Depression that begins before or during pregnancy, rather than after, is often more severe because it lasts longer and usually goes undetected until a doctor screens for it after the birth.
“There’s a difference between postpartum depression and depression that started before or during the pregnancy. It’s not a homogenous disorder,” says Sheehan Fisher, instructor of psychiatry and behavioral sciences at Northwestern University Feinberg School of Medicine.
“When clinicians see a mother during the postpartum period and diagnose her with depression, it’s important for them to ask how long this depression has been an issue so they can assess the longevity and severity.”
The study is one of the first to evaluate the rate of depression in mothers at the three onset time points: 24.9 percent of participants developed depression pre-pregnancy, 36.7 percent developed it during pregnancy (prenatal), and 38.4 percent developed depression during the postpartum period.
Mothers who develop depression during the postpartum period are more likely to be Caucasian, older, educated, married or cohabitating, and have private health insurance than mothers whose depression begins before or during pregnancy, according to the study that is published in the Journal of Affective Disorders.
“Mothers who develop postpartum depression often experience protective risk factors such as better access to resources, have fewer children, and are more mature, which helps them adapt to the stress of pregnancy,” Fisher says. “Once their babies are born, they show more obsessive-compulsive symptoms—like over-worrying about their baby’s health—than mothers who developed depression before or during pregnancy.”
Women who had depression before they became pregnant were more likely to experience hypersomnia or difficulty falling asleep. They also experienced more symptoms of paranoia, such as a psychotic episode, than women who developed depression during or after pregnancy. And they had a higher severity of postpartum depression than the other onset periods.
The proportion of mothers who had a bipolar disorder, which is more severe than unipolar depression, was significantly higher among mothers whose depression began during the pre-pregnancy period (38.7 percent), compared with prenatal (22.6 percent) and postpartum (17.9 percent).
Agitation was the distinctive factor that differentiated mothers with unipolar and bipolar depression in the study. Mothers who had a bipolar disorder and developed depression during pregnancy exhibited the highest amount of agitation.
The study evaluated depression symptoms during the four- to six-week postpartum period for 727 women from an urban women’s hospital in Pittsburgh. This period was chosen because women typically visit their doctors for post-birth evaluations six weeks after birth, and the four- to six-week time period is associated with the highest depression onset.
The National Institute of Mental Health supported the study.
Source: Northwestern University