Depression during pregnancy: Risks, signs & treatment
PREGNANCY is an emotional roller coaster for many women — it’s natural to experience many highs and lows, especially as the mom-to-be experiences the flood of pregnancy hormones. Obstetrician-gynaecologist Dr Leo Walker says while it is natural to experience a kaleidoscope of emotions, including fear, confusion, anxiety, and depression when pregnant, when feelings of hopelessness, fear, sadness, and negative thoughts linger, especially beyond two to four weeks, you may be experiencing antenatal depression.
“Antenatal depression describes the more than the average serious, negative emotional changes that pregnant women experience. These emotions are usually so debilitating that they significantly affect the woman’s day-to-day ability to do the things that she wants to do,” Dr Walker told All Woman.
He pointed out that, while pregnancy is usually seen as a time of mental and emotional well-being for women, many pregnant women suffer from mental disorders, including new-onset or recurrence of depression.
According to the American College of Obstetricians and Gynaecologists, about one in 10 pregnant women, or about 14 per cent of all pregnant women, are affected by antenatal depression. In Third World countries, however, Dr Walker said that the percentage is much higher.
In developing countries like Jamaica, the prevalence of depression during pregnancy can be as high as 20 per cent. This figure, however, can be misleading as depression during pregnancy often goes undiagnosed or underdiagnosed as many women feel stigmatised by having mental health disorders, Dr Walker reasoned.
He explained that one of the primary reasons for underdiagnosis of antenatal depression in women may be linked to the fact that some of the symptoms associated with depression may overlap with symptoms simply related to pregnancy. These include weight gain, increased fatigue, disturbed sleep, and mood swings.
Other symptoms of antenatal depression are:
•An unusual amount of worry about giving birth and parenthood
•Lack of energy and disturbed sleep
•Losing interest in yourself or your pregnancy
•Chronic anxiety
•No interest in sex
•Poor concentration.
Dr Walker said that, while all pregnant women are at risk of antenatal depression, some women are at a greater risk of developing the condition. Factors that increase a woman’s risk include:
•A previous history of depression (during pregnancy or otherwise)
•Women experiencing adverse life events (divorce or relationship problems)
•Women who are victims of partner violence/domestic abuse
•Women with little or no social support
•Women who have other pre-existing illnesses (diabetes, hypertension)
•Women with body image dissatisfaction – A woman’s body will undergo several major changes throughout pregnancy and some of these changes, unfortunately, can have negative effects on her self-confidence.
“If you think that you are depressed, then it is important to seek medical assistance. It is important that clinicians ask patients the right questions and listen to moms-to-be whenever they visit them. It is important that we focus on disturbances in mood, such as feelings of sadness, emptiness, or hopelessness, thoughts of suicide, feelings of worthlessness, or diminished interest in most, if not all activities, as opposed to other traditional depressive symptoms which may simply be related to pregnancy such as decreased/increased appetite, insomnia or hypersomnia, and loss of energy,” Dr Walker advised.
He said that proper management of women who develop depression during pregnancy is very important to protect them and their unborn children and to reduce the chances of pregnancy complications that may be triggered by uncontrolled depression.
“Unfortunately, women who develop depression during pregnancy are at an increased risk of preterm labour, operative deliveries, and having depressive episodes following pregnancy. The unborn foetus is also exposed to potential risks such as childhood sleep problems, excessive crying, and even sudden infant death syndrome,” Dr Walker underscored.
On the bright side though, Dr Walker said that it is important to note that there is a variety of treatment options available to women who experience depression during pregnancy.
“For those women who require antidepressants, studies suggest that most of the widely used medications are safe during pregnancy and breastfeeding, and discontinuing the medication may increase the risk of recurrent depressive episodes. The approach to treatment should therefore be discussed with your health-care provider to have a shared decision-making process,” Dr Walker advised.
Dr Leo Walker is a Maternal Foetal Fellow at the University Hospital. His obstetrics and gynaecology practices are located at the Westminster and Oxford Medical Centres.
