Perinatal Depression Part I
Perinatal depression is defined as any minor to major episode of depression during the perinatal period with symptoms including constant exhaustion, poor concentration, feelings of overwhelm, numbness, sadness, or thoughts of wanting to harm themselves and their baby. The perinatal period begins at conception and lasts one year post birth, but may extend further if mothers continue to breastfeed their infants. This time can be a significant adjustment for mothers and their partners.
STATISTICS
50% of cases begin in the first trimester, with 20% of women and 10% of partners affected worldwide; however, lower income and minority groups are closer to 40%. In Australia, 1 in 10 women experience depression during pregnancy and 1 in 7 the year after birth. 1 in 5 mothers with children under two years of age are diagnosed with perinatal depression, equating to 111,000 cases of perinatal depression diagnosed per year. Furthermore, suicide is the leading cause of maternal deaths in Australia today. Perinatal depression is more common in mothers under 25 years, women from lower-income homes, smokers, obese women and those needing emergency caesareans. It is less common in higher-educated mothers, working mothers and those receiving suitable maternal care. Higher risk categories include a history of sexual abuse or domestic violence. Globally, 50-70% of women diagnosed with perinatal depression are left untreated. Of these, 25% experience recurrent depression throughout their lives and 25% will develop a chronic illness.
PATHOPHYSIOLOGY
During the perinatal period, the HPA axis goes through dramatic changes. Cortisol levels rise threefold by the third trimester, following a rapid drop in cortisol 24 hours to 3 days post partum lasting up to three months before normalising. Significantly low cortisol levels have been recorded at 3 days, 6 weeks and 12 months post-partum, with hypocortisolaemia associated with chronic depression in non-pregnant people. Hormonal changes, HPA axis dysregulation and genetics may contribute to perinatal depression, however factors such as a history of mental illness, poor maternal care, and a histoy of previous trauma, specifically sexual or physical abuse, are important risk factors to consider when treating patients experiencing perinatal depression.
PART II - Current Medical Treatment vs Alternative Therapies….cont’d in next blog post.
REFERENCES
Australian Institute of Health and Welfare. (2012). Experience of perinatal depression: Data from the 2010 Australian National Infant Feeding Survey. 97(4). Retrieved from https://www.aihw.gov.au/reports/primary-health-care/perinatal-depression-data-from-the-2010-australia/contents/table-of-contents
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Austin M-P, Highet N, & the Expert Working Group. (2017). Mental Health Care in the Perinatal Period: Australian Clinical Practice Guideline. Melbourne: Centre of Perinatal Excellence. Retrieved from https://www.cope.org.au/wp-content/uploads/2018/05/COPE-Perinatal-MH-Guideline_Final-2018.pdf
Buckley, S. J. (2015). Executive Summary of Hormonal Physiology of Childbearing: Evidence and Implications for Women, Babies, and Maternity Care. The Journal of Perinatal Education, 24(3), 145–153. https://doi.org/10.1891/1058-1243.24.3.145
Duthie, L., & Reynolds, R. M. (2013). Changes in the Maternal Hypothalamic-Pituitary-Adrenal Axis in Pregnancy and Postpartum: Influences on Maternal and Fetal Outcomes. Neuroendocrinology, 98(2), 106–115. https://doi.org/10.1159/000354702
Fitelson, E., Kim, S., Baker, A. S., & Leight, K. (2011). Treatment of postpartum depression: Clinical, psychological and pharmacological options. International Journal of Women’s Health, 3(1), 1. https://doi.org/10.2147/IJWH.S6938
Lam, R. W., Tam, E. M., Grewal, A., & Yatham, L. N. (2001). Effects of Alpha-Methyl-Para-Tyrosine-Induced Catecholamine Depletion in Patients with Seasonal Affective Disorder in Summer Remission. Neuropsychopharmacology 2001 25:1, 25(1), S97–S101. https://doi.org/10.1016/s0893-133x(01)00337- 2
Meltzer-Brody, S. (2011). New insights into perinatal depression: Pathogenesis and treatment during pregnancy and postpartum. Dialogues in Clinical Neuroscience, 13(1), 89. https://doi.org/10.31887/DCNS.2011.13.1/SMBRODY
Perry, D. F., Nicholson, W., Christensen, A. L., & Riley, A. W. (2011). A Public Health Approach to Addressing Perinatal Depression. International Journal of Mental Health Promotion, 13(3), 5–13. https://doi.org/10.1080/14623730.2011.9715657
RANZCOG. (2018). Perinatal Anxiety and Depression. Retrieved 11th July, 2021 from https://ranzcog.edu.au/RANZCOG_SITE/media/RANZCOG-MEDIA/Women's%20Health/Statement%20and%20guidelines/Clinical-Obstetrics/Perinatal-Anxiety-and-Depression-(C-Obs-48)-Review-March-2015.pdf?ext=.pdf
Seth, S., Lewis, A. J., & Galbally, M. (2016). Perinatal maternal depression and cortisol function in pregnancy and the postpartum period: A systematic literature review. BMC Pregnancy and Childbirth 2016 16:1, 16(1), 1–19. https://doi.org/10.1186/S12884-016-0915-Y
