>With all of the excitement and exhaustion (for the parents) of a new baby, one concern is all too often overlooked…maternal depression. Women are raised to believe that having a child is the most joyous occasion. Yes you are tired. But you are also so elated at this tiny little bundle of joy and life couldn’t be better, right? Well, maybe. I will admit that when I was pregnant there was a part of me that was a bit concerned that since I had the propensity for depression (family history, and once needing medication for it myself) I would be a fine candidate for post partum depression. Or that I would even encounter prenatal depression. My son is 7 months old and (so far) I have not experienced true post partum depression. But I know many women that have and I think it is just now being truly talked about and assessed.
Honestly I really thank Brooke Shields for bringing this issue to light (and on a certain level Tom Cruise and his “vitamins and exercise can take care of depression” rant…anyone else longing for the days of Top Gun?). She was open and honest about her experience. But what does it mean to have post partum depression? We know Mom isn’t herself, it affects the way she interacts with her baby, husband, family, job, everyday activities…but what about the effects on the kid(s)? A review paper published in the Clinical Child and Family Psychology Review (2006) did a fabulous job of taking a lot of research and highlighting some of the deleterious consequences of untreated maternal depression.
Here are some interesting statistics:
1. During adulthood, women are almost twice as likely as men to have depression, and
onset is usually in the mid-20’s (childrearing years)
2. Approximately 20% of pregnant women experience depression (and tend to seek less
prenatal care)
3. Postpartum depression affects 5-25% of women
So how does prenatal depression/stress a fetus? Glad you asked. Many studies have shown that prenatal depression/stress undermines good prenatal care. These women do not seek basic prenatal check-ups, engage in more alcohol and drug abuse, gain less weight, smoke cigarettes more, and feel more stressed. The increase in feelings of stress and depression in turn affect the quality of cortisol (the primary human stress hormone) release from the mother. Depression and stress both increase the release of cortisol. Elevated levels of maternal cortisol affect the growing fetus by: altering the fetus’ development of the HPA axis (makes the HPA axis more responsive to stress), and higher rates of premature labor and slower growth of the fetus. Prolonged or elevated HPA axis activation has been shown to interfere with learning and memory in children. 
http://speakingoffaith.publicradio.org/programs/2008/stress/images/stressresponse.jpg
But what if there is postpartum depression? According to recent research, postpartum depression may interfere with the cognitive and language development of infants. Infants of depressed mothers have deficits in vagal tone measures (vagus nerve activates facial expressions, vocalization and maintains slower heart rates). These infants vocalize less and show muted facial expressions which could interfere with the depressed mothers’ ability to interpret the needs of the infant. Maternal depression also appears to alter brain activity in the frontal lobes. Using electroencephalogram (EEG) recordings, infants and toddlers of depressed mothers have decreased activation in left frontal brain activation and more right frontal activation. Activation in the left frontal region is associated with positive emotions, whereas right frontal activation is associated with negative emotions. The negative emotional responses would thus interfere with the infants’ ability and motivation to process and interpret external stimuli (i.e. learning). As a side note, most women do experience postpartum blues (I know I did) but this does not appear to interfere with the development of the child, and does not last as long.
Honestly this article is HUGE with vast amounts of information. I have definitely not done justice to how much maternal depression can interfere with the social, emotional, and cognitive development of infants. What is most important is not IF a mother is experiencing depression, but HOW will she, her family and her community respond. No one, especially a pregnant woman or one that just gave birth, should feel isolated and embarrassed for their depression. A mothers’ ability to care for her kids is the most important part of this equation. Therefore, if medication aids in allowing the mother to be more interactive and respond better to her kids’ needs, which in turn allow for the child to develop in a more enriched environment, I am all for it. However, if a woman can find other methods to deal with her depression I think that is great too! Medication doesn’t have to be the only solution. But if it works, go for it.
Of course, it would be interesting to see what role Dad plays in this. If Dad compensates for Mom’s lack of interaction, will it offset some of these negative outcomes? What if the baby attends daycare? Will the interaction from the caregivers be enough?
Any other thoughts?
Sohr-Preston SL, Scaramella LV. Implications of timing of maternal depressive symptoms for early cognitive and language development. Clin Child Fam Psychol Rev. 2006 Mar;9(1):65-83. Review.
neuronmommy 