When Britney Spears announced her third pregnancy in an Instagram post on Monday, she made yet another revelation: She said she suffered from perinatal depression during a previous pregnancy.
“I have to say it’s absolutely awful,” Spears wrote.
Spears, 40, has two children — Sean Preston, 16, and Jayden James, 15 — with ex-husband Kevin Federline. She did not specify when she suffered from perinatal depression, what symptoms she had, or how long they lasted.
But her post resonated, more than 2 million people left likes and comments. “Women didn’t talk about it back then,” she wrote. “Thank God we don’t have to keep this pain to ourselves.”
Spears isn’t alone: research shows that up to 1 in 5 pregnant women have experienced perinatal depression.
“The experience of depression during pregnancy and postpartum is very common,” said Karen Tabb Dina, associate professor in the School of Social Work at the University of Illinois at Urbana-Champaign.
Finding help can be difficult for Black parents with postpartum depression
But for Rachelle Robertello, who is eight months pregnant and suffers from perinatal depression, it still feels like there is a lack of awareness of the condition.
“I see articles all the time about postpartum depression, what warning signs to look out for,” said Robertello, 28, a graduate student living in Centreville, Virginia. But “nobody talks about” perinatal depression, she added.
Unlike postpartum depression, which occurs after birth, perinatal depression begins during pregnancy and, according to Tabb Dina, can last for a “nearly two-year window” — from the beginning of a pregnancy to the end of the first year after birth.
According to the National Institute of Mental Health, research suggests that perinatal depression “is caused by a combination of genetic and environmental factors,” including life stresses, the demands of childbirth, and changes in hormones during and after pregnancy. Symptoms can include “feelings of extreme sadness, anxiety and fatigue, which can make it difficult for them to do daily tasks, including caring for themselves or others.”
Other symptoms, according to Tabb Dina, can include “any sharp change in your normal mood,” which can manifest itself in anger, “an inability to feel joy about the pregnancy,” trouble sleeping, and loss of appetite, she said.
Recognizing these symptoms early is “very important,” Tabb Dina added. “For most people, the signs and symptoms of what later becomes postpartum depression begin during pregnancy.
Postpartum depression occurs after about 15 percent of births, according to the NIMH, and research has found that adolescents are most at risk of perinatal and postpartum depression; Blacks and Asians; people experiencing domestic violence and people dealing with chronic illnesses; and people living in rural areas. Studies also suggest that perinatal depression may have become even more prevalent during the pandemic, with up to 1 in 4 pregnant women suffering from depression.
Postpartum depression can affect new mothers at least three years after giving birth, the report said
But doctors don’t always discuss or look for symptoms of depression in pregnant people, Tabb Dina said. And a 2010 study published in the Journal of Women’s Health found that the majority of people who test positive for depression after childbirth did not receive psychiatric treatment from their providers during pregnancy or after childbirth.
Robertello said she’s suffered from depression for years, but her symptoms during pregnancy, which include fatigue and a lack of excitement about her pregnancy, are “particularly debilitating.”
“It was really tough because… [my husband and I] wanting children, that’s not an unexpected result,” she said.
To cope, she’s “tried to do every single fun thing that’s on the list of things to do during pregnancy” — including having a baby shower and taking pregnancy photos, she said — but “it is like I’m just doing the moves and not really excited.”
Robertello addressed her concerns with her doctors in her first trimester, and they increased her dose of the antidepressant Zoloft, she said, which helped “a little.”
But just last month, when she was in her third trimester, Robertello found out about perinatal depression, which she discovered by Googling her symptoms, she said.
Tamar Canady, a 42-year-old photographer and substitute teacher from Phoenix, also used Google to diagnose herself with perinatal depression a few years after she became pregnant nearly two decades ago, she said.
“We’ve all heard about depression after childbirth … but I had never heard of depression during pregnancy,” said Canady, who added that her main symptom was paranoia that the baby would be taken away from her.
Tabb Dina said that Google’s postpartum depression self-assessment tool can actually be a useful source of information to help people understand possible perinatal or postpartum depression symptoms. (The tool notes that this is not an official medical diagnosis and that people should speak to their doctors for further advice.)
Watching Canady Spears’ post about her new pregnancy and her past experience with perinatal depression, “she loved that she didn’t make a big deal out of it… like, ‘Yeah, that happens to women and stuff like that, I’m worried and I’m ready , deal with it.’ ”
For her part, Robertello was struck by the fact that Spears “actually used the term ‘perinatal depression,'” she said, adding that “it was just nice to see recognition [of] that.”
Spears, who was released from her conservatory in November, testified last June that the people who ran her conservatory refused to let her have the IUD removed so she could try to have another child. In her Instagram post on Monday, she said she will be “doing yoga every day” this time during her pregnancy.
For people suffering from or at risk of perinatal depression, treatment options include doctor-prescribed medications, which Tabb Dina describes as the “gold standard” for people suffering from perinatal depression, although she acknowledged some pregnant people prefer it not to take any medication during treatment pregnancy.
The NIMH recommends that pregnant women “should work with their doctor to weigh the risks and benefits of treatment,” noting that it can take six to eight weeks for antidepressants to work. It also notes that people may need to try several different medications “before finding one that improves their symptoms and has manageable side effects.”
Drug-free options include home-visiting programs with professionals who practice cognitive behavioral therapy — which Tabb Dina says can be particularly powerful for people who already have other children they may not be able to leave alone — and group prenatal care sessions that enable people to share their experiences and share symptoms with other pregnant women.
“You could listen to someone else and say, ‘I didn’t know that was normal,'” she said.
Robertello has turned to pregnancy app Peanut for these kinds of discussions, she said, “It’s been a comfort just reading other people’s posts, commenting on someone who was like, ‘What you’re going through is valid.’ ”
Canady’s pregnancy is long behind her, but she is constantly working with pregnant people in her photography business, photographing newborns and coordinating maternity shoots.
Upon seeing Spears’ post, she said she thought about how she could do more to share information about perinatal depression with the parents she works with who may be struggling.
Maybe, she said, start by linking to resources on her website.