Depression After Miscarriage: Symptoms & How To Cope 2023

Approximately 10-25% of pregnancies^[1] end in miscarriage. Early pregnancy loss can be a traumatic and heart-wrenching experience that triggers intense emotional distress. Grief, sadness, hopelessness, anger, guilt, and other mental health problems are common in the aftermath. The pain of a miscarriage is often compounded by isolation and shame, as the stigma surrounding this type of loss causes many to suffer in silence.^[2]

Women’s mental health may start improving about six weeks after a prenatal loss but often doesn’t begin to improve before three months. As many as 20% of women^[1] who experience a miscarriage develop clinically significant depression and anxiety, and if not treated, these symptoms can persist for years. 

Further risk factors for depression associated with pregnancy loss include previous prenatal loss, a history of recurrent miscarriage, frustrated desire to become pregnant again, loss of a planned pregnancy, economic hardships, and lack of emotional, domestic, or economic help. 

What Are The Psychiatric Disorders Associated With Pregnancy Or Pregnancy Loss? 

Pregnancy presents as a total revamping of an expectant mother’s physiology, which can interfere with or complicate the psychological aspects already at work. It is no wonder that there is a range of disorders^[3] that can occur:

• Postpartum blues: This affects 60-80% of new mothers. Crying, irritability, sleep disturbances, and moodiness occur. This is quite complicated because mixed into the biological changes are issues associated with quality of life, such as having to put aside the normal activities of daily living and lifestyle. Typically lasting a few weeks, it goes away on its own. Of note is that the father can suffer blues, too, as he is forced to put aside his plans, employment, or other activities. 
• Postpartum depression: This affects 10-20% of new mothers. It lasts longer and is more severe than the blues, including feelings of hopelessness and inadequacy. Most concerning is disinterest or lack of care for the baby because this may blur the dividing line between depression and psychosis. As a subset, depression after a miscarriage can remain clinically valid^[4] as a diagnosis for up to nine months. 
• Postpartum psychosis: This affects about 0.1% of new mothers. There is a dissociation from reality, with confusion, delusions, and even risks of self-injury or hurting the baby. This is a medical emergency and requires immediate hospitalization. 
• PTSD: This disorder is most likely associated with pregnancy loss since the others above usually follow a completed pregnancy. Statistics are inconclusive except that there is an increased rate of PTSD^[5] in women — and to a lesser extent, men — following early pregnancy loss.

Especially vulnerable are those women who fought hard to become pregnant due to infertility issues that involved months, if not years, of hormonal therapy and artificial reproductive technology, i.e., ART. 

Ectopic pregnancy, i.e., implantation of a fertilized egg in any place other than the uterus, occurs in 2%^[6] of all pregnancies and is considered just as much a pregnancy loss as miscarriage. 

While the rates vary across studies, research shows a consistent link between prenatal loss and depression in the postpartum period. In fact, postpartum depression is considered PTSD. A large multi-site study investigating rates of depression^[7] in women following miscarriages or ectopic pregnancies revealed that 11% experienced moderate to severe depression one month after the loss. After nine months, 5% of women who experienced a miscarriage continued to exhibit moderate to severe depression.

Another study found that 8.9% of women who had a miscarriage met diagnostic criteria for depression, anxiety, or an adjustment disorder after one year,^[8] indicating that miscarriages are a risk factor for psychological morbidity. 

Risk Factors

In a study using Internet surveys to evaluate the risk factors for depression^[9] among women who had experienced miscarriage, most women reported sadness, despair, confusion, emptiness, and self-blame. Scores on a depression measure showed an increased risk of depression in 60% of participants and an increased risk of PTSD of 47%. Not having other children was a strong predictor of psychological morbidity. 

An investigation of the prevalence of positive depression screens^[10] following miscarriages demonstrated that 34% of women were flagged for depression risk in the first two weeks. Another study used structured clinical interviews^[11] to assess women six to ten weeks post-miscarriage and found that 18.6% met the diagnostic criteria for a depressive disorder.

Signs Of Depression After Miscarriage

While feeling intense grief and sadness after a miscarriage is normal, many women feel their grief begin to lift after about six weeks. This doesn’t mean that they don’t continue to mourn their loss, but that joy and hope resurface. If your distress escalates to the point that you cannot experience joy or pleasure, work, go to school, or take care of yourself, these are signs of postpartum depression after miscarriage. 

The WHO presents this list of depression symptoms:^[12]

• Feeling sad, irritable, or empty.
• Loss of pleasure, interest, etc., in previously enjoyable activities.
• Poor concentration.
• Excessive guilt or low self-worth.
• Hopelessness.
• Thoughts of death or suicide.
• Sleep disruptions.
• Changes in appetite or weight.
• Low energy/fatigue.

If you experience any of these symptoms every day for at least two weeks, you may be suffering from major depressive disorder, and you should see a healthcare provider for further evaluation.

Ways To Cope With Depression After Miscarriage

The emotional aftermath of a miscarriage can leave you with feelings of isolation and cause you to disengage from the world. While it is important to take time to rest and begin healing, continued social isolation can increase depression. Here are some coping strategies for managing depression:

• Seek support from a healthcare provider. This is, first and foremost, mandatory since depression is a clinical diagnosis.
• Mindfulness meditation.
• Schedule pleasant activities.
• Find social support.
• Exercise.
• Recruit help so you can get adequate sleep.

Mental Health Strategies 

If your depressive and anxiety symptoms make self-care or engaging with others nearly impossible, seek help from a healthcare provider. Medications like selective serotonin reuptake inhibitors are effective in treating depression, as are many types of psychotherapy, like cognitive behavioral therapy. Many forms of therapy are available online, including online group therapy.

Mindfulness meditation teaches people to embrace the present moment by shifting their thoughts away from ruminating about the past or worrying about the future. Research has shown that the use of a mindfulness app^[13] by women with moderate to severe postpartum depression may improve depressive symptoms and sleep quality, but more study is needed. Mindfulness meditation promotes acceptance of the current reality and self-compassion, which are helpful for feelings of guilt following miscarriages.

Social Health Strategies

After pregnancy loss, many women feel isolated and alone in their pain, which can further increase depression. Combat isolation by scheduling pleasant activities and confiding in trusted friends and family members. These experiences provide opportunities for positive emotional experiences and help you re-engage with the world. They also demonstrate to you that you are not unique in your depression.

Peer-reviewed studies have shown that exercise can reduce postpartum depressive^[14] symptoms and improve well-being. Participating in group exercise activities^[15] may help reduce anxiety, provide social support, and combat social isolation.

How To Get Over A Miscarriage

Your world feels shattered after a pregnancy loss. Many women feel as though they never get over a miscarriage, but with time, recovery is possible. While it may be the last thing you feel like doing, taking care of yourself during this vulnerable time is critical. Give your body plenty of liquids, good nutrition, and enough sleep. Give yourself the time and space you need to process your loss. 

Get help. Life is hard enough without the devastation of a pregnancy loss. The psychological fallout may just be bigger than you. Reach out.

Many find comfort in creating a family memorial for their loss. Planting a tree, making a charitable donation, or purchasing a special piece of jewelry can be tangible ways to acknowledge and memorialize your loss.

Finding support groups^[16] for women who have experienced pregnancy loss can help you understand your experience. By connecting you with others who have similar experiences, support groups can reduce social isolation, give comfort by showing that others have experienced what you have, and encourage the healing process. 

How To Help Someone With Depression After Miscarriage?

Friends and family members often want to help but aren’t sure how to help someone with depression after a loss. Understand that it is common for people to experience sadness, grief, and anger in the wake of their loss. Familiarize yourself with the symptoms of depression and monitor your loved ones, especially those with a history of depression, anxiety, or previous losses.

Here are some practical ways to be helpful:

• Acknowledge that the pregnancy existed and was important.
• Be mindful of anniversary dates, like due dates, to anticipate exacerbations.
• Handle news of pregnancy and the birth of a healthy baby delicately.
• Help with household tasks, like cooking and cleaning.
• Find resources for pregnancy loss and depression.
• Encourage support groups.

You might be wary of bringing up their loss, but acknowledging the pregnancy existed is often powerfully validating. Be mindful of anniversary dates, like the due date, and recognize that your loved one might need more support during those times. Handle news of pregnancy and the birth of a healthy baby sensitively, knowing that this can trigger feelings of grief, sadness, and anger.  

Takeaway

When pregnancies end in miscarriage, it is a devastating emotional experience. Feelings of despair, guilt, anger, and hopelessness and symptoms of depression are common. While the pain of the loss may diminish over time, mental health treatment, coping strategies, and support from friends and loved ones can help relieve depression and anxiety.

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