Mental Health

Key Messages

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These are the main health messages that should be conveyed to all future and new parents. They have been written in the second person and at a reading level appropriate for the general public so that they can be shared with them directly. They are based on a consensus founded in scientific research and professional practice. Clicking an underlined word or group of words in the text will redirect you to the section in Supporting Evidence that deals with that topic.

key message

How you feel mentally affects your whole body. Take care of your mental health before, during, and after pregnancy.

You can take care of your mental health by:

  • Taking time to relax.
  • Getting enough sleep.
  • Building a support network.
  • Accepting help.
  • Eating a healthy diet.
  • Exercising regularly.
  • Seeing your health care provider regularly.
  • Seeking help and treatment if you feel emotionally or physically unwell.

key message

Some people experience anxiety and/or depression during pregnancy.

During pregnancy, a variety of physical, hormonal, and emotional changes occur. These changes can lead to stress for you and/or your partner. If you and/or your partner experience anxiety and/or depression, seek extra help and support as soon as possible. Mental health problems are common and are not a sign of weakness. A family history of anxiety, depression, or other mental illness, or stress during your pregnancy (such as a loss of a loved one) can increase your risk of developing anxiety or depression.

key message

Baby blues are common in the first two weeks after giving birth.

Baby blues can include feeling sad, tired, irritable, and/or overwhelmed. These feelings are normal in the first week or two after giving birth. They are typically caused by hormonal changes, fatigue, and a lack of sleep. Close friends and family members can help you get through this period. These feelings should not last longer than two weeks. If you have a very dark mood, are unable to sleep between your baby’s feeds, feel confused, or have suicidal thoughts, seek professional help immediately.

key message

Ask for help if you have symptoms of anxiety and/or depression.

Feeling anxious or depressed during pregnancy and after birth can occur, and it is important to note this is not your fault. If they are not treated, anxiety and depression can have a negative impact on your pregnancy, your health, and the health of your baby.

There are signs when it is important to reach out for help. Fathers or partners may experience symptoms too. You may:

  • Not feel yourself.
  • Be sad and tearful.
  • Feel exhausted but unable to sleep.
  • Have changes in eating or sleeping patterns.
  • Feel overwhelmed and unable to concentrate.
  • Have no interest or pleasure in activities you used to enjoy.
  • Feel hopeless or frustrated.
  • Feel restless, irritable, or angry.
  • Feel extremely high and full of energy.
  • Feel anxious.
  • Feel guilty and ashamed – thinking you are not a good mother/father.
  • Not be bonding with your baby or be afraid to be alone with your baby.
  • Have repeated scary thoughts about your baby.
  • Have thoughts about harming yourself or your baby.

There is help for you and your family. Talk to your health care provider about services for women and their families dealing with mental health issues. Effective and safe treatments can include therapy and medication. Most medications suggested are safe for your baby when you are breastfeeding. Getting prompt treatment will help you to feel better and improve the health of your baby.
If you have questions call the Mental Health Helpline at 1-866-531-2600. It is free and is available 24 hours a day.
If you have thoughts of harming yourself or your baby, get help right away. Call the Mental Health Helpline or go to the nearest hospital emergency room.

key message

Learn more about mental health during pregnancy and after birth.

You can learn more about mental health from the following resources. More suggestions can be found in the Resources and Links section.

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Supporting Evidence



The supporting evidence is written in third person and is aimed at prenatal education providers. It is not intended to be shared directly with new and expectant families; it is meant to provide the background information and evidence for the key messages.

About Mental Health during the Perinatal Period

Defining mental health

Mental health is an integral component of health and is defined as follows:

“a state of well-being in which an individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community.”1

“…knowing and accepting yourself, understanding what makes you happy, building meaningful relationships, coping with problems of day-to-day living and maintaining a sense of humor. It also means striking a balance in all aspects of your life: social, physical, spiritual, economic and mental. Reaching a balance is a learning process. At times, you may tip too much in one direction and have to find your footing again. Your personal balance is unique, and your challenge is to stay mentally healthy by keeping that balance.” 2

A good state of mental health is not simply the absence of a mental disorder1. Rather, mental health varies along a continuum that ranges from a feeling of psychological well-being (optimal mental health) to a feeling of psychological distress (poor mental health).3

A mental disorder is a diagnosed illness in which the individual exhibits symptoms characterized by changes in thought, mood, or behaviour. Symptoms can lead to a state of distress or suffering and interfere with how a person is able to function.2 Mental disorders also vary along a continuum.3

Mental health problems lie between these two extremes of the continuum. Symptoms are the same as for a mental disorder but of a lesser severity and duration.4

The importance of positive mental health

Positive mental health is “a positive sense of well-being, or the capacity to enjoy life and deal with the challenges we face.”5 Having positive mental health helps people to feel good about themselves, develop positive relationships, and make reasonable life decisions. Expectant and new parents experience a variety of rewards and challenges, thus it is important that they foster and maintain good mental health during the transition to parenthood.

Pregnancy is a time in which new parents start to develop their relationship with their baby. Positive mental health will help as they begin this important relationship.

Strategies that maintain and improve positive mental health are varied and can include:

  • Eating well.
  • Exercising.
  • Getting enough sleep.
  • Taking multivitamins.
  • Avoiding excessive alcohol or drug use.
  • Relaxing.
  • Establishing a support network.
  • Regular visits with a health care provider.
  • Seeking treatment if one feels mentally or physically unwell.

Mental health and the transition to parenthood

Parenthood is often idealized in our society. This may lead future parents to believe that parenting should always be positive. Parents whose experiences do not conform to this ideal do not always talk about their experiences out of fear of being misunderstood or judged harshly. They may feel guilty, question their parenting skills, and sometimes even question their decision to have a child.

For pregnant women, the transition to parenthood involves acquiring a new identity – that of mother. Although this transition occurs without too much trouble for the majority of women, the associated changes can cause stress and significant psychological distress for others. The perinatal period is characterized by increased risk for mental health issues, particularly for women with a history of childhood abuse, mental health issues, and/or those who suffer from mental health disorders.

While prenatal medical consultations usually involve a systematic check for various physical conditions such as gestational diabetes, blood pressure, and certain infections, pregnant women are rarely asked about the state of their mental health or history of mental disorders.6

Given the potential impact on the health of mothers and their unborn children, pregnant women’s psychological distress should never be ignored. This should be the case whether her condition is severe, minor, temporary, or prolonged.

National statistics

Mental health challenges that women may experience in pregnancy or postpartum can vary from problems in adjustment with symptoms of depression, anxiety, or irritability to more severe mood concerns such as a major depressive episode in pregnancy or postpartum, an anxiety disorder, or psychosis.

Women who experience problems with their mental health in the perinatal period should know that they are not alone.

According to the literature, up to 20 percent of women (about one in five) have depressive symptoms during pregnancy.7 The prevalence of a major depressive episode is 12.4 percent (or about 1 in 10 of pregnant women).8 In addition, up to half of women with clinically significant depression in pregnancy or postpartum have concurrent symptoms of anxiety.9

Anxiety in pregnancy is not as well studied as depression. About 8.5 percent of women have a clinically significant level of worry or “what if” concerns in their third trimester; this rate remains about the same postpartum. However, a much larger group of women (up to 30 percent) can have symptoms of anxiety.10

Baby blues is the most commonly experienced postpartum psychological reaction with up to 80 percent of new mothers reporting symptoms. This is followed by postpartum depression with up to 20 percent of new mothers reporting symptoms.

Postpartum, the incidence of anxiety is about 10 percent (the range is 6 percent to 16 percent). It is notable that, in contrast to depression, anxiety may increase over time.10

Postpartum psychosis occurs in one or two women per 1000 births.11

The physiological mechanisms associated with mood and stress

Reproductive hormones and mood

During pregnancy, a woman’s body has higher levels of estrogen and progesterone, which are the hormones required for the development and maintenance of the pregnancy. Higher concentrations of these hormones, which act on the brain’s neurotransmitters, can affect a woman’s emotional well-being. 12

Estrogen increases energy levels and triggers greater levels of euphoria in pregnant women. This hormone can be considered an antidepressant and natural mood stabilizer.12

Progesterone is associated with increased fatigue, a greater need for sleep, and changes in appetite. These sedative and antianxiety effects can trigger symptoms of depression or aggravate existing depressive symptoms.12

Hormonal effects on the human body vary according to the stage of pregnancy. For example, at the end of the third trimester, the level of reproductive hormones is a thousand times higher than normal. However, in the hours following delivery of the placenta hormone levels drop dramatically, which can affect a woman’s emotions.13 The neurobiological mechanisms underlying postpartum baby blues and the onset of postpartum depression in the first few weeks after giving birth are unclear. One hypothesis suggests that the decline in estrogen post-parturition may be a trigger.14

Cortisol and stress

Stress is a part of everyday life15 and is a normal reaction to adapting to a difficult or threatening situation.16 Cortisol is referred to as the stress hormone and is released during times of stress. Cortisol triggers various processes that give the brain sufficient energy to deal with a stressful event. Therefore, stress can have a positive effect and be a source of motivation for overcoming difficulties.15

Pregnancy may be accompanied by a number of stressors, including the following:

  • Life events (e.g., separation, serious illness).
  • Everyday events (e.g., pressure at work, spousal conflict).
  • Pregnancy concerns (e.g., vaginal bleeding, pregnancy-induced medical conditions, health of the unborn baby).16,17

At moderate levels, stress is a normal and useful state that allows an individual to react quickly to a situation. For an expectant mother, however, having one or more life or obstetric challenges adds risk for emotional disturbance in pregnancy or after giving birth. A high level of cortisol can impact the health of the developing child. A simple stress test can be found at www.cmha.ca/mental_health/whats-your-stress-index.

It is important for prenatal education providers to converse with women using a positive, non-blaming approach about the benefits to mother and baby of getting prompt help to mitigate stress effects. For more information, see the section Possible Treatments: What You Need to Know .

Primary Mental Health Problems and Disorders in the Perinatal Period

Introduction to mental health problems in the perinatal period

It is important to watch for mental health problems in the perinatal period. Such problems may appear for the first time or could be a worsening of pre-existing conditions during pregnancy or giving birth. Mental health concerns may include symptoms of depression, anxiety, irritability,18 as well as problems with adjustment, bereavement, or traumatic stress. Some mental health problems arise in the context of medical conditions such as gestational diabetes or thyroid dysfunction. In this section, manifestations of the most commonly occurring mental health problems of pregnancy and the postpartum period are described. A list of symptoms for each problem or disorder is included. It is not intended to replace the opinion and clinical experience of a medical professional.

The baby blues

What are the baby blues?

After the baby is born, it is common for women to feel highly emotional, tearful, fatigued, and overwhelmed. This is what we call the baby blues.

Some women report that they do not know why they feel down, that they feel like their reactions are stupid, and that they sometimes laugh and cry at the same time.15,19

Prevalence

Between 50 percent and 80 percent of women experience the baby blues following the birth of their baby19. Recovering from the baby blues does not require intensive psychiatric treatment. Under most circumstances, experiencing the baby blues should resolve by two weeks postpartum.

Help from one’s support system (e.g., confiding in friends or family, getting more support, making time to rest) helps to alleviate the symptoms in the weeks following childbirth.20,21

Symptoms

The baby blues generally start three to four days after the birth of the baby and can last anywhere from a few days up to two weeks. The most common symptoms include:13,15

  • Mood swings.
  • Frequent crying.
  • Sadness, irritability, anxiety, or feeling overwhelmed (e.g., feeling unable to look after the baby, fear of being a bad mother).
  • Loss of appetite.
  • Trouble sleeping.
  • Fatigue.
  • Difficulty concentrating.

If symptoms get worse and last longer than two weeks, the baby blues can turn into depression. Women with a history of depression should have their baby blues symptoms more closely monitored by a health care provider.

Depression

What is depression?

Depression is a mood disorder characterized by a sad mood and loss of pleasure that occurs almost every day for at least two weeks. It prevents an individual from accomplishing certain daily activities and interferes with his or her life and relationships.22,23,24

Prevalence

Approximately 10 percent of women suffer from prenatal depression. During pregnancy, the highest prevalence rates are observed in the second and third trimesters.25

Moreover, the period following birth is an especially vulnerable time for women since 10 percent to 20 percent will experience postpartum depression, which generally appears two weeks to six months after childbirth.15,26,27

Symptoms

Depression includes the presence of at least five of the following symptoms. In addition, one of the symptoms must be a depressed mood or a loss of interest or pleasure.23

  • Sad or irritable mood.
  • Loss of interest in activities or pleasure derived from activities (e.g., a low libido is common).
  • Reduced or increased appetite or weight.
  • Insomnia or hypersomnia.
  • Psychomotor agitation or retardation.
  • Fatigue or loss of energy.
  • Feeling of deprecation or excessive guilt (e.g., feeling like a bad mother, difficulty developing an emotional bond with the baby).
  • Concentration difficulties or indecision.
  • Thoughts of death and/or suicidal ideas.
  • The symptoms interfere with one’s ability to function and with one’s relationships.

Given that symptoms such as fatigue, change of appetite, and minor mood swings are associated with a normal pregnancy, it can be more difficult to detect depression in pregnant or postpartum women.28

Anxiety disorders

What is an anxiety disorder?

Anxiety is a feeling of worry, nervousness, or unease, typically about an imminent event or something with an uncertain outcome. Anxiety can be a common reaction to a stressful situation (e.g., job interviews). Anxiety can become problematic if the sufferer is no longer able to control it, or if it persists beyond specific triggers. Anxiety that causes difficulties in everyday life is referred to as an anxiety disorder.29, 30

Prevalence

It is estimated that 15 percent to 24 percent of pregnant and postpartum women experience anxiety-related symptoms.31

As compared to the abundant literature on perinatal depression, there is much less literature on anxiety. A comprehensive review noted 8.5 percent of expectant women will experience excessive worrying known as generalized anxiety disorder. This decreases slightly giving birth to between 4 percent and 8 percent.10

Symptoms

Anxiety disorder symptoms include:23, 29

  • Persistent fear that is hard to control and is recognized as being irrational by the sufferer.
  • Concerns, images, or thoughts causing excessive or recurrent worry.
  • Physiological manifestations or somatic complaints that cannot be explained by an organic illness (e.g., heart palpitations, trembling, sweating, muscle stiffness, feelings of suffocation, tingling, trouble sleeping).
  • Avoidance behaviours or repetitive behaviours to manage the anxiety.
  • Changes in normal functioning (e.g., the woman isolates herself, develops insomnia).

It is common for women dealing with anxiety disorders during pregnancy to also suffer from depression.31,32,33,34,35,36 Anxiety disorders during pregnancy increase the risk of anxiety disorders or depression in the postpartum period.31,37

Less common mental disorders

Other, less-common mental disorders may be observed in the perinatal period.

Psychosis in pregnancy

An episode of psychosis in pregnancy is usually pre-existing bipolar disorder (also called manic depression). Bipolar disorder is a brain disorder that causes dramatic mood swings from wild highs to devastating lows. In pre-existing bipolar disorder, the overall risk of at least one recurrence of a mood episode (depression or dysphoric state) in pregnancy is 71 percent. The risk for recurrence is greater for women who discontinue a mood stabilizer, and the time to recurrence is hastened with rapid or abrupt discontinuation of medication. About half of recurrence occurs during the first trimester.38

Postpartum psychosis

It is estimated that one to two women out of every 1000 who have given birth experience postpartum psychosis.15 Onset of postpartum psychosis is usually within 48 – 72 hours after birth, although the risk can remain for up to four months postpartum. Manic or mixed mania-depression episodes follow 20 percent to 30 percent of births in pre-existing bipolar disorder. In some cases, postpartum psychosis can be the first onset of bipolar disorder.26 Some of the earliest signs include feeling excited; elated or high (about 50 percent of cases); not needing to sleep or not being able to sleep (about 50 percent); feeling active or energetic (about 35 percent); or talking more or feeling very chatty (about 30 percent).39

Other notable features of postpartum psychosis include:

  • Delusional beliefs (e.g., beliefs of being persecuted, of infant death, or denial of birth; beliefs that their infant is possessed or has special powers). About 50 percent of women will have delusional beliefs.
  • Hypervigilance about the baby. A mother may get agitated or distressed if separated from her baby.
  • Symptoms having an on/off course. Switching of mood can occur within several hours.40

If a mother exhibits any of these symptoms, it is strongly recommended that the safety of the mother and child be secured as the mother is unable to look after the baby or herself. Postpartum psychosis is considered a medical emergency that requires rapid pharmacological treatment and often hospitalization.15

Who is at Risk?

What are the risk factors for poor perinatal mental health?

A mental disorder does not mean that someone has a weakness or is a bad parent. Likewise, no woman is totally immune from experiencing mental disorders in the perinatal period.

The exact causes of mental disorders in the perinatal period are unknown. Scientific data and clinical experience suggest that there is no single cause but rather a combination of risk factors is at play.41,42

The following risk factors are generally thought to be primary risk factors for poor mental health in the perinatal period:

  • Individual factors.
    • History of mental disorders in the family (i.e., biological predisposition)43,44,45
    • History of mental disorders before the pregnancy.31,43,44,46
    • Traumatic events in childhood, also known as Adverse Childhood Experiences (ACE).47
  • Environmental factors.
    • Stressful living conditions (e.g., poverty, moving, separation, job loss).34,43,48,49
    • A lack of social support (from a spouse or family).20,20,50

The following table presents in detail the risk factors related to the onset of certain mental disorders in the perinatal period.

Table 1: Risk factors associated with mental disorders in the perinatal period.

Major
Depression
Anxiety
Disorders
Bipolar
Disorder
Postpartum
Psychosis
  • Family history 12
  • History of depression or anxiety disorders prior to pregnancy 31,43,44
  • Unplanned or wanted pregnancy 51,52
  • Difficulties associated with motherhood (e.g., miscarriage, abortion) 53
  • Traumatic experiences in childhood (e.g., abuse) 47
  • Low self-esteem 52
  • Discontinuation of antidepressant medication during pregnancy 46
  • Family history 32
  • History of anxiety disorders prior to pregnancy 35
  • Presence of depression during pregnancy 35,36,37,38,
    40,59,60
  • Traumatic experiences during childhood (e.g., abuse) 32
  • Low self-esteem 38
  • Family history 49
  • History of bipolar episodes 61
  • Discontinuation of mood stabilizing medications in early pregnancy 61
  • Family history 9
  • Personal history 9
Environmental factors
  • Stressful life events 34,43,48,49
  • Economic deprivation 54
  • Relationship and family problems 32,43,44
  • Lack of social support or inadequate social support 43,44


Potential Health Consequences

Introduction

Mental disorders in the perinatal period can impact several members of the family (i.e., the woman, her partner, her unborn baby, other children, and relatives) in different spheres of their lives. The following section briefly outlines several of the potential repercussions of mental disorders in the perinatal period.

Consequences for the pregnant woman

Mental disorders in the prenatal period can result in a number of negative consequences for women who are pregnant. For pregnant women these consequences can include:

  • Poor diet.55
  • Insufficient weight gain.56,57
  • Low levels of physical activity.56,57
  • Inadequate obstetrical care.56,57
  • Postpartum depression.31,32,54,58,59,60,61
  • Postpartum anxiety disorder or mood disorder.31,37,62
  • Affected social and personal skills.27
  • Increased suicide risk.27

Consequences for the pregnancy

Mental disorders in the prenatal period can also lead to negative consequences for the pregnancy. These negative consequences can include:

  • Miscarriage.16
  • Preterm birth.27,33,63
  • Pre-eclampsia.64
  • Obstetrical complications.65

Consequences for the child

Perinatal mental disorders can result in a number of negative consequences for the unborn child. These negative consequences can include:

  • Low birth weight.27
  • Emotional and behavioural disorders.66
  • Cognitive and language development difficulties.67
  • Diminished mother-child interactions (e.g., difficulty creating an emotional bond with the child, less than adequate care, fewer positive interactions between a depressed mother and her baby, less attention and consistency in the mother’s responses to the child’s needs).68,69

Mental Health of the Father

Introduction

It has been documented that men between the ages of 25 and 44 run the greatest risk of suffering from depression. This is of importance as a high proportion of men in this age bracket are likely to become fathers.70,71

Fathers may also experience psychological distress during their partner’s pregnancy or after the baby arrives. Although the mental health problems affecting men are not as well understood as those affecting women, researchers and health and social services professionals are taking a greater interest in the issue.

Paternal depression

What is paternal depression?

Men generally manifest psychological distress differently than women. Depression among women is often expressed through feelings of sadness and being emotional, while in men, it is often expressed through irritability, aggression, and substance overuse or abuse.

In our society, the image of a strong man is usually valued while mental health problems are sometimes viewed as being synonymous with weakness or are considered to be a female characteristic. As a result, men are generally not encouraged to express their emotions and tend to speak more about their physical symptoms. They also sometimes do not realize that they are suffering from depression.72,73

Men are generally more reluctant to seek help for mental health issues making these problems more difficult for health and social services professionals to identify.

Professionals are encouraged to be particularly attentive to the specific manifestations of distress in men as aggressive or angry behaviour may be attributable to depression that requires professional help.73

Paternal depression by the numbers

The numbers on paternal depression vary greatly from one study to the next depending on the methodology used. A recent meta-analysis estimates that approximately 10 percent of men experience symptoms of depression during the perinatal period and that symptoms peak around three to six months after childbirth.74

Symptoms of paternal depression

The symptoms of depression in men are the same as those in women. For more information, see the What is depression? section for a list of symptoms.

However, external symptoms are those most commonly observed in men. The following symptoms are the most common: 72,73,75,76,77,78,79

  • Mood swings.
  • Fits of anger or rage.
  • Irritability or aggression.
  • Inability to control impulses.
  • Physical symptoms (e.g., fatigue, stomach pain, indigestion, headache, difficulty breathing).
  • Alcohol or drug abuse.
  • Hyperactive behaviour (e.g., taking refuge in work, sports, gambling, or other activities performed at an intense level).
  • Suicidal thoughts or intentions.

Although women who suffer from depression attempt suicide more often than men, men are four times more likely to be successful in their attempts. This is primarily explained by the more aggressive methods that they use (e.g., firearms) while women tend to use less fatal means (e.g., drug overdose).79

Who is at risk for paternal depression?

The following factors are associated with an increased risk of paternal depression:

  • Personal history of depression.80
  • Unplanned or unwanted pregnancy.81
  • Traditional paternal role and a low level of involvement in the children’s education.72,81
  • Changes in the family structure.72,82,83
  • Having a spouse who suffers from depression.80,84,85,86
  • Low level of marital satisfaction.80,84,85,86
  • Lack of social support or insufficient social support.86,87
  • Low socioeconomic status.71
  • Unemployment.85

Potential health consequences

Paternal depression can have the following impacts on a man, his partner, and the unborn child (some effects are not specific to the perinatal period).

Consequences for the man
  • Alcohol or drug abuse.73
  • Violent behaviour.73
  • Risk of suicide.73
Consequences for his partner
  • Negative influence on the partner’s mood during her pregnancy.80
  • Marital problems and risk of separation.85
Consequences for the child
  • Excessive crying of the baby.88
  • Language development difficulties.89
  • Emotional and behavioural problems,71,90,91 particularly if both parents suffer from depression at the same time.92,93
  • Diminished father-child relationship (e.g., fewer positive interactions between the father and his child104 and increased conflicts).71

Building a Support System

Introduction

Social support, both formal and informal, helps new parents adjust to parenthood at a physically and emotionally challenging time. Social support also enhances positive mental health in new parents and is associated with higher indicators of maternal, child, and family well-being.

Sources of social support

Social support can come from a variety of sources, including the partner, friends, hired help, peers, and professionals. Support can be instrumental, informational, emotional, or therapeutic.

Instrumental support

Instrumental support is practical help that is given to the mother and her family (such as cooking and childcare). Instrumental support can be provided by partners, extended family members, friends, neighbours and community, and also can include hired help (such as a home-care company, night nurse, or postpartum doula).

Informational support

Informational support is information that is provided to new parents and their families regarding the mental health challenges that they are facing as well as information about coping and self-care. This type of support can be offered through books, printed resources, websites, classes, support groups, or presentations on perinatal mental health.

Emotional support

Many new mothers feel that simply because they are female they are supposed to know how to take care of an infant. In fact, this new role often requires learning by doing and education from external sources. It is important to remind new mothers and their partners that they are not expected to know everything. They can be provided with emotional support by validating that they are doing a good job.

Therapeutic support

Mothers suffering from perinatal mood disorders often require treatment. In addition to pharmacological treatment, treatment can also take the form of talk therapy. Individual, couple, and group therapy may be useful. In the latter, sharing experiences and learning from other new parents can confer significant benefits. Often, a combination of professional therapy and medication is the most effective.11

Possible Treatments: What You Need to Know

Introduction

The choice of treatment depends on the mental health problem, the severity of the symptoms, and individual preferences. A brief outline of supported self-management, pharmacological, and psychological treatment is provided.

Supported self-management

For mild-to-moderate symptoms of depression, anxiety, or irritability, self-management strategies can help improve mood symptoms and improve a person’s coping ability. Most important is regular sleep and nutrition routines as well as rest breaks and exercise. There is growing amount literature on the benefits of complementary and alternative medicine for perinatal mental health and well-being94 such as yoga95 or mindfulness-based cognitive-behaviour therapy.96 Resources and Links section refers to websites and client resources that can easily be accessed from home.

Breastfeeding

Breastfeeding mothers may experience less depression, and infants of mothers experiencing depression are less affected by the  mother’s depression. For mothers experiencing postpartum depression, it is important there is sufficient support for breastfeeding and that any treatment for postpartum depression is compatible with breastfeeding.103, 104, 105

Pharmacological treatment

Taking medication is one way to treat mental disorders. Pharmacological treatment can be taken alone, or combined with psychological treatment. For some women, pharmacological treatment during pregnancy can be viewed negatively. It is estimated that only 20 percent of women suffering from depression receive adequate treatment.97 Some women who received pharmacological treatment for their mood disorders prior to pregnancy may choose to stop taking their medication once they learn that they are pregnant. They might feel guilty about the potential effects of the medication on the baby or fear being judged or stigmatized.98 These reasons may explain why few women seek treatment for their symptoms.

Pregnant women suffering from pre-existing mental disorders are advised to consult their regular physician to find out if they should continue, switch, or stop their medication during pregnancy. This decision will be based upon an assessment of their mental health history, current symptoms, and the risks and benefits of treatment.

Psychological treatment

Psychological treatment can range from several sessions of individual supportive counselling to several months of intensive psychotherapy. In Ontario, most OHIP-covered therapeutic treatment is found at hospital psychiatry programs, community mental health centres, or family health teams. Non-OHIP (fee-based) therapy is available from registered psychologists, social workers, or psychotherapists. For more information, see Professional Associations in the Resources and Links section.

For perinatal women, there is evidence of the effectiveness of Interpersonal Psychotherapy (IPT) and Cognitive Behaviour Therapy (CBT) for mild-to-severe depression.99 IPT, considered by experts as a first-line treatment option for pregnant and breastfeeding women, is a semi-structured therapy up to 16 sessions that focuses on reducing depression symptoms and increasing social supports. CBT, a highly structured therapy with emphasis on identifying distorted thinking, modifying beliefs, and changing behaviours, has been researched for perinatal depression and more recently perinatal anxiety.96,100

Referrals

When to refer

It is strongly recommended that professionals refer future parents to specialized resources for a more in-depth assessment and treatment if any of the following factors are present:

  • The symptoms occur almost every day and continue over time (e.g., depressed symptoms lasting longer than two weeks or manic symptoms lasting longer than one week).
  • The symptoms are causing psychological distress or are negatively affecting daily activities.

For a list of the risk factors for mothers and fathers, refer to the sections Who is at Risk? and Who is at risk for paternal depression?

New mothers can be screened for depression using the Edinburgh Postnatal Depression Scale Screening Tool. This screen assists with early detection and validation of postpartum depression symptoms and can also indicate the need for referral to a physician or mental health specialist for further assessment.101

Future parents should be advised to seek help as the longer they wait, the greater the likelihood that the symptoms will worsen and be more difficult to treat. It is also important to let new mothers know that there are safe and effective treatments available, and they can get help to end their suffering.

Where to refer

Within Ontario, there are several points of access to mental health services. Individuals can start by reaching out to any trusted health care provider, including a community mental health worker, public health nurse, obstetrician, paediatrician, or family doctor. These providers may be able to provide treatment, recommend local resources and/or make a referral to a specialized mental health care provider if additional care is required.

Individuals with identified mental health problems can be referred to a variety of services, including:102

  • Psychotherapy.
  • Psychiatrist-delivered services.
  • Local health services.
  • Community-agency-delivered services.
  • Crisis services.
  • In-hospital treatment.

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Resources & Links



Please note this is not an exhaustive list of available resources, nor should any of these resources be used in place of seeking professional advice. The resources cited throughout this resource are not necessarily endorsed by the Best Start Resource Centre or the Government of Ontario. When in doubt, professionals should contact the organization responsible for issuing a specific recommendation/practice guideline.

Professional Guidelines

Professional Associations

Websites: Mental Health Information

Websites: Mental Health Support

Helplines

 

 

Prenatal Education Provider Tools

Client Resources and Handouts

Videos

Apps

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References

  1. World Health Organization. (2010). Mental health: Strengthening our response. Geneva, CH: Author. Retrieved from http://www.who.int/mediacentre/factsheets/fs220/en/
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Health Before Pregnancy

Health Before Pregnancy

Routine Prenatal Care

Routine Prenatal Care

Physical Changes

Physical Changes

Healthy Eating & Weight Gain

Healthy Eating & Weight Gain

Active Living

Active Living

Alcohol

Alcohol

Smoking

Smoking

Medications & Drugs

Medications & Drugs

Safety During Pregnancy

Safety During Pregnancy

Abuse

Abuse

Mental Health

Mental Health

Pregnancy & Infant Loss

Pregnancy & Infant Loss

Preterm Labour

Preterm Labour

Labour Progress

Labour Progress

Labour Support

Labour Support

Interventions in Labour

Interventions in Labour

Pain Medications in Labour

Pain Medications in Labour

Caesarean Birth

Caesarean Birth

Vaginal Birth After Caesarean

Vaginal Birth After Caesarean

Breech Birth

Breech Birth

Newborn Care

Newborn Care

Newborn Safety

Newborn Safety

Breastfeeding

Breastfeeding

Recovery After Birth

Recovery After Birth

Transition to Parenthood

Transition to Parenthood