Perinatal Depression and Anxiety

Perinatal depression and anxiety are perhaps more common than what we may realise.

It is listed as the most common complication of pregnancy, with 18% of women having depression during pregnancy and 19% during their first year postpartum.

Anxiety is also a common perinatal mental disorder with around 14% of women experiencing an anxiety disorder during pregnancy and 20% following the birth of their child.

Another 3% of women will experience post-traumatic stress disorder.

These numbers are quite significant as depression and anxiety can have major impacts on both the women and their family’s lives. Some of the effects it can have on women include poor self-care, compromised caregiving and increased morbidity from other causes.

It can also affect the children as well through malnutrition, poor physical and cognitive development and increased risk of illness.

These numbers are even more significant when statistics show that mental illness is one of the leading indirect causes of death for women in the six weeks to one year period following the birth of their child (Ford et al. 2017; Rahman et al. 2015; Sparling 2017).

Despite the dangers of these illnesses and the fact that one in five women will experience perinatal depression or anxiety, it continues to remain underdiagnosed and undertreated. However, this can be due to the fact that often the symptoms of perinatal depression and anxiety can often be attributed to the many discomforts of pregnancy instead as they can be quite similar (Sparling 2017).

Risk Factors for Developing Perinatal Depression or Anxiety

• History of anxiety and/or depression;
• Family history of mental illness;
• Fear regarding childbirth;
• Difficult or complex pregnancy;
• Birth trauma;
• Premature or sick baby;
• Challenges with feeding or settling;
• Sleep deprivation;
• Pre-existing physical illness;
• Low socioeconomic status;
• Lack of social support;
• Financial stress;
• Relationship stress;
• Age (adolescent or advanced maternal age);
• Single marital status;
• Prior pregnancy terminations;
• Anaemia;
• Gestational diabetes.

(PANDA 2017; Raisanen et al. 2014)

• Postnatal depression is also associated with early cessation of breastfeeding. This is often due to the mother’s perceptions that they have an insufficient supply of breast milk, however, this is often not the case and their milk production is satisfactory for their baby’s needs.
• It is also surprising to most people that fathers can also develop depression during their partners perinatal period, with 1 in 20 dads experience depression during their partner’s pregnancy and 1 in 10 dads following the birth of their baby (PANDA 2017).

Signs and Symptoms of Perinatal Depression and Anxiety

Signs and symptoms of perinatal depression and anxiety can be mild, moderate or severe and can include:

• Panic attacks (palpitations, shortness of breath, shaking);
• Persistent, generalised worry, often focused on fears for the health, wellbeing or safety of the baby;
• Development of obsessive or compulsive thoughts and/or behaviours;
• Abrupt mood swings;
• Feeling constantly sad and/or crying for no obvious reason;
• Being nervous or panicky;
• Feeling constantly tired and lacking energy;
• Decreased interest in things that normally bring joy;
• Sleeping too much or not sleeping very well;
• Losing interest in intimacy;
• Withdrawing from friends and family;
• Being easily annoyed or irritated;
• Feeling angry;
• Finding it difficult to focus, concentrate or remember;
• Engaging in more risk-taking behaviour;
• Having thoughts of harming yourself or your baby.

(PANDA 2017)

If a mother or father experience one or many of these symptoms for more then two weeks, or if they are concerned about their feelings or struggling to understand them, they need to seek support.

Support can be sought through midwives, general practitioners or other medical professionals they may be seeing. If the individual is at immediate risk of harm, they need to seek medical help urgently, often through the emergency department (PANDA 2017).

Is it Perinatal?

In order for the depression or anxiety to be classed as perinatal, it needs to have occurred anytime between the onset of pregnancy until 12 months after the birth of the child (Ford et al. 2017).

It is important to differentiate postnatal depression from ‘the baby blues’. It is not uncommon for women to experience what is called ‘the baby blues’ a few days following the birth of their child, but this experience is different from postnatal depression.

Although similar symptoms present, these usually resolve within a few days with understanding, acknowledgement and support. Therefore, ‘the baby blues’ is not considered a mental health concern that requires treatment (PANDA 2017).

Postnatal Psychosis

Postnatal psychosis can also occur, usually in the first 4 weeks following birth, but can occur up to 12 weeks postpartum. This condition affects 1-2 women in every 1,000 and is a very serious and potentially life-threatening condition. It not only puts the mother at risk but also the baby.

Early detection is essential, and women with postnatal psychosis will most likely need hospitalisation.

Most women usually experience a full recovery with both treatment and support. Often symptoms develop quite quickly and include:

• Sudden extreme mood swings;
• Aggressive and/or violent behaviour;
• Agitation;
• Irrational or delusional thoughts;
• Hallucinations;
• Paranoid or strange believes about the baby that cannot be changed by rational discussion;
• Grandiose or unrealistic beliefs about their own abilities as a mother;
• Unusual or inappropriate responses to the baby;
• Disordered and/or nonsensical thoughts and conversations.

(PANDA 2017)

Treatment for Perinatal Depression

As with all mental health conditions, the treatment will vary according to the individual and their experience.

Most guidelines recommend that all primary care practitioners, from midwives to general practitioners, ask about depression and anxiety when seeing new mothers.

Some of the treatment options include medication management, counselling, and referrals to other health professionals such as psychiatrists, psychologists, social workers and support groups.

There are many antidepressant medications that are suitable for postnatal depression in Australia. However, currently, there is more of a focus on non-pharmacological treatment (Ford et al. 2017; Sparling 2017).

Some general strategies that can be implemented by individuals include:

• Seek company when feeling low in mood;
• Share your experiences with others feeling the same way;
• Join a support group;
• Talk to a trusted family member or friend;
• Prioritise rest;
• Look after your own health. Eat well and do some gentle exercise;
• Limit alcohol and other drugs;
• Be gentle with yourself – remember recovery can take time.

(PANDA 2017)

Barriers to Treatment

There can also be potential barriers to the successful treatment of perinatal depression and anxiety, these include:

• Unavailability of resources;
• Patient and family reluctance for treatment;
• Cultural barriers;
• Financial constraints;
• Denial by the patient of the condition;
• Physician attitudes;
• There can also be a reluctance of women to take antidepressant medication if they are pregnant or breastfeeding, which then can decrease adherence to treatment, and increase the risk of relapse.

(Ford et al. 2017)

Unfortunately, if you have experienced perinatal depression before, your risk of experiencing it with future pregnancies and births is up to 40%.

But, the good news is that you will have more understanding due to your previous experience such as knowing when to get help and ensuring you have a strong network surrounding you so the severity can be reduced.

It is also beneficial to have some agreed ‘signs’ for that individual and their loved ones to be aware of, and if they start to show these signs (e.g. increased irritability or changes in sleep), it means they will initiate seeking help (PANDA 2017).

Seeking Help for Perinatal Anxiety and Depression

If you or someone you know is seeking help for perinatal anxiety or depression in Australia, PANDA (Perinatal Anxiety and Depression Australia) is an organisation that supports women, men and families during this time. They also offer a National Helpline, which is Australia’s only helpline relating to perinatal anxiety or depression. This helpline is staffed Monday to Friday between 9 AM and 7:30 PM on 1300 726 306.

Further resources for healthcare professionals can be found at COPE (Centre of Perinatal Excellence).

References

• Ford, E, Shakespeare, J, Elias, F & Ayers, S 2017, ‘Recognition and management of perinatal depression and anxiety by general practitioners: A systematic review’, Family Practice, vol. 34, no. 1, pp. 11-9, viewed 8 October 2018, https://academic.oup.com/fampra/article/34/1/11/2503180
• PANDA 2017, Perinatal Anxiety and Depression Australia (PANDA), viewed 8 October 2018, https://www.panda.org.au
• Rahman, A, Hafeez, A, Bilal, R, Sikander, S, Malik, A, Minhas, F, Tomenson, B & Creed, F 2015, ‘The impact of perinatal depression on exclusive breastfeeding: A cohort study’, Maternal and Child Nutrition, vol. 12, no. 3, pp. 452-462, viewed 8 October 2018, https://onlinelibrary.wiley.com/doi/full/10.1111/mcn.12170
• Raisanen, S, Lehto, SM, Nielsen, HS, Gissler, M, Kramer, MR & Heinonen, S 2014, ‘Risk factors for and perinatal outcomes of major depression during pregnancy: A population-based analysis during 2002-2010 in Finland’, BMJ Open, vol. 4, no. 11, viewed 8 October 2018, https://bmjopen.bmj.com/content/4/11/e004883.info
• Sparling, TM, Nesbitt, RC, Henschke, N & Gabrysch, S 2017, ‘Nutrients and perinatal depression: A systematic review’, Journal of Nutritional Science, vol. 6, viewed 8 October 2018, https://www.cambridge.org/core/journals/journal-of-nutritional-science/article/nutrients-and-perinatal-depression-a-systematic-review/FDAE0154396623DA013708DA41DC58A8/core-reader