Perinatal Depression Can Recur—But Screening and Treatment Can Help

Britney Spears revealed she previously struggled with the condition in an Instagram post on Monday.

The journey of pregnancy and childbirth is often portrayed as a time of joy and anticipation, but for many expectant mothers, it can also be marked by emotional challenges. Perinatal depression, a mood disorder occurring during pregnancy and up to a year after childbirth, casts a shadow on this otherwise transformative period. In light of Britney Spears’ recent revelation about her struggle with perinatal depression during a past pregnancy, it is essential to delve deeper into this condition. This comprehensive exploration aims to shed light on perinatal depression, its symptoms, the risk factors associated with past diagnoses, and the crucial role of screening and treatment.

Understanding Perinatal Depression

Perinatal depression encompasses a spectrum of mood disorders that emerge during the perinatal period, spanning from pregnancy through the postpartum phase. This period includes the conception phase, pregnancy, childbirth, and the initial months after giving birth. It is important to note that the term “perinatal depression” encompasses not only postpartum depression but also depression that may occur during pregnancy itself.

The National Institute of Mental Health (NIMH) emphasizes that the perinatal period is not solely confined to the time following childbirth. Even when a woman is attempting to conceive, she is within the perinatal period. This broader understanding highlights the emotional challenges that can accompany various stages of the journey to motherhood.

The Impact of Perinatal Depression

Perinatal depression is not an uncommon experience, affecting up to 20% of pregnant individuals in the United States during pregnancy, the postpartum period, or both, as reported in a 2020 review published in the Cleveland Clinic Journal of Medicine (CCJM). This condition does not only affect the mother but also poses potential risks to the child. Untreated perinatal depression has been associated with adverse outcomes in infants, including impaired cognitive, social, and emotional development, as well as low birth weight.

The Connection Between Past Diagnosis and Future Risk

One crucial aspect of perinatal depression is its potential to recur in subsequent pregnancies, especially if an individual has a history of previous diagnoses. Experts suggest that a prior diagnosis of anxiety, depression, or perinatal depression increases the likelihood of experiencing perinatal depression again. While this does not guarantee that perinatal depression will recur, it does raise the risk.

The precise reasons behind this increased risk remain a subject of ongoing research. Factors such as elevated stress levels and hormonal fluctuations are believed to contribute to this vulnerability. A study published in PLoS Medicine in 2017 found that individuals who experienced postpartum depression were substantially more likely to face a recurrence of the condition following subsequent pregnancies.

Recognizing Perinatal Depression: Signs and Symptoms

Identifying perinatal depression is essential for timely intervention and support. To be classified as perinatal depression, the condition must persist for more than 14 days and significantly impair the individual’s quality of life, as outlined in the CCJM review.

Perinatal depression can manifest in various ways, and the severity and combination of symptoms can vary among affected individuals. Some common signs and symptoms, as listed by the NIMH, include:

1. Feeling sad, anxious, or experiencing a sense of emptiness.
2. Irritability.
3. Feelings of guilt, worthlessness, hopelessness, or helplessness.
4. Loss of interest or pleasure in activities.
5. Fatigue or a decrease in energy.
6. Restlessness or difficulty sitting still.
7. Difficulty concentrating, making decisions, or remembering.
8. Sleep disturbances, including difficulty sleeping or oversleeping.
9. Changes in appetite and weight.
10. Physical symptoms such as headaches, cramps, aches, pains, or digestive issues that cannot be attributed to a clear physical cause.
11. Challenges in forming an emotional attachment with the newborn.
12. Persistent doubts about the ability to care for the baby.
13. Thoughts related to death, suicide, or self-harm.

It is crucial for pregnant individuals to recognize these symptoms and seek support when needed. Silence should not be the path chosen when facing perinatal depression. According to Gloria A. Bachmann, MD, associate dean of women’s health at Rutgers Robert Wood Johnson Medical School, any unusual symptom experienced during pregnancy warrants reaching out to a healthcare provider or a supportive family member.

Janelle Bolden, MD, chief of maternal fetal medicine at Northwestern Medicine, emphasizes that certain symptoms require immediate attention, including thoughts of self-harm, harming the baby, or death. Urgent help, such as contacting 911, visiting an emergency room, or reaching out to the National Suicide Prevention Hotline, is necessary in such cases.

Normalizing Perinatal Depression and the Role of Screening

Perinatal depression is a common condition, and healthcare providers play a pivotal role in recognizing and addressing it. Multiple prominent health organizations, including the U.S. Preventive Services Task Force, American College of Obstetricians and Gynecologists, American Psychiatric Association, and the American Academy of Pediatrics, recommend universal screening for perinatal depression in pregnant individuals.

Screening tools, such as the Edinburgh Postnatal Depression Scale and the Patient Health Questionnaire (PHQ-9), are commonly employed to assess perinatal depression. These screenings should be integrated into routine care during the perinatal period, helping identify those in need of support.

The screening process is most effective when conducted appropriately and followed by appropriate interventions. Pregnant individuals may undergo multiple screenings during visits to their child’s pediatrician, ensuring a comprehensive approach to mental health during this critical period.

The Spectrum of Treatment for Perinatal Depression

The treatment of perinatal depression is a multifaceted journey, tailored to the individual’s unique needs and circumstances. Psychotherapy, medication, or a combination of both can be effective approaches, as outlined by the NIMH.

Cognitive behavioral therapy (CBT) and interpersonal therapy (IPT) are two forms of psychotherapy commonly used to address perinatal depression. CBT focuses on altering thought patterns, behaviors, and reactions to situations, while IPT aims to enhance communication skills within relationships, develop robust social support networks, and establish realistic expectations for coping with challenges.

In some cases, antidepressant medication may be recommended to address perinatal depression. These medications work by influencing the brain’s utilization of chemicals that regulate mood and stress. However, it is crucial to note that antidepressants may take six to eight weeks to yield noticeable results.

Dr. Tamar Gur, a reproductive psychiatrist at the Ohio State University Wexner Medical Center, underscores the importance of personalized treatment. She emphasizes that the right approach varies from person to person, with space for both therapy and, if necessary, medication when dealing with severe depression.

The Need for Structural Support

While screening and treatment options are vital components of addressing perinatal depression, structural changes in societal support are equally important. Dr. Gur points out the inadequacies in supporting pregnant individuals during maternity leave and highlights the negative impact of online platforms that subject women to undue criticism and scrutiny.

Normalization and open conversation about perinatal mood disorders are essential. Women should be informed early in their pregnancy journey that seeking help for perinatal depression is not only acceptable but also a fundamental aspect of maternal care.

Conclusion

Perinatal depression is a complex condition that transcends the boundaries of pregnancy and childbirth, impacting the emotional well-being of both mothers and children. Awareness, early recognition of symptoms, and access to screening and treatment are pivotal in addressing this condition. The experience of Britney Spears serves as a reminder that, while progress has been made in discussing perinatal depression, there is still a long journey ahead in destigmatizing and normalizing this aspect of the pregnancy experience.