Preventing Postpartum Depression

Preventing Postpartum Depression

Postpartum depression is a common complication of pregnancy. It can make you feel so sad, hopeless, and exhausted that you may have trouble caring for yourself and your baby. A recent review of studies on prevention of postpartum depression offers some good news. The review, published in Clinical Psychology Review, looked at 137 studies and concluded that preventive strategies may reduce the risk or the symptoms.

Postpartum depression affects about 15 percent of women. It has many causes. One cause is a sudden drop in the female hormones estrogen and progesterone. There is not much you can do about that. Hormone changes can cause a mild and temporary depression called the “baby blues.”

Baby blues affect 80 percent of women and usually go away in one or two weeks. Baby blues can snowball into major depression if you start to become worried and anxious and if you are not getting enough sleep or support. That’s where prevention strategies can help.

Why is prevention an important part of prenatal care?

Full postpartum depression can be overwhelming. It can keep you from bonding with your baby, wreak havoc on your relationship with your partner, and can have long-term effects on your child. Studies show that the stress of poor or chaotic parenting caused by depression raises stress hormone levels in babies. This may lead to future emotional and behavior problems.

Studies also show that husbands of women with postpartum depression are likely to become depressed. Women with depression are less likely to breastfeed. Postpartum depression can become long-lasting, major depression if not treated. In other words, you want to prevent this problem or reduce your risk.

Prevention strategies that can help

The first and most important thing to do is to know if you are at risk. Risk factors for postpartum depression include:

  • Postpartum depression with a previous pregnancy
  • A personal or family history of depression
  • Emotional stress during pregnancy
  • A history of drug or alcohol abuse
  • Lack of support at home

Many obstetrical care providers are using a questionnaire-screening test for women who may be at risk. The test is called the Predictive Index of Postnatal Depression. Ask your care provider if you should be screened. If screening shows high risk, you may benefit from preventive treatment with psychotherapy or antidepressants medication.

Other strategies may also be effective. They include:

  • Education and support programs. An example is a program called Practical Resources for Effective Postpartum Parenting (PREPP). Programs like PREPP include parenting techniques that reduce exhaustion, increase bonding, and reduce stress. Childcare and mental health providers may give coaching.
  • Earlier postnatal care. Traditionally, the first postpartum checkup is six weeks after birth. Some studies suggest having this visit at one week. This may give you a chance to discuss potential stressors or symptoms that could lead to postpartum depression.
  • Exercise is a known antidote for depression. It stimulates brain chemicals – endorphins – that fight depression. Women who get overweight and out of shape during pregnancy may be at higher risk emotional stress, fatigue, and low self-esteem. An exercise program before and after pregnancy may reduce the risk of postpartum depression.
  • Many studies show that depressed women are less likely to breastfeed. Recent studies suggest that the link goes both ways. Breastfeeding may reduce the risk of depression. If you want to breastfeed, make sure you have good coaching and support. Increase your chance of success.
  • A recent study from the University of Colorado at Boulder found that a program of mindfulness meditation and yoga reduced postpartum depression in women at risk better than psychotherapy or medication. Starting a yoga class or a mediation program could be a simple and healthy addition to your pre and post-natal care.

Bottom Line

For most women, pregnancy and a new baby is a time of hope and joy. The last thing you want to think about is depression. But talking to your health care provider about your risk for postpartum depression and starting some preventive strategies makes a lot of sense. One of the most interesting findings from Clinical Psychology Review was that many types of preventive strategies seem to work equally well. It may be that education, planning, and support are the keys to reducing your risk.

Christopher Iliades
Dr. Chris Iliades is a medical doctor with 20 years of experience in clinical medicine and clinical research. Chris has been a full time medical writer and journalist since 2004. His byline appears in over 1,000 articles online including EverydayHealth, The Clinical Advisor, and Healthgrades. He has also written for print media including Cruising World Magazine, MD News, and The Johns Hopkins Children's Center Magazine. Chris lives with his wife and close to his three children and four grandchildren in the Boston area.

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