Preventing depression in pregnancy: New guidelines

While pregnancy and a child’s birth are often depicted in pastel tones, many women struggle with depression during this time. Up to 14% of women are diagnosed with depression during pregnancy. Far more report having symptoms of depression during pregnancy and the first year after birth. Now new guidelines published by the US Preventive Services Task Force in the Journal of the American Medical Association provide the first-ever recommendations for preventing perinatal depression.

How can the new guidelines help?

Depression can be difficult during any period of life. Its main symptoms — a depressed or hopeless mood, a loss of interest and joy — can be accompanied by trouble sleeping, eating, and managing daily life. When depression occurs during pregnancy (perinatal) or up to 12 months after childbirth (postpartum), it can have a negative impact on the health of both the mother and the infant. For example, women with postpartum depression engage in fewer positive maternal behaviors, such as playing or praising, and more negative maternal behaviors, such as hurtful comments or harsh discipline. Children whose mothers had perinatal or postpartum depression are more likely to develop behavior problems and other psychiatric disorders.

The new guidelines recommend that health care providers discuss mental health with women during pregnancy and after birth, and screen women for depression. They can then refer women who report such symptoms, or have risk factors, to an appropriate mental health clinician. Simply raising the topic with a woman might help her feel more comfortable asking questions about depression and sharing her concerns.

Are there ways to prevent depression during pregnancy?

The Task Force reviewed a number of studies aimed at preventing depression in pregnant women. It identified two counseling interventions as recommended practices: cognitive behavioral therapy and interpersonal therapy. Both can effectively prevent perinatal depression.

Cognitive behavioral therapy, or CBT, helps people identify and change negative and incorrect thoughts. It helps people develop alternate, and more accurate, ways of viewing themselves and life events. For example, you might have broad, global, negative views of your ability to parent (“I am a terrible parent”). Therapy focuses on identifying these thoughts, challenging the errors in them, and developing more balanced thoughts. The behavioral component of CBT includes increasing positive activities, such as social interactions and pleasant events.

Interpersonal therapy focuses on helping people resolve interpersonal conflicts and navigate role transitions, such as becoming a mother for the first time. It also teaches people how to increase effective communication with others.

The Task Force found limited or mixed evidence for other approaches to preventing depression in pregnant women, including taking dietary supplements and engaging in physical activity.

What else is important for preventing depression during pregnancy?

Further, the Task Force identified a number of risk factors that make women more vulnerable to perinatal depression. These factors include having a history of depression, experiencing abuse, having an unplanned or unwanted pregnancy, or complications during pregnancy. Other possible risk factors are stressful life events, diabetes, low socioeconomic status, lack of financial or social support, and teen parenthood. Women who have these risk factors may wish to consider counseling during pregnancy and after childbirth. Counseling can be a source of support and a way to prevent, or cope with, depression.

The Task Force recommended further efforts to develop new ways to screen women for depression and prevent depression.

What if you’re experiencing depression?

If you are experiencing symptoms of depression, it is important to talk to your health care provider about treatment options. Your provider can refer you to mental health professionals who have experience working with women during pregnancy or after a birth. Encourage friends and family who are experiencing depression to seek help.

In addition to seeking help for symptoms of depression, if you or a friend of yours is thinking about harming themselves, please call the Suicide Prevention Hotline at 800-273-8255 (TALK), or go to the closest emergency room for help.

Editor’s note

In March 2019, the FDA approved the first treatment for moderate to severe postpartum depression. Brexanolone (Zulresso) is given intravenously over a 60-hour period. During this time, women must be monitored at a certified health care facility. While the medicine can work quickly to ease depression (within 48 hours), it is not effective for everyone.

Comments:

  1. Tim Lundeen

    I’d suggest Dr Kelly Brogan’s book, A Mind of Your Own: The Truth About Depression and How Women Can Heal Their Bodies to Reclaim Their Lives

  2. Charles Beauchamp MD, PhD

    Hypothesis 1: Pregnancy is a risk factor for depression & depression is a risk factor for pregnancy outcomes with endothelial dysfunction as an intermediary as follows:

    Depression endothelial dysfunction Pregnancy

    Depression endothelial dysfunction poor pregnancy & perinatal outcomes.

    Hypothesis 2: BioPsychoSocialInteractionalCulturalRacial HarmonyHistoricalCognitiveSpiritualMotivationalBehavioralCircadian CycleEpigeneticEnvironmenatal…etc Stressors can cause endothelial dysfunction via redox imbalance (e.g., with an induced increase in oxidative stress)

    Modulators of Oxidative Stress occurrence and intensity are NF-kB, Nff2, Intracellular Thiamine Pyrophosphate & Magnesium – both cofactors of a redox regulating enzyme, Transketolase

    Positive Modulators of Oxidative Stress are: downregulators of NF-kB (e.g. Pycnogenol), upregulators of Nrf2 (e.g., sulforaphane), agents that increase intracellular thiamine pyrophosphate (e.g., Benfotiamine and forms of magnesium that can effectively replete intracellular magnesium).

    Unifying Hypothesis: At the correct dose and combination Pycnogenol, sulforaphane, Benfotiamine and magnesium can prevent pregnancy complications such as depression, miscarriage, premature birth, infant mortality & maternal mortality while promoting normal birth of a very well developed newborn at term AND while significantly reducing disparities in pregnancy outcomes between whites and blacks.

    • Charles Beauchamp MD, PhD

      Expressed another way:

      Possible pathway to greatly reducing racial disparities in health care outcomes:

      Recognize racial disparities in the occurrence – age of onset, fastness of progression, age of untoward result – of the oxidative stress & endothelial dysfunction patholophysiologies

      BioPsychoSocialInteractionalCulturalEnvironmentalExposureHistoricalEpigeneticCircadianRhythm….etc reasons exist for the disparities in oxidative stress –> endothelial dysfunction –> vascular dysregulation –> systemic & regional blood flow abnormalities –> adverse pathophysiologies –> adverse results;

      There are key BIOCHEMICAL positive and negative modulators of intensity: NF-KB, Nrf2, intracellular thiamine pyrophosphate & magnesium.

      There are low cost Rx agents that downregulate NF-kB (Pycnogenol), upregulate Nrf2 (sulforaphane), support intracellular Transketolase activity (magnesium, Benfotiamine) that individually and in combination can be therapeutic AT THE APPROPRIATE DOSAGE

      There are also chronotherapeutic approaches (e.g., bedtime dosing of anti-hypertensive) that can make a big difference in very important clinical outcomes as stroke & heart attack

      The above can apply to men as well as women – e.g., non-occurrence of the normal nocturnal systolic BP dip in African American men & Hispanic men.

      There is a need for PRIMARY CARE studies that are best done as multi-state Comparative Effectiveness trials.

  3. Linda Robbins

    Hi David,  I read your article with interest  –  A lot of moms are really suffering from depression even after the first year after birth, awareness is very important.  I found this article quite useful when faced with a similar problem https://www.stuff4tots.com/transition-of-a-lifetime-the-importance-of-emotional-health-for-moms/

    Best wishes.

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