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UI researchers study postpartum anxiety, depression

IOWA CITY, Iowa -- Doctors know that depression after pregnancy is fairly common, affecting as many as 10 to 15 percent of women who give birth. Less attention, however, has been given to women who suffer anxiety after giving birth, according to University of Iowa researchers who studied postpartum anxiety among Iowa women.

In a study published in the July issue of the Journal of Nervous and Mental Disease, Scott Stuart, M.D., UI assistant professor of psychiatry, and colleagues from the UI and Iowa State University report that anxiety's effects on the mother and child can be just as serious as depression, can occur as late as months after giving birth and sometimes overlap with postpartum depression symptoms.

"A fair number of women experience postpartum depression or anxiety and shrug it off as part of being a parent, or ignore it for fear that they may be criticized for not handling motherhood properly," Stuart said. "Often the depression or anxiety comes after the first child because the new mother doesn't have the previous experience with which to compare it."

Stuart and his colleagues studied 107 women across Iowa who had recently given birth, none of whom sought treatment for depression or anxiety. The women were selected randomly from state birth records. The average age of the women in the study was 31 years old. All were married, and 46.5 percent were having their first child.

The women completed psychological questionnaires that measure depression and anxiety at 14 and 30 weeks after giving birth. The researchers found the prevalence of anxiety among the mothers was 8.7 percent at 14 weeks and 16.8 percent at 30 weeks postpartum. The prevalence of depression was measured at 23.3 percent at 14 weeks and 18.7 percent at 30 weeks postpartum. These prevalence rates are comparable to findings from previous studies, the researchers noted.

A number of women in the study did not develop anxiety or depression for as many as seven months after giving birth, Stuart said, but there is no single explanation as to why women become depressed or anxious in the weeks or months after delivery.

"It depends on how life circumstances change and how those affect what's going on," he said. "For example, a woman may give birth to her first child and things go smoothly for the first few weeks. However, after her maternity leave is up and she prepares to go back to work, childcare issues become more salient and the conflict between working and staying home becomes greater. There are a lot of different factors that can trigger anxiety or depression."

The researchers also found a strong correlation between anxiety symptoms and concurrent depressive symptoms, meaning that some women may experience both depression and anxiety during the postpartum period.

"My feeling is that postpartum depression and anxiety is underdiagnosed and undertreated," Stuart said. "In part, this is due to the fact that some women are not aware they should seek help for these conditions. Additionally, some parents and doctors have concerns about the safety of antidepressant medicine for mothers who are breastfeeding."

Stuart noted that recent studies, however, indicate that commonly prescribed antidepressants are safe for mothers who are breastfeeding. "Once the child is around 10 weeks old, it's relatively safe to use these medications," he said. "There have been some concerns with benzodiazapines, which are drugs commonly used for anxiety. These medications are probably best avoided during breastfeeding. Most of the proven antidepressants also work well for treating anxiety, however. Overall, the potential problems are far outweighed by the known effects of postpartum depression to the mother and child."

Psychotherapy is another option. Stuart and his colleagues have completed a study on interpersonal psychotherapy and postpartum depression. The results, which the researchers will publish, are very promising, he noted.

Whatever the treatment, doctors should screen mothers for depression or anxiety during routine postpartum check-ups, Stuart said. "Our studies show that postpartum anxiety or depression is quite common. Mothers need to know that safe, effective treatments are available."