Many people associate pregnancy and new parenthood with feelings of immense joy – and for some people, that can definitely be the case.
For others, difficult emotions can also arise during pregnancy and the postpartum period, including the kind of stress or worry that can often accompany a major life change. While that is not necessarily anything to be alarmed about, doctors say that if such feelings interfere with a person’s ability to enjoy or carry out their daily routines, they should speak with their healthcare provider about whether they might need additional mental health supports.
At Sunnybrook’s latest Speaker Series, leading experts in perinatal mental health discussed how depression and anxiety can affect pregnant people and those who have recently given birth — and what treatment options are available.
According to Sunnybrook psychiatrist Dr. Sophie Grigoriadis, head of the Women’s Mood and Anxiety Clinic: Reproductive Transitions, perinatal mood disorders affect about 20 percent of women. That translates to approximately 28,000 people in Ontario each year.
Risk factors can be biological, psychological, and environmental. Experts also say there are some groups, including people who have experienced intimate partner violence, people with disabilities, people with a history of depression or anxiety, and people who have been through a birth trauma in the past, who are at greater risk of developing a perinatal mood disorder.
Symptoms of perinatal depression and anxiety — such as low mood, difficulty sleeping, or recurring anxious thoughts — can persist for several years postpartum if left untreated, Dr. Grigoriadis explained.
The good news is these mood disorders are very treatable with methods such as psychoeducation, psychotherapy, psychosocial interventions (e.g. self-care or breastfeeding support), or antidepressant medication.
New approaches such as mindfulness-based group therapy delivered online to treat anxiety in pregnancy are also being studied, said Dr. Grigoriadis, who is also a scientist with the Hurvitz Brain Sciences Program.
In addition, Dr. Grigoriadis along with research teams at Sunnybrook, Women’s College Hospital, and CAMH are recruiting patients for a clinical study into an innovative treatment called Transcranial Direct Current Stimulation for Depression in Pregnancy.
Transcranial Direct Current Stimulation is a non-drug treatment involving a small device that can be used at home. It is already approved by Health Canada – but Dr. Grigoriadis and her colleagues hope to evaluate whether it is effective in treating depression in pregnancy.
The treatment could provide a useful alternative for patients who are reluctant to take antidepressant medication during pregnancy, Dr. Grigoriadis explained. “If we can show that it is helpful, it will be revolutionary because this is a treatment you can do at home with minimal side effects,” she said.
Sunnybrook obstetrician Dr. Anne Berndl, Director of the Accessible Care Pregnancy Clinic and Associate Scientist with the DAN Women & Babies Research Program, said getting help is key to the health of the person who is pregnant as well as the baby.
Untreated depression during pregnancy significantly impacts quality of life and can lead to an increased risk of preeclampsia or substance use. There are also health risks for the baby, such as preterm birth or low birth weight.
Postpartum depression that is not treated can increase the risk of self-harm for the birth parent. It can also have a negative effect on infant attachment, breastfeeding, and development.
Dr. Berndl encourages people who are experiencing symptoms of depression or anxiety during pregnancy or postpartum – such as a feeling of hopelessness, loss of appetite, frequent irritability or tearfulness, severe sleep deprivation, or simply feeling ‘stuck’ — to reach out for help.
But the first step might be acknowledging that pregnancy and new parenthood doesn’t automatically come easily to everyone.
“One of the things that makes this really hard for people to understand are motherhood myths, which are a real barrier to accessing care,” Dr. Berndl explained.
“There are myths that once you become a mother you will have complete joy and fulfillment, or that motherhood is easy and you will naturally know what to do, or that being a mother always means sacrificing your own needs but these are all myths,” she added. “The problem with these myths is that people have a sense of shame when they feel otherwise, and it can delay asking for and receiving help.”
Mental health supports should be personalized based on a patient’s needs, Dr. Berndl said. For instance, a patient who has experienced a prior stillbirth or neonatal death might need more appointments with an interdisciplinary care team and a greater focus on birth planning.
People with disabilities, who have higher rates of depression and anxiety, also benefit from an interdisciplinary approach to perinatal care that includes medical management of the birth parent, pain management, early access to lactation consultants, psychiatry, and if needed community resources.
The take home message, Dr. Berndl said, is that “anxiety and depression during pregnancy and after birth can happen to anyone – but they are treatable so talk to your care provider about it.”
If you are looking for more mental health resources please speak to your doctor or see some of the resources listed here.