Royal Alexandra Hospital Foundation

Written by Kristin Baker, originally created and published for shoppersloveyou.ca.

Sometimes it’s difficult to tell if the moods and feelings you experience during and after pregnancy are normal. Many women discount their feelings of anger, irritability, worry or sadness as ‘hormones’ or chalk it up to having a bad day. But if these feelings persist, they may signal a perinatal mental health issue.

What are perinatal mental health issues?

Perinatal mental health issues include depression, anxiety or stress that can affect a woman during pregnancy and after the birth of her child.

“Depression and anxiety are the most common complications of pregnancy,” says Dr. Dawn Kingston, RN, PhD, an expert in perinatal mental health at the Lois Hole Hospital for Women. “There’s far more of mix of anxiety and depression in the perinatal period than there is outside of it.”

In fact, one in four women experiences a perinatal mental health issue, and 80% of women who have postpartum depression or anxiety showed signs of it during pregnancy.

What causes it?

Many women are predisposed to perinatal anxiety and depression – pregnancy hormones actually have very little to do with it. If you had pre-pregnancy anxiety or depression, this is the biggest predictor that you may experience it again during pregnancy.

You may also be susceptible if you have any of these other key risk factors:

• High levels of stress
• Partner conflict
• Low social support

What are the signs and symptoms of perinatal depression or anxiety?

Chronic stress is one of the key risk factors for depression and anxiety, both in pregnancy and postpartum. As it goes on, this stress can develop into feelings that you may not associate with depression and anxiety, such as irritability and anger. A lot of the things you would have traditionally used to cope with stress may also go by the wayside, and depression starts to set in.

 You may also experience symptoms such as:

• Tiredness
• Low energy
• Disinterest in exercise or socializing
• Low mood
• Irritability or edginess
• Anger
• Constant worry

In many cases, pregnant women don’t understand whether or not these feelings are normal. If you recognize any of these signs or symptoms in yourself, tell your doctor, clinic nurse, or other primary care provider. They can help to diagnose you and begin treatment.  

Importance of early detection

The sooner you recognize symptoms of perinatal depression or anxiety, the sooner you can start to get help. “When it comes to depression, women think they have to be at a point where they’re just not functioning at all. And that’s really late,” says Dr. Kingston.

Early help can combat the distress that perinatal depression and anxiety can cause for you and your family. But many women are reluctant to tell their doctor about their symptoms. Sometimes this is because they don’t know perinatal depression or anxiety exists; sometimes it’s because they want to be a ‘good patient’ and don’t want to ‘waste’ their doctor’s time.

In Canada, screening for perinatal mental health issues isn’t usually part of a regular prenatal visit. But if you’re concerned about anything you’re feeling or experiencing, bring it up with your healthcare provider. You’re not alone and you don’t have to suffer in silence!

What if a friend or family member is showing signs?

Often, if a woman is experiencing symptoms, she may not recognize them as signs of perinatal depression or anxiety. Rather than raise the issue with her doctor, she will tell her spouse, mother or friend. Very often, these well-meaning friends and family will dismiss the concerns as just part of pregnancy, which can lead to the woman not seeking professional help.

If you suspect that someone close to you is experiencing perinatal depression or anxiety, one of the key things you can do is talk to her and be receptive to her feelings. “Lots of times, people need permission to start talking. This kind of an open invitation from a caring individual is powerful,” Dr. Kingston says. “The way to bust stigma is to open up a conversation!”

Can perinatal depression and anxiety be prevented?

Managing the stress in your life can lower the chances that you will develop mental health concerns during pregnancy. You can do this by incorporating three simple strategies into your life:

• Exercise regularly
• Enjoy nature
• Talk to friends

“Part of anxiety and depression is having unhealthy thoughts ‘stick’. When you get out and walk in nature with a friend to talk to, you can shift that sticky thought,” says Dr. Kingston.

What are some of the treatments?

If exercise, being in nature and talking to friends aren’t working to reduce your stress, you may benefit from online or in-person talking therapies. Both cognitive and interpersonal therapies show the most evidence for supporting people, says Dr. Kingston. These therapies help you to identify your thinking patterns and their impact on behaviour and can also help you to deal with stressful conflict in your relationships.