While pregnant, most women expect to feel the impending joy of motherhood. But for many that's replaced by depression.
Although awareness of postpartum depression has increased in recent years, and doctors usually gauge new mothers for symptoms, depression at other points around pregnancy has been less studied.
A new study from Northwestern University is one of the first, its authors say, to evaluate depression related to motherhood at three times: pre-pregnancy, prenatal and postpartum.
Knowing about, and anticipating, how women feel at different junctures is key, "so it's not dismissed as blues," said author Sheehan Fisher, an instructor of psychiatry and behavioral sciences at Northwestern University's Feinberg School of Medicine.
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Depression "is a serious disorder that needs to be treated," he said.
Fisher and his co-authors found that more than one-third of women were depressed while pregnant.
Their data showed 37 percent said they experienced depression during the nine months of pregnancy, 25 percent pre-pregnancy and 38 percent during the postpartum period.
Everything from infertility to sickness to undergoing an enormous life change - to seeing others' happy belly bump photos on social media while not feeling similarly happy - can be part of a depression equation, women said in a previous report.
The women in the 2015 Chicago Tribune story spoke of depression so serious it meant delaying a second child or even had led to suicidal thoughts.
Despite more awareness around postpartum depression, that time period was least severe, researchers found.
The Northwestern study, published in the Journal of Affective Disorders, evaluated symptoms during the four- to six-week postpartum period for 727 women in Pittsburgh.
The research looked into when patients, asked at a postpartum checkup, felt depressed. Women were asked whether depression started before pregnancy, during pregnancy or after pregnancy.
The study found, Fisher said, that those whose depressive symptoms started earlier experienced a more chronic depression, with higher levels of symptoms, such as difficulty falling asleep or paranoia.
Depression that begins before or during pregnancy often persists longer, because it is more likely to go untreated, Fisher said.
Unlike postpartum, depression during pregnancy is less publicly discussed, and no guidelines exist to ensure that doctors check for it.
This year, the U.S. Preventive Services Task Force recommended that pregnant women be screened for depression.
"Screening is the first key factor," Fisher said.
Mental illness before, during and after pregnancy is not "a homogenous disorder," he said.
Factors such as age, education, marital status and health insurance influence anxiety and depression, also.
Finding out when women are struggling is vital to treatment, Fisher said.
If a physician did not know a woman felt troubled in the third week of pregnancy, for example, by the time patients are at a postpartum checkpoint, that depression could be nearing a year.
"Severity can fluctuate over time," he said.
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