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A new study found that postpartum depression often begins before a woman gives birth. Here's what soon-to-be moms need to know.

February 16, 2015

When I was pregnant with my son, I was lucky that I never had back pain, swollen feet, or even morning sickness. My only complaint was trouble sleeping: Night after night I lay awake worrying about anything and everything related to the baby in my belly: How long has it been since he last moved? Am I going to be a good mom? What if that queso fresco on my taco wasn’t pasteurized?

Pre-baby anxiety is so common—my pregnant friends and I used to compare our long lists of “what ifs”—that I think many women view these thoughts as normal symptoms of expecting. And for the most part, they are. But when the dread of the “what ifs” starts to become excessive, it may be a sign of something more serious to come, new research suggests.

A study published last month in Lancet Psychiatry found that postpartum depression often begins before a woman gives birth. The study of more than 8,200 women revealed that two-thirds of mothers with severe depression (involving frequent crying and even suicidal thoughts) started experiencing mood shifts during pregnancy.

Scientists have always linked postpartum depression to a dramatic drop in hormone levels after giving birth. But this finding suggests there may be other biological triggers, Samantha Meltzer-Brody, MD, one of the study authors, told the New York Times.

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She also pointed to another question the research has raised: Her team found that 60% of mothers with moderate postpartum depression experienced complications during their pregnancy, such as gestational diabetes. Dr. Meltzer-Brody, who is the director of the University of North Carolina’s perinatal psychiatry program, wondered if their depression might be related to glitches in the immune system.

If one thing is clear, it’s that maternal depression isn’t one-size-fits-all. There's a lot to learn, and answers can’t come soon enough. As many as 20% of mothers experience anxiety or depression after giving birth. To better understand what the latest findings mean for moms, I reached out to two therapists who specialize in mood and anxiety disorders during pregnancy and through the postpartum period. Here is their advice for every soon-to-be mom.

Pregnant women need to pay attention to their emotions

“One of the takeaways from this study is that pregnant women should take their feelings seriously,” says Anne Marie Hinrichs, a social worker at Pospartum Pathways in Morristown, New Jersey. “If you don’t feel right, or notice yourself feeling sad or worried a lot, you need to talk to someone you trust, like your doctor or midwife, or a therapist.”

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Depression isn't your fault

“Pregnant women and their partners need to understand that they are not to blame for a perinatal mood disorder," says Robin Muskal, PhD, a postpartum depression wellness coach in Florham Park, New Jersey. “There are many contributing factors to [pregnancy-related] mood shifts. None of them are the fault of the mother."

And you are not alone

“The reality is that mental health symptoms are the most common complication of childbirth,” Hinrichs says. “Many women feel reluctant or embarrassed to get help, in part because the 'myth of motherhood' is so strong in our culture. People expect a woman to be joyful after having a baby, and if she is not, there is a lack of understanding. What we need is a broad cultural awareness that it’s common to have the symptoms.”

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The sooner you seek treatment, the better

“Getting help early on makes the situation easier to manage,” Muskal says. “These mood disorders can have an impact on attachment and bonding. For that reason alone, treatment should begin immediately. There is no reason that a woman should wait for help.”

Getting help is important for you, and your baby

“Anxiety and depression can snowball,” Hinrichs says. “Being the mother of a baby is challenging enough as it is, so having panic attacks every day or feeling deeply sad puts both you and your baby at risk for things getting worse.”

Treatment is very effective

“Perinatal depression and anxiety respond well to treatment because being pregnant and having a baby throw things out of balance in a woman’s life,” Hinrichs says. “But with help from someone who has seen all of this before, a woman can find ways to create a new balance that feel right to her.”

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Progress often happens quickly

"Some women I see feel better after one or two sessions, some after five, and some after 13 or 14. Depending on their needs, they might stay in therapy longer or take medication longer for various reasons, but they make many steps of progress along the way,” Hinrichs says.

Therapy may include support groups

“Often women feel isolated and ashamed, so treatment can include connecting with other mothers. As a woman becomes aware that support is available, her struggles tend to decrease in intensity, and in many cases, are eradicated,” Muskal says.

You can take a first step online

“One of the simplest ways to get help is through Postpartum Support International,” says Muskal, who sits on the organization’s board. The site lists resources, including providers and support groups, in every state. "With help, you will get well," she assures.

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