Perinatal depression: Common reasons women don't seek help

Postpartum depression gets a lot of attention, while depression during pregnancy is often overlooked. The biggest risk factor for postpartum depression, however, is having untreated depression during pregnancy. Although non-medication treatment options like psychotherapy—coupled with lifestyle and behavioral changes that improve self-care and decrease stress—are often sufficient for mild to moderate depression, women with more significant illness generally need medication as well.

While there are many reasons women don't seek help, here is a list of what I frequently hear:

1. "I didn't think I could take anything when I was pregnant [or nursing]."
   We have a significant amount of information about antidepressant medications in pregnancy, most of it reassuring. Womensmentalhealth.org is a website hosted by Massachusetts General Hospital offering comprehensive and up-to-date information about psychiatric illness and medications in pregnancy, and a great resource for patients and providers.
   
   
2. "I thought it would go away."
   Although up to 80 percent of women experience symptoms of "baby blues" including sadness, tearfulness, worry, disrupted sleep and mood swings, these symptoms generally improve about ten days to two weeks postpartum. Up to 20 percent of women may experience some type of postpartum depression. If mood symptoms worsen or last beyond two weeks postpartum, are associated with decreased ability to function, and/or are associated by thoughts of harm to self or baby, women need to be evaluated for postpartum depression.
   
   
3. "I felt like a failure."
   People who struggle with mental health issues often experience a great deal of shame. Women tell me how if only they were "stronger," somehow they would have been able to beat their depression. Often people experience their depression not as a medical illness, but as a moral failing. This is not the case! Postpartum depression is the most common complication of pregnancy, and is caused by a complex combination of genetics, hormones, biology and circumstance; not by weakness or lack of effort.
   
   
4. "I worried people would think I'm a bad mother."
   Our cultural celebration of motherhood brings with it many widely-held assumptions, leaving many women to expect that pregnancy will be a time of emotional well-being, and that caring for infants and young children will be positive and fulfilling. For many women, the transition to motherhood is difficult and fraught with negative or conflicting feelings. Difficulty bonding with your baby is a classic symptom of postpartum depression, and does not mean you are a bad mother!  It means you deserve further evaluation to determine if these feelings are a normal part of a difficult transition to motherhood or a symptom of depression.
   
   
5. "I didn't know how to get help."
   Many women are not sure who to turn to when they are experiencing depression during or after pregnancy. The first step is to speak up and reach out to those you trust. Starting with a friend or family member, contacting your doctor, and if possible, bringing a family member or close friend in with you when you go see your doctor are all good ways to start to get the help you deserve.

Remember, the best thing you can do for your baby and your family is to get your depression treated!