Major Depressive Disorder with Peripartum onset

Major Depressive Disorder with Peripartum Onset

Major Depressive Disorder (Single Episode) with Peripartum Onset is a mood disorder that had its onset either during pregnancy or in the first two years after welcoming a baby into the home. About 13 percent of pregnant women experience depression during pregnancy or in the month-long period after the delivery of their babies, with perinatal (in pregnancy or the postpartum period) mood and anxiety disorders (PMAD) impacting over one fifth of new mothers.

Perinatal mood and anxiety disorders

Perinatal mood and anxiety disorders are the most common complication of childbirth and can present in a number of ways, including fatigue, frequent crying, mood swings, scary and intrusive thoughts, and feelings of shame, guilt, hopelessness or rage. Perinatal distress can manifest in many forms which can interfere with an individual's efforts to get help. Major Depressive Disorder (Single Episode) with Peripartum Onset is one of several perinatal mood and anxiety disorders that can impact individuals during the perinatal period, including General Anxiety Disorder, Obsessive-Compulsive Disorder, Post Traumatic Stress Disorder, Bipolar Mood Disorder, and Psychosis.

Additionally, studies suggest that nearly one in four fathers experienced both anxiety and depression at some point during their children’s first year. It is not uncommon for the symptoms of MDD with peripartum onset to go undiagnosed for months or years after the birth of a child, as many of the symptoms are often brushed off as “normal parenthood stressors.”

Different depression, different treatment

There are three common types of depression, and treatment usually looks different for each kind.

• Dysthymia: having ongoing, low-level depressive symptoms
• Major Depression, Single Episode: Having had one period of moderate or severe depression
• Recurrent Major Depressive Disorder (Recurrent MDD): Having two or more periods of moderate or severe depression.

Another way some doctors characterize someone’s specific case of depression is “treatment-resistant” depression (TRD), which is when any of the above three diagnoses does not get better after being treated with at least two different categories of antidepressant medications. This is important to know, because there are some forms of treatment that are only approved for TRD. Some experts say that about 5 percent of women with peripartum major depressive disorder have treatment-resistant depression.

Major Depressive Disorder (MDD) Single episode with Peripartum Onset

With Major Depressive Disorder (MDD) Single Onset with Peripartum Onset, the individual is currently experiencing a depressive episode for the first time and it is one that had its onset either during pregnancy or shortly after delivery. There are many effective treatments for individuals with MDD with Peripartum Onset.

What it looks like

It is important to know the major components of Major Depressive Disorder (MDD) Single Episode with Peripartum Onset. Common symptoms may include the following:

• Having a sad mood
• Sleeping much more or much less every day than in the past
• Eating much more or much less than in the past, causing an unintentional weight gain or loss
• Having difficulty meeting the daily requirements of life, such as dealing with work and one's family
• Extreme fatigue much of the time
• Difficulty with concentrating most of the time
• Feeling like a worthless or bad person, although one hasn't done anything wrong
• Taking no pleasure in activities that formerly made one happy
• Laughing less often or never
• Thoughts of death or suicide

Some describe depression as feeling like their “tank” is empty. Others report feeling extremely sad, or they start to feel insignificant - that other people are looking right through them. Many people with depression stop getting pleasure from the things that used to make them happy, and can’t imagine being happy again. They sometimes wonder “if it’s all worthwhile,” and imagine how life would be if they weren’t around. The depressed mind can play horrible tricks on one’s thinking.

Major Depressive Disorder (MDD) Single Onset with Peripartum Onset often presents as severe anxiety and/or obsessions. Karen Kleiman, a leading expert in postpartum depression, states: “postpartum depression, whether mild, moderate, or severe, is generally a very agitated depression. The term postpartum depression itself can be misleading to both sufferers and health providers because it often presents with anxiety or obsessional thoughts rather than depressive symptoms.

The acute anxiety may be unlike any the client has experienced and is easy to neither endure nor conceal…postpartum anxiety, however, is unique in that it often relates directly to the baby, ranging from over worrying to hypervigilant, obsessive worries to scary, intrusive thoughts about hurting the baby. When the baby is involved in the anxious thought process, it very quickly propels the anxiety to absolute panic. This state of intense agitation is difficult for the client to go through, difficult for loved ones to observe, and difficult for the clinician to interpret.” While intrusive thoughts and obsessions during MDD with peripartum onset are a normal part of the symptoms profile, these symptoms can be frightening to experience.

Having depression is nobody's fault

Many individuals with Major Depressive Disorder (MDD) Single Onset with Peripartum Onset may blame themselves for not being able to “shake” their feelings. But depression is no one’s fault. And, most of the time, it is highly treatable. Blaming oneself for depressive symptoms is like people blaming themselves for having brown eyes or blonde hair. Depression is no one’s fault.

The ongoing management of Major Depressive Disorder (MDD) Single Episode with Peripartum Onset

When a depressed person feels better as a result of medication, therapy, or circumstances, they might assume they are cured, and stop taking their medication. The illusion of being “cured” is enticing, and it is common to feel well when depression is being treated. But, oftentimes ongoing treatment is necessary. This approach is different from taking an antibiotic for a week for an infection and achieving a complete recovery. It’s important to distinguish whether signs of improvement are a response to the treatment or the elimination of the depressive episode.

In the case of Major Depressive Disorder (MDD) Single Episode with Peripartum Onset, when the medication is working and helping a person, this is a positive indicator of its effectiveness rather than a sign the underlying depression is gone. For that reason, the process of determining if a person is ready to stop treatment should be made in partnership with a health care provider to avoid stopping medication too abruptly or too soon.

Outlook

While living with Major Depressive Disorder (MDD) Single Episode with Peripartum Onset can present unique obstacles, and finding the best treatment may take several tries, the right treatment can dramatically improve one’s quality of life. The majority of people who are properly diagnosed and treated for Major Depressive Disorder (MDD) with Peripartum Onset gain transformative results. In fact, people who have received medical treatment for their depression often say that starting an antidepressant was one of their most important positive decisions. With treatment, people with peripartum depression can reclaim their lives.

In good company

Many prominent individuals have struggled with peripartum depression, including singer Celine Dion, actress Brooke Shields, and actress Gwyneth Paltrow. Individuals who struggle with depression during pregnancy or soon thereafter are not alone in suffering from this condition.

The current thinking on what causes MDD with Peripartum Onset

In the past, doctors have explained conditions such as depression as a “chemical imbalance.” This may make it seem like depression is similar to a vitamin or mineral deficiency, and that just taking the right drug will easily cure someone. Unfortunately, depression is more complicated, and it’s unclear whether the imbalance causes depression, or the depression causes the imbalance, or other factors entirely. And what’s more, there is disagreement over whether people are born with the imbalance or it gets triggered by the environment. Most likely, it’s a combination of both.

In support of “chemical imbalance” being a cause, medications that act to increase brain chemicals such as serotonin, dopamine, or norepinephrine often make depressed people feel better. In fact, by increasing the levels of neurochemicals in the brain, symptoms of depression can sometimes be quickly resolved.

Depression may also be genetic, and healthcare providers may say that it “runs in families.” If a parent or sibling has depression, it often puts their relatives at increased risk for having an episode. But, it is a complicated issue: Some people have many depressed family members, and they never develop depression. In contrast, some people deny having depressed relatives yet they develop the condition. Researchers are constantly studying the causes and potential ways to mitigate the effects of this common condition.

Other possible causes of MDD with Peripartum Onset are the sometimes dramatically fluctuating hormone levels that occur during pregnancy, as well as the hormonal changes that occur during the month-long period after the delivery of the baby, and especially directly after the delivery of the infant. Even among women who do not experience MDD with Peripartum Onset, many new mothers report experiencing the “baby blues,” or a low level of sadness that remits within several weeks after delivery, and is likely due to hormonal changes.

In addition, there are major environmental changes to adjust to with a new baby; for example, although new parents may receive help from a spouse or partner, often they must adapt to many new experiences, such as frequent awakenings and feedings for a newborn infant, as well as the sometimes overwhelming feeling of being totally responsible for a helpless child. This is also true for a parent who has had children before this new baby. These changes may lead to sleep deficit, by itself a possible trigger to depressive symptoms. Parenting a newborn can be both physically and psychologically challenging for many people, because there are so many demands on the new parent’s time and energy.

These challenges can be exacerbated by the systemic lack of support facing today’s parents including absence of parental leave policies and the rising costs of daycare, together with the emotional expectations of this time period.

Additionally, some pregnant women have gestational diabetes, which is diabetes that only occurs during pregnancy, and these women may have an increased risk for depression because of the additional burden and constraints that the disease overlays on the woman. Women with gestational diabetes must take extra measures with their personal care, such as testing their blood sugar multiple times each day and watching their diet more carefully than most pregnant women do, not only for the sake of their own health but also for the sake of their child. They may also need to inject insulin to control their blood sugar, and combined with the frequent testing, this can be stressful for many women.

Researchers have also found that women who have cesarean sections to deliver their babies as well as women with prolonged and difficult labors are more likely to experience peripartum depression.

Some researchers have found that smoking cigarettes during pregnancy triples the risk for MDD with Peripartum Onset, and certainly women who smoke prior to pregnancy should end their smoking habit during the pregnancy. According to the Centers for Disease Control and Prevention (CDC), 5.5 percent of pregnant women in the United States reported smoking during pregnancy in 2020.