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Depression is twice as common in women than in men, and the initial onset tends to peak during the reproductive years.

By C ORI U RBAN Special To The Republican

“So, it is not surprising that depression during and after pregnancy is one of the most common medical complications that a pregnant or postpartum woman may face,” said Dr. Elizabeth A. Rottenberg, chief of obstetrics and gynecology at Mercy Medical Center in Springfield and director of the Family Life Center.

Perinatal depression is defined as any major or minor depressive episode that occurs during pregnancy or the first 12 months after delivery.

Depression during pregnancy or within 12 months postpartum affects approximately 10-15 percent of mothers annually; 8-10 percent of men also experience symptoms of pregnancy- related depression, she added.

Some risk factors for pregnancy-related depression are history of anxiety and/ or depression, life stress, unplanned pregnancy, lack of social support, domestic violence or poor relationship quality.

Some risk factors for postpartum depression also include traumatic birth experience, neonatal intensive care unit admission and breast-feeding difficulties. Thus, “history of depres- sion, whether postpartum or otherwise, is a risk factor for depression in subsequent pregnancies,” Rottenberg said.

If you or someone around you notices any of these symptoms, she recommends you make an appointment with your OB/GYN. “But do not feel like it is only up to you to recognize symptoms and seek help. We are here to help navigate the normal vs. abnormal mood changes of pregnancy and post-partum.”

Her practice screens for postpartum depression at the beginning of pregnancy, at around 28 weeks, immediately post-partum and again at six weeks post-partum using the Edinburgh screening tool.

The Edinburgh screening tool is the one most frequently used in research and clinical practice. It has been translated into more than 50 languages; it takes about five minutes to complete the 10 questions that prompt “recognition of depressive and anxiety-related symptoms but excludes some constitutional questions about things like sleep which are common … during pregnancy and post-partum,” Rottenberg said. “This tool is effective at its core, but also needs to be used in clinical context. In other words, if a patient’s score is normal, but they are tearful in the office and/or have a flat affect that is different from baseline, these are symptoms that still need to be addressed.”

If based on answers/results healthcare providers believe someone is experiencing abnormal mood changes or is at risk for depression, there can be a conversation in the privacy of the medical office.

But the doctor pointed out that the “baby blues” are normal for new parents to experience over the course of the first several weeks after delivery. This can include mood swings, crying and anxiety.

“Bringing home a new baby pears as though everyone else “has it together,” she added. “Anyone who has not spent moments crying or feeling inadequate after delivery or bringing a child home has had a different experience than most of us. This is normal!”

Being that the baby blues are such a normal part of pregnancy — specifically been a complete loss of joy or motivation to get up and face the day, despite knowing that there may be challenges to overcome.”

And she emphasized that it is never normal to have thoughts of hurting yourself or others.

For those suffering from postpartum depression, medication is an option. The most common medication used to treat mild-to-moderate symptoms of pregnancy-related or postpartum depression is a selective serotonin reuptake inhibitor — a type of antidepressant — that, according to Rottenberg, are safe and effective for pregnant and/or breast-feeding women.

“There are other medications that may be useful that aren’t as common, so it is important to discuss with your OB/GYN or mental health care provider to establish which may be best suited for you and your situation,” she added. “Referral to mental healthcare providers is important; medication and therapy together have been shown to have more benefit than either of the two alone.” not get the help that they need to ensure that they are able to safely care for themselves; one cannot care for anyone else if they are not able to care for themselves.”

She advised that if something feels “off,” say something. There are tools to help detect pregnancy and postpartum-related anxiety and depression, “but this is an art as much as it is a science,” she said. “We are here to help navigate the vast spectrum of emotions involved with being pregnant and then supporting a newborn and your family at home. We can listen and provide advice/referral to non-obstetrical providers that can help with things like mental health and lactation, and we are proficient and knowledgeable about when it is important to suggest that we get involved medically. You can be a masterpiece and a work in progress at the same time.” is a huge lifestyle adjustment that comes with changes in things like roles and responsibilities, sleep, appetite and libido. It is common to feel vulnerable, overwhelmed or ill-equipped for, arguably, one of the hardest jobs which is parenting and caring for another human,” Rottenberg said. Social media can be a “dangerous place” where it ap - post-partum — recognizing true postpartum depression can be difficult. Less than 20 percent of women diagnosed with postpartum depression outwardly report symptoms. “We start to worry that the baby blues are becoming true depression when there becomes an inability to care for oneself or their baby,” the doctor said. “We worry when it appears that there has

In more severe cases of depression, or certainly psychosis, inpatient hospitalization may be necessary to ensure safety, she said. “Untreated adults with pregnancy-related or postpartum depression may have difficulty making sure that their newborn and/or other children in the household are appropriately clothed, fed and in safe spaces for sleep. The biggest risk to infants of women with postpartum depression is that their mother (or father) does

Most depressive symptoms that are truly pregnancy and/or postpartum related improve after 6-12 months, Rottenberg emphasized that it is important to be mindful of longer-lasting symptoms that may be an indication of a more chronic anxiety and/ or depression: “This is not something to ignore or be ashamed of, and treatment can safely continue beyond the 12- month mark.”

For more information, go online to massppdfund.org/ general-resources or ppdcommission.com