Depression is a common, treatable mood disorder. About 6% of women, including up to 10% (one in 10) of women who are pregnant, will experience depression at some time during their lives.
Women are more at risk of depression while they are pregnant, and during the weeks and months after having a baby. Depression during these times can be confused with the symptoms of pregnancy or with the ‘baby blues’ that many women experience right after birth.
The good news is that depression can be treated. It’s important to talk to your doctor if you think you are depressed. If left untreated, depression can lead to problems for you and your baby or child.
What are the signs of depression?
Depression can come on slowly, and the symptoms are different for each person. Some of the more common signs are:
changes in appetite, either eating too much or having little interest in food;
changes in sleep, either having trouble sleeping or sleeping too much;
fatigue or lack of energy;
feelings of great sadness, hopelessness or worthlessness;
crying for no reason; and
feeling little interest or pleasure in things you used to enjoy.
New moms with depression may have trouble caring for their baby. They may not want to spend time with their baby.
How does depression affect pregnant women?
Without treatment, pregnant women with depression tend to receive less prenatal care, don’t eat as well and don’t get enough rest. They are at risk of having a miscarriage, delivering their baby before their due date (preterm) or having a baby who is too small (low birth weight).
If depression isn’t treated during pregnancy, it can lead to postpartum depression. Postpartum depression is a serious condition that can last for months after giving birth and can affect the way a mother bonds with her baby.
What’s the difference between ‘baby blues’ and postpartum depression?
The ‘baby blues’ is a mild form of postpartum depression that many new moms experience. It usually starts one to three days after the birth, and lasts for about 10 days to a few weeks. With baby blues, many women have mood swings – they’re happy one minute and crying the next. They may feel anxious, confused, or have trouble eating or sleeping. The baby blues is very common – up to 80% of new moms have it, and it will go away on its own.
About 13% of new mothers experience postpartum depression, which is more serious and lasts longer. It can start up to a few months after childbirth. If you have a family history of depression or have suffered from depression before, you’re more at risk. Postpartum depression needs to be treated.
Some of the symptoms of postpartum depression include:
feelings of inadequacy (like you are not able to care for your baby);
extreme anxiety or panic;
having trouble making decisions;
feeling sad;
hopelessness; and
feeling out of control.
No one knows exactly what causes postpartum depression. If you think you may have postpartum depression, it’s important to get help. Talk to your doctor or call your local public health office.
How does a mother’s depression affect her children?
It’s important to remember that depression is treatable. But if depression is not treated, children will be affected.
Other things in a woman’s life may make the depression worse, such as financial or marital problems, or a very stressful life event (such as the death of a loved one).
Depression can cause mothers to be inconsistent with the way they care for their children. They may be loving one minute and withdrawn the next. They may not respond at all to their children’s behaviour or they may respond in a negative way. Depending on how old children are, they will be affected by their mother’s depression in different ways.
Babies
Attachment is a deep emotional bond that a baby forms with the person who provides most of his/her care (usually the mother). A ‘secure attachment’ forms when a mother responds to her baby’s needs consistently in warm and sensitive ways. Holding, rocking or talking softly to a baby all help promote attachment. Attachment helps provide a solid base from which a baby can explore the world. It makes a baby feel safe and secure, and helps them learn to trust other people.
A mother who is depressed may have trouble responding to her baby in a loving and caring way all the time. This can lead to an ‘insecure attachment’, which can cause problems during infancy and later in childhood.
Babies who don’t develop a secure attachment may:
have trouble interacting with their mother (they may not want to be with their mother, or may be upset when with them);
be withdrawn or become passive; or
develop skills later than other babies.
Toddlers and preschoolers whose mothers are depressed may:
be less independent;
be less likely to interact with other people;
have more trouble accepting discipline;
be more aggressive and destructive; or
not do as well in school.
School-age children may:
have behavioural problems;
have learning difficulties;
have a higher risk of attention deficit and hyperactivity disorder;
not do as well in school; or
have a higher risk of anxiety, depression and other mental health problems.
Adolescents whose mothers suffer from depression are at high risk for a number of problems including major depression, anxiety disorder, conduct disorder, substance abuse, attention deficit and hyperactivity disorder, and learning difficulties.
How is depression treated?
With treatment, most people recover from depression. Treatment often includes one or more of the following:
Medication: the drugs used most often to treat depression are called tricyclic antidepressants and SSRIs (selective serotonin reuptake inhibitors).
Individual therapy: talking with a psychologist, psychiatrist or other professional.
Family therapy: involves others in the family, like a partner or children. This may be helpful when children are older.
Social support: such as community services or parenting education.
If I take antidepressants during my pregnancy, will they hurt my baby?
To date, children whose mothers have taken these drugs during pregnancy have not had problems.
Some women think they should stop taking medication for depression when they are pregnant. If you are taking antidepressants and are thinking about getting pregnant (or are already pregnant), talk to your doctor first.
If I am taking antidepressants, can I breastfeed my baby?
In addition to having many health benefits for babies, breastfeeding helps mothers and babies bond.
If you are taking antidepressants, small quantities of them will come out through your breast milk. But studies have shown that children exposed to these drugs through breast milk have not had problems.
Even if you are taking antidepressants, you can breastfeed your baby for as long as you wish.
Should I take herbal remedies such as St John’s Wort?
There is not enough information about St John’s Wort to say that it is safe for pregnant or breastfeeding mothers. If you are pregnant or breastfeeding, talk to your doctor before taking any herbal products.
Additional resources
Many communities have support programs for new mothers. Talk to your doctor, nurse, midwife, or contact your local public health office or CLSC (Quebec) about services in your area.
Motherisk: provides information about prescription drug use during pregnancy or while breastfeeding at <www.motherisk.org> or 416-813-6780.
All together now: How families are affected by depression and manic depression, Health Canada: <www.hc-sc.gc.ca/hppb/mentalhealth/mhp/pub/together/index.html>.
Depression and manic depression, Canadian Mental Health Association: <www.cmha.ca/english/info_centre/mh_pamphlets/mh_pamphlet_15.htm>.
Helping children cope, Mood Disorders Society of Canada: <www.mooddisorderscanada.ca/helpingchildren/index.htm>.
Infant attachment – Helpful things for parents/caregivers to know, Health Canada: <www.hc-sc.gc.ca/hppb/mentalhealth/mhp/pub/fc/par_needtoknow.html>.
Postpartum depression, Canadian Mental Health Association: <www.cmha.ca/english/info_centre/mh_pamphlets/mh_pamphlet_pp.htm>.
Footnotes
This information should not be used as a substitute for the medical care and advice of your physician. There may be variations in treatment that your physician may recommend based on individual facts and circumstances.
May be reproduced without permission and shared with patients and their families.
Also available at www.caringforkids.cps.ca
Canadian Paediatric Society, 2204 Walkley Road, Suite 100, Ottawa, Ontario K1G 4G8, telephone 613-526-9397, fax 613-526-3332, Web site www.cps.ca