Major Depression 

• Between ten and twelve percent of women experience Major Depression during pregnancy
• Between ten and twenty percent of women experience Major Depression in the post partum period.

• Previous history of Major Depression
• Family history of Major Depression
• Marital problems
• Recent stressful life events

• depressed mood/sadness, crying spells for no apparent reasons
• disturbed sleep or change in appetite
• guilty ruminations or feelings of worthlessness
• excessive worries about your own or your baby’s health
• panic attacks with heart palpitations and shortness of breath
• thoughts of death or suicide
• symptoms are present every day for at least two weeks and significantly interfere with daily life.

• Untreated depression may interfere with your ability to enjoy your pregnancy. Early bonding with your baby may be hindered which may lead to long term consequences for you and your baby. If illness persists in the postpartum period, this impaired bonding may become chronic. This has long-term consequences for the child in terms of cognitive and behavioural problems in school.
• Symptoms may interfere with your ability to work or carry out your daily activities: self-care, including medical care, may be neglected.
• In desperation, some women may turn to alcohol and drugs, which can severely compromise the mother, the unborn child, or the new baby.
• In severe cases, women may contemplate self-harm or even suicide to cope with their depressive symptoms.

• Psychoeducation and Counselling: Offers support, reassurance and education for women with postpartum depression. Involve the significant other, friends and family supports. Teach coping strategies and how to build social networks and supports.
• Cognitive Behaviour Therapy (CBT) - is based on the fact that, the way we think and act affects the way we feel. Depressed women may experience less activity and a lot of negative thoughts. In cognitive behaviour therapy, the therapist helps the woman set realistic goals, identify her distorted thinking patterns and replace the thoughts with more realistic thoughts.

Some examples of Cognitive Disorders:

• All-or-nothing thinking: You look at things in absolute, black-and-white categories.
• Overgeneralization: You view a negative event as a never-ending pattern of defeat.
• Mental filter: You dwell on the negatives and ignore the positives.
• Discounting the positives: You insist that you accomplishments or positive qualities "don’t count".
• Jumping to conclusions: Mind reading – you assume that people are reacting negatively to you when there’s no definite evidence for this.
• Fortune-telling - you arbitrarily predict that things will turn out badly.
• Magnification or minimizing: You blow things way up out of proportion or you shrink their importance inappropriately.
• Emotional reasoning: You reason from how you feel: "I feel like an idiot, so I really must be one". Or "I don’t feel like doing this, so I’ll put it off"."
• Should statements": "You criticize yourself or other people with "shoulds" or "shouldn’ts". "Musts", "oughts" and "have tos" are similar offenders.
• Labeling: You identify with your shortcomings. Instead of saying "I made a mistake", you tell yourself, "I’m a jerk", or "a loser".
• Personalization and blame: You blame yourself for something you weren’t entirely responsible for, or you blame other people and overload ways that your own attitudes and behaviour might contribute to a problem

Adapted from David D. Burns, MD, “Feeling Good: The New Mood Therapy” (New York: William Morrow & Company, 1980.

• Family & Relationship Counseling - assists women and their significant others to develop strategies to cope with this stressful time.
• Group Therapy: Public Health Nurses in conjunction with other community service providers may co-facilitate postpartum support groups Peer support groups are offered by several non-profit organizations across B.C., such as the Pacific Postpartum Support Society. Mental Health Teams may offer general depression support groups. Find out more about groups in your community and at Reproductive Mental Health.
• Bright Light Therapy is a newer treatment for major depression. This form of therapy is being investigated through the Reproductive Mental Health Program with a small number of women with Postpartum Depression. Several of these women have positive results with Bright Light Therapy.
• Pharmacotherapy (i.e., Antidepressant Medication) Medication may be required for women with moderate to severe illness or who have a shown a limited response to psychotherapy. Medication may help relieve symptoms allowing the woman to pursue counseling, make life-style changes and improve quality of life.
   
  The type of drugs are described in Best Practices Guidelines (link)
  

Antidepressant Medication