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A NOTE FROM THE DOCTOR: ADVICE FOR PARENTS AND CAREGIVERS
Depression in pregnant women and mothers:
How children are affected
Depression is a common, treatable mood disorder.
About 6% of women, including up to 10% (one in 10)
of women who are pregnant, will experience depres-
sion at some time during their lives.
Women are more at risk of depression while they
are pregnant, and during the weeks and months after
having a baby. Depression during these times can be
confused with the symptoms of pregnancy or with the
‘baby blues’ that many women experience right after
birth.
The good news is that depression can be treated.
It’s important to talk to your doctor if you think you
are depressed. If left untreated, depression can lead to
problems for you and your baby or child.
What are the signs of depression?
Depression can come on slowly, and the symptoms
are different for each person. Some of the more com-
mon signs are:
• changes in appetite, either eating too much or
having little interest in food;
• changes in sleep, either having trouble sleeping or
sleeping too much;
• fatigue or lack of energy;
• feelings of great sadness, hopelessness or
worthlessness;
• crying for no reason; and
• feeling little interest or pleasure in things you used
to enjoy.
New moms with depression may have trouble car-
ing for their baby. They may not want to spend time
with their baby.
How does depression affect pregnant women?
Without treatment, pregnant women with depression
tend to receive less prenatal care, don’t eat as well
and don’t get enough rest. They are at risk of having
a miscarriage, delivering their baby before their due
date (preterm) or having a baby who is too small
(low birth weight).
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If depression isn’t treated during pregnancy, it can
lead to postpartum depression. Postpartum depression
is a serious condition that can last for months after
giving birth and can affect the way a mother bonds
with her baby.
What’s the difference between ‘baby blues’ and
postpartum depression?
The ‘baby blues’ is a mild form of postpartum depres-
sion that many new moms experience. It usually
starts one to three days after the birth, and lasts for
about 10 days to a few weeks. With baby blues, many
women have mood swings – they’re happy one
minute and crying the next. They may feel anxious,
confused, or have trouble eating or sleeping. The
baby blues is very common – up to 80% of new moms
have it, and it will go away on its own.
About 13% of new mothers experience postpartum
depression, which is more serious and lasts longer. It
can start up to a few months after childbirth. If you
have a family history of depression or have suffered
from depression before, you’re more at risk.
Postpartum depression needs to be treated.
Some of the symptoms of postpartum depression
include:
• feelings of inadequacy (like you are not able to
care for your baby);
• extreme anxiety or panic;
• having trouble making decisions;
• feeling sad;
• hopelessness; and
• feeling out of control.
No one knows exactly what causes postpartum
depression. If you think you may have postpartum
depression, it’s important to get help. Talk to your
doctor or call your local public health office.
How does a mother’s depression affect her children?
It’s important to remember that depression is treatable.
But if depression is not treated, children will be affected.
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Other things in a woman’s life may make the
depression worse, such as financial or marital prob-
lems, or a very stressful life event (such as the death
of a loved one).
Depression can cause mothers to be inconsistent
with the way they care for their children. They may
be loving one minute and withdrawn the next. They
may not respond at all to their children’s behaviour
or they may respond in a negative way. Depending on
how old children are, they will be affected by their
mother’s depression in different ways.
Babies
Attachment is a deep emotional bond that a baby
forms with the person who provides most of his/her
care (usually the mother). A ‘secure attachment’ forms
when a mother responds to her baby’s needs consistently
in warm and sensitive ways. Holding, rocking or talk-
ing softly to a baby all help promote attachment.
Attachment helps provide a solid base from which a
baby can explore the world. It makes a baby feel safe
and secure, and helps them learn to trust other people.
A mother who is depressed may have trouble
responding to her baby in a loving and caring way all
the time. This can lead to an ‘insecure attachment’,
which can cause problems during infancy and later in
childhood.
Babies who don’t develop a secure attachment may:
• have trouble interacting with their mother (they
may not want to be with their mother, or may be
upset when with them);
• be withdrawn or become passive; or
• develop skills later than other babies.
Toddlers and preschoolers whose mothers are
depressed may:
• be less independent;
• be less likely to interact with other people;
• have more trouble accepting discipline;
• be more aggressive and destructive; or
• not do as well in school.
School-age children may:
• have behavioural problems;
• have learning difficulties;
• have a higher risk of attention deficit and
hyperactivity disorder;
• not do as well in school; or
• have a higher risk of anxiety, depression and other
mental health problems.
Paediatr Child Health Vol 9 No 8 October 2004
A Note from the Doctor
Adolescents whose mothers suffer from depression
are at high risk for a number of problems including
major depression, anxiety disorder, conduct disorder,
substance abuse, attention deficit and hyperactivity
disorder, and learning difficulties.
How is depression treated?
With treatment, most people recover from depres-
sion. Treatment often includes one or more of the
following:
• Medication: the drugs used most often to treat
depression are called tricyclic antidepressants and
SSRIs (selective serotonin reuptake inhibitors).
• Individual therapy: talking with a psychologist,
psychiatrist or other professional.
• Family therapy: involves others in the family,
like a partner or children. This may be helpful
when children are older.
• Social support: such as community services or
parenting education.
If I take antidepressants during my pregnancy,
will they hurt my baby?
To date, children whose mothers have taken these
drugs during pregnancy have not had problems.
Some women think they should stop taking med-
ication for depression when they are pregnant. If you
are taking antidepressants and are thinking about
getting pregnant (or are already pregnant), talk to
your doctor first.
If I am taking antidepressants, can I breastfeed
my baby?
In addition to having many health benefits for
babies, breastfeeding helps mothers and babies bond.
If you are taking antidepressants, small quantities
of them will come out through your breast milk. But
studies have shown that children exposed to these
drugs through breast milk have not had problems.
Even if you are taking antidepressants, you can
breastfeed your baby for as long as you wish.
Should I take herbal remedies such as St John’s Wort?
There is not enough information about St John’s
Wort to say that it is safe for pregnant or breastfeed-
ing mothers. If you are pregnant or breastfeeding, talk
to your doctor before taking any herbal products.
Additional resources
Many communities have support programs for new
mothers. Talk to your doctor, nurse, midwife, or contact
your local public health office or CLSC (Quebec)
about services in your area.
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A Note from the Doctor

Motherisk: provides information about prescription
drug use during pregnancy or while breastfeeding at
<www.motherisk.org> or 416-813-6780.
All together now: How families are affected by
depression and manic depression, Health Canada:
<www.hc-sc.gc.ca/hppb/mentalhealth/mhp/pub/
together/index.html>.
Depression and manic depression, Canadian Mental
Health Association: <www.cmha.ca/english/
info_centre/mh_pamphlets/mh_pamphlet_15.htm>.
Helping children cope, Mood Disorders Society of
Canada: <www.mooddisorderscanada.ca/
helpingchildren/index.htm>.
Infant attachment – Helpful things for
parents/caregivers to know, Health Canada:
<www.hc-sc.gc.ca/hppb/mentalhealth/mhp/pub/fc/
par_needtoknow.html>.
Postpartum depression, Canadian Mental Health
Association: <www.cmha.ca/english/info_centre/
mh_pamphlets/mh_pamphlet_pp.htm>.

This information should not be used as a substitute for the medical care and advice of your physician. There may be variations
in treatment that your physician may recommend based on individual facts and circumstances.
May be reproduced without permission and shared with patients and their families.
Also available at www.caringforkids.cps.ca
Canadian Paediatric Society, 2204 Walkley Road, Suite 100, Ottawa, Ontario K1G 4G8,
telephone 613-526-9397, fax 613-526-3332, Web site www.cps.ca

586 Paediatr Child Health Vol 9 No 8 October 2004