Maternal Mental Health: Effective Intervention for Perinatal and Postpartum Depression
Behavioral Health Insights
By Micah Hoffman, MD, DABPN, FAPA, QME, CIME, CHCQM
AllMed Behavioral Health Medical Director
Pregnancy and childbirth can trigger powerful emotions. Of these, joy gets the most attention, but fear and anxiety often also apply. Feeling worried or doubtful is normal, especially for first-time parents dealing with hormonal, physical, emotional, financial, and social changes. But too often what’s dismissed as “normal” worry or fatigue is, in fact, a more serious form of depression. Sometimes overlooked due to stigma or lack of awareness, perinatal and postpartum depression can have negative consequences that extend beyond the woman and infant to the entire family and community. For providers and health plans, understanding the nuances of these conditions and knowing how and when to intervene appropriately are essential to providing optimal care for new-parent members.
Prevalent and Often Preventable
Studies show a higher prevalence of anxiety and depression among women than men.1 Multiple factors contribute to women’s increased risk, including hormonal and endocrine changes during the different stages of the reproductive cycle, individual vulnerabilities stemming from genetics, and psychosocial and socioeconomic factors.
Pregnancy and supporting children are significant and complicated stressors that contribute to mental health disorders in women, sometimes with dire consequences. Maternal mortality is usually discussed in connection with childbirth, but what’s not commonly known is that suicide is a leading cause of maternal mortality in the United States.2
While not all maternal mental health conditions lead to such tragic results, untreated postpartum depression can have multiple potential negative effects on maternal-infant attachment and on child development, with costly downstream repercussions for society. Centers for Disease Control (CDC) data suggests that as many as one in eight new mothers are affected3, so it’s not surprising that postpartum depression increasingly is cited as a public health issue.
Notably, many of the negative consequences are preventable because both perinatal and postpartum depression respond to early interventions and/or treatment. Recommended approaches include counseling and behavioral interventions and, in some circumstances, antidepressant medications.
Three Degrees of Postpartum Depression
There are three types of postpartum mood disorders, distinguished by level of severity:
Between 50% and 75% of women experience what’s known as “the baby blues” after giving birth as their bodies reacclimate hormonally to no longer being pregnant.4 Symptoms include mild mood shifts, crying for no apparent reason, sadness, or anxiety—but nothing that should be alarming. The baby blues typically subside within two weeks without treatment. Receiving support from friends, family, and partner is the most effective help during this time.
A far more serious form of postpartum depression affects roughly one in seven new parents.5 For them, alternating highs and lows, frequent crying, irritability, and fatigue added to feelings of guilt and anxiety can result in a woman being unable to care for her baby or herself. Symptoms range from mild to severe and may appear within a week of delivery or gradually, even up to a year later. Signs to watch for include a condition referred to as “wired tired,” in which the new mom is exhausted due to sleep deprivation but unable to sleep when given the opportunity. Psychotherapy is the most often prescribed treatment, sometimes with antidepressants and/or anti-anxiety medication. It’s important for women and their providers to work together to weigh the potential risks and benefits of specific medications.
Relatively rare but most severe is postpartum psychosis. Affecting only one to two in 1,000 people after delivery, postpartum psychosis symptoms generally appear soon after delivery and may last weeks to several months.6 Symptoms may include severe agitation, paranoia, and/or intrusive thoughts or delusions, sometimes of harm to self or baby. Postpartum psychosis requires immediate medical attention due to the increased risk of suicide and harm to the baby. Treatment usually includes hospitalization, psychotherapy, and medication.
Effective Preventive and Therapeutic Treatments
Universal screening for depression and substance use and integrating mental health treatment into primary and prenatal care can enhance prevention efforts. Practices across the U.S. are adopting these processes as more move toward integrative medicine.
Treatment may look different depending on the type and severity of symptoms:
Education plays a vital and fundamental role in the treatment process for all new parents and their families. Learning how lifestyle changes can affect well-being and how to recognize symptoms of depression can go a long way to preventing or minimizing the impact of maternal mental health issues.
Similarly, sleep and social support are two indispensable elements of treatment. For some women who are experiencing the baby blues or mild depression, bringing family members from out of town to help care for the baby and household may provide sufficient support. For others with more serious conditions, antidepressant medications such as selective serotonin reuptake inhibitors (SSRIs) may also be needed. It’s important to note that SSRIs should be started as soon as possible as they take several weeks to start working.
When women present in the emergency room (E.R.) with signs of postpartum psychosis, ruling out the possibility of underlying medical or substance abuse issues is a critical step in identifying appropriate treatment. For E.R. medical professionals, checking labs and doing a urine screen are crucial prerequisites to developing an informed care plan.
The Right Care at the Right Time
At AllMed, our board-certified mental and behavioral health specialists understand postpartum mental health as a key component of women’s overall health. Drawing on extensive clinical experience, they review each postpartum case with care, looking for possible risk factors and warning signs. AllMed experts synthesize case-specific information and their own up-to-date expertise to provide evidence-based guidance that ensures members receive the right postpartum care at the right time.
In my next article, I’ll explore the implications of recent legislation restricting medical and reproductive care on women’s mental health and on U.S. society. Check back in this space soon.
- Kalin, Ned. The Critical Relationship Between Anxiety and Depression. The American Journal of Psychiatry. May 1, 2020. https://doi.org/10.1176/appi.ajp.2020.20030305. Accessed Jan 26, 2023.
- Chin K, Wendt A, Bennett IM, Bhat A. Suicide and Maternal Mortality. Curr Psychiatry Rep. 2022 Apr;24(4):239-275. doi: 10.1007/s11920-022-01334-3. Epub 2022 Apr 2. PMID: 35366195; PMCID: PMC8976222. Accessed January 23, 2023.
- Centers for Disease Control and Prevention. Depression Among Women. May 23, 2022. Accessed January 23, 2023.
- Rezaie-Keikhaie, M.E. Arbabshastan, H. Rafiemanesh, M. Amirshahi, S.M. Ostadkelayeh, A. Arbabisarjou. Systematic review and meta-analysis of the prevalence of the maternity blues in the postpartum period. J. Obstet. Gynecol. Neonatal Nurs., 49 (2020), pp. 127-136, 10.1016/j.jogn.2020.01.001. Accessed January 23, 2023.
- Mughal S, Azhar, Y, Siddiqui, W. Postpartum Depression. National Library of Medicine. October 7, 2022. https://www.ncbi.nlm.nih.gov/books/NBK519070/. Accessed January 23, 2023.
- Sehar R, Syed R. Postpartum Psychosis. National Library of Medicine. June 27, 2022. Accessed January 23, 2023.