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Miscarriages and Postpartum Depression

Miscarriages and Postpartum Depression

Miscarriage

 

Many people have asked about whether or not it is possible to suffer from postpartum depression following a miscarriage. Furthermore, academic research has investigated this area. This article gathers evidence to provide an overview of the current thinking concerning postpartum depression associated with miscarrying.

What is Postpartum Depression?

Postpartum depression refers to when a mother experiences depressive symptoms following giving birth and affects up to 15% of new mothers1. Symptoms2 of postpartum depression may include, but are not limited to, the following:

  • constant worry;
  • regular crying;
  • sleeplessness, even when the baby is sleeping;
  • finding decision-making too challenging;
  • irritability; and
  • loss of appetite.

If you or someone you know is experiencing these symptoms, regardless of whether or not you or they have recently had a baby, medical advice must be sought.

Why does Postpartum Depression Occur?

Hormonal shifts are typical after giving birth due to a woman’s body changing its hormone levels during pregnancy. Common hormonal changes3 while pregnant include:

  • increasing estrogen, peaking during the third trimester;
  • a massive rise in progesterone levels;
  • gradual increase in the secretion of cortisol;
  • some rise in production of T3 and T4 (thyroid hormones); and
  • an enormous spike in oxytocin when giving birth.

 Following the pregnancy, the woman’s body attempts to return to its normal hormonal levels much quicker than the nine to ten months that the pregnancy lasted for, which can cause imbalance. Typically, hormonal balance is likely to be achieved approximately six to eight weeks after giving birth3, though this isn’t the case for everyone. In some cases, higher production of cortisol (often referred to as the stress hormone because of its links with heightened anxiety and stress4) can trigger depressive episodes.

Can This Be Possible Without Giving Birth?

It is believed that “some women may experience similar, although less dramatic, hormonal shifts”5 following a miscarriage as those that many women face after childbirth. Around 10% of women who miscarry meet the criteria for having major depression5. Although this may be a different situation, it can still be traced to hormonal changes associated with pregnancy.

Indeed, emotional distress is not only possible, it is very likely following experiencing such a traumatic event as early pregnancy loss6. The physical and psychological trauma of miscarriage cannot be underestimated. Therefore, depressive episodes are common following miscarriage and can be linked to the same internal chemical changes as cause postpartum depression.

Is It Actually Depression?

Actually Depression?

 

People sometimes downplay what they are experiencing and say that they’re just a bit down or something like that. This is because they doubt that they genuinely have a mental ill health concern and often ignore the symptoms that they’re facing.

If you are undergoing symptoms such as excessive worry, inability to focus, or sleeplessness, you may be suffering from depression. This is certainly nothing to be ashamed of and should undoubtedly be discussed openly. In the USA alone, 40 million adults each year (around 18.1% of the population) experience depression or anxiety; however, only 36.9% receive treatment7. Without treatment, symptoms are likely only to get worse.

If you are unsure, seek medical advice. A wide range of scales is used to assess the level of depression or anxiety that a person is experiencing8. For these, patients typically rate different statements by considering the extent to which they apply to them personally. The medical professional then assess the ratings that the patient has given, using the findings thereof to ascertain how depressed or anxious the person is. This is a scientifically accepted means of understanding whether or not someone is depressed.

How Can Depression Be Treated?

 

Treatment

 

There are different options for treating depression, which may vary in appropriateness depending on individual circumstances. For most people, counseling, medication, or a combination of the two can be successful. Studies have found that many people prefer counseling as they have previously found antidepressant drugs to be addictive, particularly with female patients9.

Cognitive-behavioral therapy (CBT) is a common approach to treating patients with depression through counseling10. This is usually a comparatively short process, with sessions running for eight to twelve weeks10. The CBT therapist discusses concerns with the patient during the sessions and sets them specific goals to achieve before the next session. This collaborative therapeutic relationship has been found to be the leading cause of the success of CBT11.

The alternative approach to counseling is medication using antidepressant drugs. Selective serotonin reuptake inhibitors, such as Prozac, have been the first line of treating depression in adults for some time12. These work by raising serotonin levels (a hormone that stabilizes one’s mood and causes happiness) in the brain in people who aren’t naturally producing enough13. However, some research has suggested that prolonged use of these can cause addiction14 and even increase suicidal behavior12.

Summary

The root cause of postpartum depression is not fully understood and isn’t necessarily the same for everyone. That said, it is generally believed to be stimulated by hormonal changes associated with pregnancy and childbirth. However, that doesn’t mean that it’s impossible to suffer from postpartum depression following a miscarriage.

Indeed, mental ill-health is likely after an early pregnancy loss due to how upsetting and traumatic such an experience is. Furthermore, the internal, chemical cause of this could be the same as that of typical postpartum depression.

Depressive symptoms include but are not limited to sleeplessness, excessive worry, inability to make decisions, irritability, difficulty focusing, and loss of appetite. These symptoms remain faithful to all kinds of depression, including that following giving birth or suffering a miscarriage.

Depression is ordinarily treated through counseling - such as CBT - or the use of antidepressant medication, commonly selective serotonin reuptake inhibitors. Antidepressants have a positive success rate but also come with side effects. On the other hand, while CBT has proven to benefit many people, it doesn’t work for everyone.

Ultimately, each circumstance should be taken as an individual case. There is no ‘one-size-fits-all’ regarding any kind of depression, its causes, or how best to treat it. Therefore, professional medical guidance must be sought if you, or someone you know, could be suffering from depression, whether that has been brought about by childbirth, miscarriage, or anything else.

 

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Reference List

  1. https://www.sciencedirect.com/science/article/abs/pii/S0002937808022710 
  2. https://www.nejm.org/doi/full/10.1056/NEJMcp011542 
  3. https://foreverfitmama.com/postpartum-health/hormonal-changes-after-pregnancy/ 
  4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4436856/ 
  5. https://womensmentalhealth.org/posts/postpartum-depression-miscarriage/ 
  6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4468887/ 
  7. https://adaa.org/understanding-anxiety/facts-statistics 
  8. https://www.cambridge.org/core/journals/psychological-medicine/article/abs/measuring-depression-comparison-and-integration-of-three-scales-in-the-gendep-study/7977986C45B2E80DC79BB5CAD2A57C59 
  9. https://bjgp.org/content/50/460/905.short 
  10. https://psycnet.apa.org/record/2000-02102-015 
  11. https://www.cambridge.org/core/journals/behavioural-and-cognitive-psychotherapy/article/abs/seven-cs-of-cbt-a-consideration-of-the-future-challenges-for-cognitive-behaviour-therapy/F2DDA44BB6AF762028F584D67B989385 
  12. https://www.bmj.com/content/331/7509/155.short 
  13. https://connect.springerpub.com/content/sgrehpp/10/1/16.abstract 
  14. https://journals.sagepub.com/doi/abs/10.1177/026988119901300321