Sharon Praissman Fisher

Beyond the Egg Timer

Pre-empting Postpartum Depression

Exercise and talk therapy are two strategies to prevent this common condition.

Posted Oct 02, 2014

Postpartum depression affects at least 10-15% of new mothers, and it may be more common among certain demographics. Plus, it is often underdiagnosed.  Knowing that, how can you prevent it? Based on our review, the best advice is to: (1) find a good therapist and (2) exercise.

Among women, the risk factors for postpartum prevention commonly mentioned are: having experienced infertility, having twins or triplets, having a baby with a health problem or experiencing a birth complication, and being an adolescent mother, according to the Centers for Disease Control (http://www.cdc.gov/reproductivehealth/depression/. If you have experienced depression before, or have a family history of depression (postpartum or otherwise) it is reasonable to think that it could happen to you.

A recent Canadian study suggested that older mothers may also be at greater risk. There’s some evidence that perfectionist tendencies contribute to postpartum depression, which fits nicely with our previous suggestion that aspiring mothers read Brene Brown’s work instead of parenting books.

Basically, it could to happen to anyone, even if you are thrilled to be pregnant and have a nice, long paid maternity leave to look forward to.   It is a neurochemical process in the brain and no reflection on your fortitude or competency as a mother.

Why Therapy?

The recommendation that talk therapy can prevent postpartum depression comes from a Cochrane review, the most rigorous type of medical research evidence. Particularly if you have a past history of depression that required treatment or one of the risk factors mentioned above, we would suggest being proactive. Research therapists while you are pregnant to find one that you like who accepts your insurance (if you live in the United States) and whose schedule is convenient for you. Some therapists even practice online. You can have a pre-baby visit to make sure that the therapist is a good match for you or simply hold on to the information and call if needed.

If you don’t have a history of depression or a risk factor but still want to be proactive, that is great, too!  You don’t have to have an actual problem to benefit from therapy. There are psychotherapists who specialize in postpartum depression.  Your obstetrician or midwife may be able to recommend one.  If not, call your health insurance or access them on line through a list of therapists in your area.  Many therapists now have websites which will list their areas of expertise.  If not, simply call them and ask.  Therapists are used to this.

Also, educate your partner and family.  Having them understand what to look for and give you gentle feedback about their concerns can facilitate treatment faster. 

Why Exercise?

The exercise recommendation is based on a recent review that concluded that exercise before, during, and after pregnancy are all associated with a reduction in postpartum depression. So far there are no clear guidelines about how much exercise, what type, or how often. So just choose based on your personal preference and what you can work into your schedule.

That sounds like an easy and obvious suggestion. But sometimes the postpartum days slip by quickly, and you find that its 5 p.m., you are still in your pajamas, and all you have done that day is nurse the baby and change diapers. This is a gentle reminder to keep exercise at the top of your priority list. It’s more important than writing thank-you notes for baby shower gifts!

Of course it is important to eat your fruits and veggies, but there is no good evidence that dietary supplements that could prevent postpartum depression, again from a Cochrane review. (Until next week when someone publishes opposite findings …. Nutritional research is frustrating like that, isn’t it?)

It’s plausible to think that light therapy could help new mothers, especially during the winter months, and there’s little risk associated with this intervention, but a 2012 review said there’s no consistent high-quality data to support this.

What Else?

If you plan to breastfeed,  you also might want to find a good lactation consultant and keep her number handy after you deliver. Some emerging research suggests that breastfeeding problems are related to postpartum depression, particularly among women who intended to breastfeed.

 Certainly, having incredibly sore nipples never made anyone feel cheerful.

One final note: understand that if you become depressed you may not realize you are depressed.  This Mayo Clinic site  lists commons symptoms and differentiates between “baby blues” and depression.  The key is really length of time and severity.

And on that cheerful note, we close this blog post. We post every other Thursday, and in the meantime please keep in touch on Facebook or twitter.

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