence of depression during pregnancy ranged from just over 7% of women in the first trimester, to 12% in the second and third trimester (Bennett et al, 2004). In the postpartum period, approximately 20% or one in five women will experience major depressive disorder symptoms (Getahun et al, 2023). Pregnant mothers who suffer from untreated depression and anxiety are at significantly greater risk for prematurity and low birth weight, and children born to mothers with untreated depression may be more at risk for cognitive and behavioral difficulties (Anderson et al 2004; Dayan et al, 2002). Thus - identification and treatment of peripartum (the period of time before, during and after pregnancy) depression is critical.
There is no one-size-fits-all solution to peripartum depression. However, most professionals recommend starting with a thorough behavioral health evaluation if you suspect that you are depressed and you are thinking about having a child. A psychiatric prescriber who specializes in perinatal mood disorders (depression and other mood concerns that arise in and around childbirth) can help with assessment and discussion of pros and cons of various plans. Depending on recommendations, this person would likely discuss so in collaboration with your GYN, or other medical team members.
For some, a robust course of therapy alone is a reasonable option for treating depression symptoms. For others, medication may be an important part of the discussion. In general, SSRIs (selective serotonin reuptake inhibitors), as well as several other antidepressants, are the best studied in pregnancy. It is critical to discuss the risks and benefits of treatment as well as non-treatment in perinatal depression. Ultimately it will be up to you to make a decision about how to proceed with the support of your team. A partnership with a trusted and experienced psychiatric provider is a critical part of decision making - this person could in some cases be your primary care doctor; your GYN; or a specialist psychiatric prescriber. If you are in Pennsylvania, consider asking your primary care doctor to contact TiPS to connect with a perinatal psychiatry specialist (https://www.upmc.com/locations/hospitals/western-psychiatric/services/professional/perinatal-tips ). Outside of PA, have them consider the Lifeline4Moms (https://www.umassmed.edu/lifeline4moms/ ). If you or a loved one is struggling with depression around pregnancy, reach out. Remember that help is available and can be life changing and even life-saving.
