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| Perinatal Depression |
Pregnancy and childbirth are special times in the lives of many women. And many of us, women, will experience motherhood, or at least come in close contact with pregnant women. But sometimes, instead of being excited, joyful and in the brink of good health, a picture which we have come to associate with motherhood, you can find yourself struggling to cope with depression.
Pregnancy is a period that can bring on worrying changes in the psyche of a woman, as she navigates a dramatic transition within herself. This booklet aims to provide information on depression occurring during and after pregnancy, the symptoms and possible causes, and what can be done to help you if you suffer from perinatal depression. |
| Antenatal Depression |
Whilst the previous emphasis and awareness have been on postpartum depression, research has suggested that antenatal depression, or depression during pregnancy, may be even more common than postnatal depression. Locally, about one in five pregnant women is likely to have significant depressive symptoms associated with impairment of functioning, and about one in ten will have clinical depression - that is, depression requiring medical attention.
We also now understand that antenatal depression often marks the onset of depressive illness in women and increases the risk of postnatal depression. As the common features of depression such as loss of appetite, poor sleep, feeling tired and forgetful are so similar to those of pregnancy, women can sometimes dismiss these symptoms. More useful symptoms to look out for would be pessimism and mood swings.
The symptoms of antenatal depression are:
- Low mood
- Irritability
- Loss in interest
- Poor sleep
- Poor appetite
- Excessive self-blame or guilt
- Feeling hopeless, or that life is meaningless
Women can also look out for sign of their mood swings affecting their ability to relate to those around them, or their ability to cope with work, housework or other responsibilities.
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| Causes for Antenatal Depression |
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When a pregnant woman is tearful or emotional, the common reaction is “It’s her hormones!”. But whilst this may be partly true during the first trimester, when estrogen levels are low, and progesterone levels are relatively higher, and morning sickness adds to the misery, hormonal
changes alone do not conclusively account for antenatal depression, otherwise every pregnant woman will be depressed!
The causes for antenatal depression are usually multifactorial, as with other types of depression and most psychiatric disorders. Often, it is an interplay of various factors, which leads to the onset of depression during pregnancy. As a pregnant woman, you will need to undergo a significant psychological adjustment as you adapt to the pregnancy and the notion that you will be nurturing a new life that you are fully responsible for.
If this is your first baby, the adjustment can be more challenging, especially :
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if the pregnancy was unwanted or unplanned. |
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if you have had a difficult relationship with your ownmother. The unresolved emotional conflicts will be awakened as you prepare to be a mother. |
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if you are working. You may not be able to convince yourself to let go of your career or you may have colleagues who are not understanding and supportive. |
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if you are a teenage or very young mother. The psychological adjustment needed to become a mother may be particularly difficult, as you are still very much in need of mothering. |
Other factors that may contribute to antenatal depression include:
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Having a complicated pregnancy |
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Fetal abnormalities |
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If you have previous episodes of depression |
Finally, the same factors that contribute to depression at any other time in a woman’s life will similarly affect her during her pregnancy:
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Marital difficulties |
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Interpersonal problems |
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Financial and occupational problems |
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Lack of social support |
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Loss of a loved one |
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Substance abuse and dependency |
Lastly, if this is a precious pregnancy, or you have had difficulty conceiving or previous miscarriage, there is also an increased risk of depression.
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| What Can Be Done to Help You if You Suffer from Antenatal Depression |
If you are pregnant and depressed, you may hesitate to get help for depression because of the fear of what others might think and the concern about the medications prescribed.
However, the management of antenatal depression involves looking at the stresses and causative factors, counselling, gathering support for you, and other forms of psychological therapy. Only when the depression is severe, will medication be recommended. Furthermore, there are certain medications that are compatible with pregnancy, and are safe for both the mother and growing fetus.
If depression is left untreated, it will worsen and lead to adverse effects for you and your baby.
The first trimester is often a difficult period with uncomfortable symptoms of morning sickness and tiredness. The early hormonal changes during this stage may also contribute to depression. However, antidepressants should be avoided at this stage, as this is the time that the baby’s organs are developing. During this time, gathering assistance such as arranging for the family to help with the care of the older child, or household chores will be helpful. This will allow the woman to have much needed rest. Therapy and counselling are often beneficial too, as they will enable you to talk about your stresses and work through any difficult emotional conflicts.
In the second trimester, antidepressant use may be considered if the depression is at least of moderate severity, and is not improving with non-pharmacological methods.
During the last few weeks of pregnancy, it is recommended that antidepressants be gradually tailed off. This is because some medications may cause withdrawal symptoms in the newborn.
However, if you suffer from a pre-existing depressive illness that is severe, and require long-term antidepressant maintenance, the risk-considerations may sometimes necessitate that you remain on antidepressant medication throughout pregnancy. Risks will be kept minimal by using minimal possible dose, keeping you under close supervision, as well as utilising all other treatment modalities that are appropriate for you.
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| Case Example |
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Agnes was a 34 year-old mother, who experienced mood swings, loss of appetite and interests and was unable to concentrate at work. She also had excessive self-blame, but did not have any suicidal feelings. The main stressor she experienced was her breech pregnancy, and her worries of the outcome. This was also a long awaited pregnancy, which was precious – the couple had been married for six years, and she had had one previous miscarriage.
As she was already in her third trimester, her doctor did not prescribe her medication as it could affect the baby. She received supportive therapy, and her husband was encouraged to spend time with her. Her in-laws, who had mistakenly believed that she was somehow responsible for the complicated pregnancy, were also advised and educated on the nature of breech pregnancy.
Fortunately, she had an uneventful delivery by Caesarean operation, and delivered a healthy baby girl. |
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