The word ‘Perinatal’ refers to the time when a woman is pregnant, right through to the end of the first year of the baby’s life.
There are a number of treatment options for women with perinatal depression, both pharmacological and non-pharmacological. Talking about symptoms with a healthcare professional can help decide the best treatment path for each woman.
The most important message is that early treatment is really helpful.
- Treating women who are depressed during pregnancy reduces the risk of subsequent postpartum depression.
- Treating postpartum depression in a woman provides the best chance of her enjoying her baby and promotes a healthy start for the baby too.
- Treatment may also reduce the risk of future depressive episodes.
Any woman who is concerned about her mood during pregnancy or following the birth of her baby should talk to her healthcare provider. With the right care, many women find that their symptoms decrease and they start to enjoy pregnancy and the months following the birth.
Women are sometimes concerned about being treated with medications, particularly when they are pregnant or breastfeeding. Not everyone requires anti-depressant treatment. Women should be offered education and counselling as first line treatment. Only women with moderate to severe symptoms may require additional treatment with anti-depressants.
Decisions about medication are important and should only be taken in discussion with a professional healthcare provider. Women who have been diagnosed with depression and have been prescribed medications before becoming pregnant should not suddenly stop taking them when pregnant, but should discuss options carefully with a healthcare provider as soon as they can. Later in this section there is a discussion about medications that my be safely prescribed during pregnancy or when breastfeeding.
When non-pharmacological treatment options form part of the woman's treatment plan, treatments may be offered individually or as part of a group.
Non-pharmacological treatment options
It is sometimes difficult for women to find the time to take care of themselves. However, self-care is a way to make some positive changes that will help to lessen depression and promote the woman’s own good health. While self care on its own may not be enough to cope with and recover from depression, it is helpful alongside other treatments and as part of maintaining wellness. An easy way to remember the basic steps to self care is to think of the word ‘NESTS’.
Each letter stands for one area of self care
- Nutrition – trying to eat nutritious foods throughout the day.
- Exercise – getting regular exercise, if you can manage it, helps to reduce stress and promote health. Even a small amount of physical activity can help.
- Sleep and Rest – often in short supply with a new baby but it is worth the effort to get more rest.
- Time for yourself – take some time each day to do this, even if just for a few minutes.
- Support – everyone needs this. Don’t be afraid to ask for help and information.
More detail on self care is available for download from the Guides Depression during pregnancy and after the birth and Anxiety during pregnancy and after the birth.
Psychoeducation and Counselling
Psychoeducation and counselling can be individual or group therapy. It offers support, reassurance and education for women with perinatal depression and involves learning new tools for coping and also building on social supports. Your partner or other family members may be included. A range of groups are offered at the BC Reproductive Mental Health Program. See the Resources section for more information.
Guided self-management includes regular appointments with a healthcare professional for support using self care information and workbooks. There are workbooks for both Depression and Anxiety during pregnancy and following the birth in the Publications section of this website.
Cognitive Behaviour Therapy (CBT)
CBT is based on the evidence-based view that the way we think and behave affects the way we feel. Depressed women may experience negative thoughts that they find difficult to stop. In CBT, the therapist helps the woman set realistic goals to change the way she behaves, identify her distorted thinking patterns and develop more realistic thoughts.
Interpersonal Therapy (IPT)
Interpersonal therapy focuses on the interactions between the woman and significant people in her life. It includes regular appointments with a healthcare professional on a one-to-one or group basis.
Couples counselling assists women and their partners to develop strategies to cope with this stressful time, particularly if depression is causing conflict within the relationship. It is noteworthy that up to 10% of new fathers may suffer from depression.
Public Health Nurses in conjunction with other community service providers may co-facilitate postpartum support groups. Peer support groups are offered by several non-profit organizations across B.C. Community Mental Health Teams may offer general depression support groups. There is more information on possible contacts for support groups in the Resources section of this website.
Medication may be required for women with moderate to severe depression in conjunction with psychotherapeutic treatments. Medication may help relieve symptoms allowing the woman to pursue counselling, make life-style changes and improve their overall quality of life.
How do antidepressants work?
The most commonly used anti-depressants are the SSRIs (Selective Serotonin Reuptake Inhibitors) and the SNRIs (Serotonin and Norepinephrine Reuptake Inhibitors). In individuals with major depression, the ability of the brain to use chemical messengers, called serotonin and norepinephrine, are thought to be lower than in non depressed individuals. The SSRIs and SNRIs increase the amount of serotonin and norepinephrine available to the brain. These medication have been shown to lower the symptoms for some people with moderate to severe depression.
Different women may have a better response to one antidepressant over another and your healthcare provider will talk with you about options. It may take up to three to four weeks for the antidepressant to take effect. It is important to take the medication for long enough to know whether it is improving the depression. Side effects of the SSRIs and SNRIs are common and may include headaches and stomach upset. These side effects usually resolve within two to three weeks by which time you should be beginning to feel better.
It is important to take the medication at the same time every day and to take it for up to one year once established.
Antidepressant Medication during Pregnancy or when breastfeeding
Treatment with appropriate medication for women suffering from severe depression during pregnancy or postpartum and breastfeeding is a viable, but challenging option.
All antidepressants exposure effects for the developing fetus or the breastfed baby. The goal of treatment is to minimize these exposure effects. Women should be maintained on the lowest possible dose that will have an antidepressant effect.
Anti-depressants as a group are not associated with an increased risk for birth defects. Some babies may have mild exposure symptoms of jitteriness and mild breathing difficulties which usually resolve quickly without treatment. Breastfed babies are exposed to very small amounts of anti depressant in breast milk and most experience no adverse effects.
The risk of exposing a baby to the antidepressant medication (no matter how low the dose) has to be weighed against the risk of untreated depression.
Untreated depression during pregnancy and the postpartum period puts women at risk for:
- low levels of prenatal care
- low birth weight baby
- increased risk of substance use and smoking
- bonding difficulties between the mother and her baby with a risk of impaired cognitive development of the baby, including language and social skills
Talk to your healthcare provider who can explain the side effects and exposure effects of medication and help you to make the decision about the right treatment path for you.
More information is available in the BC Reproductive Mental Health Program's Perinatal Depression treatment Options Fact Sheet and in the guide Coping with Depression During Pregnancy and After the Birth.