"Dammit, Mother Nature!" Prepartum Depression and Misdiagnosis

Wednesday, November 01, 2017 by Meg   •   Filed under Depression

Postpartum depression (or Major Depression with peripartum onset) is not a separate disorder from prepartum depression in the Diagnostic and Statistical Manual-V. And even though the official diagnosis states that the symptoms of postpartum depression should appear in the first four weeks after birth, most practitioners are aware that postpartum depression can start at any point from the time pregnancy starts to a year following birth. 

But this confusion with diagnostics leads to some very bad things, namely that some women who need assistance during their pregnancies don’t get it. Many don’t recognize that Major Depression can rear it’s ugly head during this timeframe and fuck up every baby shower and cake eating party you have planned while you are enjoying your ballooning waistline. 

This is perhaps why prepartum depression is not much discussed. Women don’t know it’s a thing. Some doctors don’t know it’s a thing. But it is. And when pregnant women are depressed they might need help in order to care for themselves and their bun in the oven. 

I have a series on PPD starting here and for more info on postpartum psychosis, check this out

But here’s a quick run down. 

What are the Symptoms of Prepartum Depression?  

You might have prepartum depression if you have any of the following for more than two weeks: 

  • Sadness or feeling “down”
  • Helpless, hopelessness or worthlessness
  • Trouble with concentration
  • Anhedonia (lack of joy in things you used to like)
  • Changes in sleep
  • Changes in eating habits (eating too much or too little)
  • Thoughts of death or suicide
  • Anxiety with or without panic attacks
  • Irritability or anger
  • Guilt that is unfounded

Depression during pregnancy is more likely to happen if you have pregnancy complications, a previous pregnancy loss, have gone through infertility issues or are under stress such as having financial or relationship troubles. You are also more likely to suffer from any type of depression if you have a prior history of depression, or a history of abuse or trauma (see more about predisposing factors here in What is Depression?)

Challenges Unique to Prepartum Depression

Prepartum Depression and Misdiagnosis

The biggest issue with prepartum depression is that people don’t recognize it for what it is. The symptoms of prepartum depression are often misdiagnosed as normal hormonal shifts related to pregnancy, because many of them overlap. “Mommy Brain”, for instance, begins during pregnancy and can trigger concentration problems (more here in What Your Doctor Hasn't Told You About Mommy Brain). Premenstrual Dysphoric Disorder (PMDD) (more here) and even standard PMS come with hormonal alterations in our brains that can trigger depressive symptoms. And changes in appetite? Puh-lease. I once ate an entire deli-style corned beef ruben that was on the menu for three to four people. Two and a half pounds of beef and sauerkraut ain’t got nothing on a pregnant, still breastfeeding, mama.  

Mixed Emotions During Prepartum Depression

In addition, prepartum depression and postpartum depression both come with the added challenge of mixed emotions which can obscure the depression further. There is depression, but there is also excitement. There is sadness but there is also amazement that there is a person growing in there. There is love, but there is also an underlying ambivalence about the whole thing. And when people ask how you feel, most women will answer with the happier of the two emotions. It is a severely lonely position to be in and makes many women feel that much more disconnected from those around them. And still it goes untreated. 

What Can I Do About Prepartum Depression? 

The treatments for prepartum depression will be similar to those for postpartum depression and come with the added challenge of treating mom while avoiding side effects for babies. 

  • Find Support. You might be surprised by how many of your friends have experienced something similar. Talk about your feelings with them. Avoid loneliness and isolation by visiting with loved ones or having a poker night with the girls. No matter how introverted you think you are, don’t spend too much time alone. (Read more on the evolutionary reasons for this in PPD and The Benefits of Sister Wives.
  • Get Help. Therapy is very effective in treating depressive disorders, generally just as effective as medication treatment. Find a professional nearby you can talk to who will help you address the depressive symptoms. This might include general support and challenging scary or negative thoughts with CBT techniques such as thought replacement or mindfulness. 
  • Medications.  There are a number of medications that are safe while pregnant, but they might be different than those that are safe during breastfeeding so take this into consideration if you are planning to nurse (or make sure to change drugs after the birth). 
  • If your case is especially severe or comes with psychosis, your doctor may recommend Electroconvulsive Therapy.
  • Check out the books listed below for additional information and stories from other mothers. 

For more natural treatments for pre and postpartum depression, check out the next post: 4 Alternative Treatments for PPD That You Need to Know About. 

Related Posts: 

Topic-Relevant Resources

The Postpartum Husband: Practical Solutions for living with Postpartum Depression
A concise, practical guide full of useful information for the loved ones of those suffering with PPD

The Mother-to-Mother Postpartum Depression Support Book
A book on postpartum depression written by mothers, for mothers.

Against Depression
Detailed explanations of the systems involved in depression along with personal stories of success from psychiatrist Peter Kramer.

This Isn't What I Expected [2nd edition]: Overcoming Postpartum Depression
A great guide on combatting postpartum depression. You're not alone.