Start of Mom’s Depression Determines Severity

Start of Mom’s Depression Determines Severity


Depression that begins before or during pregnancy, not after, is often more severe, lasts longer and usually goes undetected until a doctor screens the mom for it after the birth, according to a new study.

“There’s a difference between postpartum depression and depression that started before or during the pregnancy,” said Sheehan Fisher, instructor of psychiatry and behavioral sciences at Northwestern University Feinberg School of Medicine. “It’s not a homogenous disorder. When clinicians see a mother during the postpartum period and diagnose her with depression, it’s important for them to ask how long this depression has been an issue so they can assess the longevity and severity.”

The study, published in the Journal of Affective Disorders, is one of the first to evaluate the rate of depression in mothers at the three different onset time points: Nearly 25 percent of participants developed depression before the pregnancy, more than 36 percent developed it during the pregnancy and 38 percent developed depression during the postpartum period. During a four- to-six-week postpartum period, associated with highest depression onset, 727 women from an urban women’s hospital in Pittsburgh were evaluated.

Researchers found that mothers who develop depression during the postpartum period are more likely to be older, educated white women who are married or living with their partners and have private health insurance.

“Mothers who develop postpartum depression often experience protective risk factors such as better access to resources, have fewer children and are more mature, which helps them adapt to the stress of pregnancy,” Fisher says. “Once their babies are born, they show more obsessive-compulsive symptoms—like over-worrying about their baby’s health—than mothers who developed depression before or during pregnancy.”

Women who had depression before they became pregnant were more likely to have difficulty falling asleep. They also experienced more symptoms of paranoia, such as a psychotic episode, than women who developed depression during or after pregnancy. They also had more severe postpartum depression than the other onset periods.

The proportion of mothers with bipolar disorder, marked by dramatic mood swings and more severe than straight or unipolar depression, was significantly higher among mothers whose depression began during the pre-pregnancy period (38.7 percent), compared with during the pregnancy (22.6 percent) and postpartum (17.9 percent).

In the study, agitation was the distinctive factor that differentiated mothers with unipolar and bipolar depression. Mothers who had a bipolar disorder and developed depression during pregnancy exhibited the highest amount of agitation.

Other recent research shows African-American and Latina women have higher rates of postpartum depression than their white counterparts.