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Pregnancy and Mental Health: Understanding Prenatal and Postpartum Depression, Anxiety, and Other Issues

For many women, pregnancy is the answer to a long-cherished dream, and giving birth to a child is fundamentally life-changing. For about 15% of women, though, pregnancy is a period of conflicted emotions and mental health concerns. If you suffer from depression or anxiety during pregnancy, struggle to bond with your child, or experience postpartum depression, you are not alone. Seeking treatment now is the very best thing you can do for you and your child.

Common Pregnancy-Related Mental Health Issues

Women can struggle with mental health issues at any time during their lives, so it should come as no surprise that, for some women, these issues take root during pregnancy. Women who face depression, anxiety, and similar challenges during pregnancy may feel that they’ve done something wrong; many worry they don’t love their babies enough or that their “maternal instinct” is somehow not working correctly. Nothing could be further from the truth. Mental illness is not your fault, and just as you’d seek treatment for gestational diabetes or severe morning sickness, you also need and deserve treatment for pregnancy-related mental health problems. Pregnancy-related mental health issues fall into two broad categories: issues caused by or related to the pregnancy, and issues that pre-dated the pregnancy.

Mental Health Issues Related to Pregnancy

Among some women, pregnancy itself is a major contributing factor to mental health issues. The best-known pregnancy-related mental health issue is postpartum depression, which results from a variety of hormonal and environmental issues. But pregnancy can also trigger memories of trauma, giving rise to anxiety and PTSD, or can be so stressful that women develop generalized anxiety disorder or obsessive-compulsive disorder. Pregnancy doesn’t typically cause personality disorders or bipolar disorder.

Mental Health Issues Predating the Pregnancy

Many women who struggle with mental health issues during pregnancy have faced mental health challenges for much of their lives. For these women – who can suffer from a variety of mental health conditions, including depression, anxiety, personality disorders, and similar issues – the pregnancy may compound pre-existing mental health problems by, for instance, re-opening old wounds or causing hormonal shifts. The pregnancy itself, though, is not the cause of the issues. Among women who have not sought proper treatment for mental illness, pregnancy can however be a strong incentive to finally seek treatment.

What Causes Pregnancy-Related Mental Health Issues?

A number of factors conspire to make pregnancy a dangerous time for women’s mental health. Some patients mistakenly believe that pregnancy-related mental health problems are solely a product of hormonal shifts, but this greatly oversimplifies the issue. After all, most pregnant women do not develop mental health issues, even though the undergo similar hormonal changes. Instead, a woman’s odds of developing serious issues increase when she faces many mental health risk factors. Some risk factors for pregnancy-related mental health issues include:

• A family history of postpartum depression or mental illness. Both genetics and environment play a role here. A family history suggests genetic vulnerability to mental illness. But women who watched a family member experience pregnancy-related mental health issues may learn unhealthy coping mechanisms, or may feel that unhealthy ways of being – such as refusing to accept help – are actual normal.
• A traumatic birth or delivery. Research has repeatedly shown that women whose babies are born sick, women who are injured during labor, and women who feel that control was taken from them during birth are more likely to have issues.
• A prior history of mental illness.
• Lack of social support. Women who are isolated from friends and family or whose partners do not do their fair share of childrearing are more vulnerable to depression. Some research suggests that help from a partner is the single most important factor protecting against pregnancy-related mental illness.
• Poverty
• Poor health
• Conflicted feelings about the pregnancy. Women whose pregnancies came as a surprise, as well as women who considered abortion or adoption, are much more vulnerable to mental illness.
• Inadequate preparation for the pregnancy. When women don’t have the supplies, money, or help they need, they’re more vulnerable to postpartum depression.
• Having to return to work immediately after giving birth.
• Not breastfeeding.

Of course, some risk factors are more likely to cause issues than others, and some women develop depression and other symptoms even with no risk factors. Thus it’s important for every pregnant woman to have a care provider she trusts, the support of a loving family, and plenty of chances to contemplate what she wants for her pregnancy.

Recognizing the Symptoms

Antenatal and postpartum depression are, far and away, the most common pregnancy-related mental health problems. Unfortunately, depression often comes with a hefty dose of denial. Women with depression may blame themselves or be unable to recognize the symptoms. If you experience two or more of the following symptoms, though, you are likely suffering from depression:

• Difficulty bonding with or relating to your baby, even several days after the birth.
• Traumatic memories of the birth.
• Unexplained anger at your partner, yourself, or your baby.
• Insomnia or excessive sleep.
• Sudden changes in weight or appetite. You may find yourself eating constantly or not at all.
• Unexplained muscle aches and pains.
• Unusual or unrealistic thoughts or perceptions. Rarely, postpartum depression causes postpartum psychosis, which can cause you to see things that aren’t really there or believe things that aren’t really true.
•  A desire to hurt your baby, yourself, or your partner. Some women with postpartum depression mistakenly believe that hurting their babies will be beneficial. For example, Andrea Yates, an American woman who killed her children due to postpartum depression, is purported to believe she was saving her kids from an evil and unkind world.
• Feelings of hopelessness, guilt, shame, or inadequacy.
• Loss of interest in activities you previously enjoyed.
• Chronic anxiety.
• Withdrawing from your friends or family.
• Difficulty concentrating, maintaining motivation, or going to work.

Of course, postpartum depression isn’t the only mental illness pregnant women and new mothers face. There are hundreds of mental illnesses, and pregnant women are not immune to mental health issues. Some signs that you may have a mental illness include:

• Experiencing unpleasant feelings that you feel you cannot control.
• A sudden change in your personality or mood.
• Emotions that aren’t appropriate for the situation. For instance, you might burst into tears at your birthday even though you’re surrounded by loved ones.
• Changes in your habits or interests.
• Difficulty doing everyday tasks or loss of interests in hobbies you used to enjoy.

A strong relationship with a partner you trust can be very helpful, since your partner may recognize the signs even before you do. No matter what you’re suffering from, if you’re in immediate crisis, don’t delay seeking help. You can contact a crisis line by following this link.

The Challenges of Treatment

Pregnant women and new mothers face unique challenges when it comes to finding treatment for their mental health issues, which is why it’s so important to work with a skilled counsellor, in addition to finding a doctor who has experience working with pregnant women who face mental health issues. Though there is always at least one treatment that will work, you may experience difficulty finding treatment for several reasons:

• Many highly effective psychoactive medications are not safe for pregnant or lactating women.
• Hormonal changes during pregnancy can mean that a mental illness medication that once worked great no longer works at all.
• New mothers and pregnant women may experience health problems that complicate treatment.
• Parenthood is highly demanding work, and new mothers may not have time to attend therapy or may struggle to find childcare when they attend medical appointments.

 It’s important to be clear with your treatment provider about what you can and cannot do. For instance, if therapy three times a week is unrealistic for you, speak up rather than setting yourself up for failure.

Treatment Options

It might not feel like it right now, but there is hope that you can feel better. And often, feeling better takes much less time than you expect. Treatment works best when it is holistic, addressing biological, social, and environmental needs. Research has repeatedly shown that women suffering from postpartum depression do best when they pursue several simultaneous treatments. Some options include:

• Medication – some drugs, notably Zoloft, are generally safe for pregnant and lactating women.
• Therapy – therapy can help you understand what factors led to your depression, thereby helping you chart a course away from your suffering.
• Lifestyle changes – research suggests that exercise can be as effective as some antidepressants. Likewise, adequate sleep and good nutrition are key to keeping both your body and mind healthy
• Relationship counselling – if your partner isn’t helping you with the baby or is contributing to your depression, relationship counselling can help. If you’re in an abusive relationship, you may need to leave to feel better.
• More social support – asking for help from loved ones, recruiting an occasional baby-sitter, and taking regular time for yourself can all help you fight your way out of despair.

Postpartum depression can be scary, not to mention deeply isolating. But research is ongoing, and each year, clinicians get closer to understanding the unique mental health issues pregnant women and new mothers face. There’s no better time than now to seek help, and we’d be thrilled to help you find a way out of the cloud of depression and into the joys of motherhood.