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All pregnant women should expect some mood variation in pregnancy. But for about 10% of pregnant women depression can become a significant problem with Antenatal Depression.

Symptoms of Antenatal Depression

Everyone’s experience of pregnancy is different, however just as there are expected physical changes, there are also some common changes in emotion associated with each trimester, such as mood swings, anxiety, sensuality and excitement. So when should a woman be concerned that what she is experiencing falls outside these normal variation in mood?

A woman may be suffering from antenatal depression if she feels some of the following symptoms during her pregnancy:

• Inability to concentrate and difficulty remembering
• Difficulty making decisions
• Anxiety about the pregnancy or becoming parents
• Feeling emotionally numb
• Extreme irritability
• Sleep problems not related to the pregnancy
• Extreme or unending fatigue
• A desire to eat all the time or not wanting to eat at all
• Weight loss or weight gain not related to pregnancy
• Loss of interest in sex
• A sense that nothing feels enjoyable or fun any more, including the pregnancy
• Feeling like a failure, feelings of guilt
• Persistent sadness
• Thoughts of death or suicide

Assessment of Antenatal Depression

It can be very difficult for a pregnant woman to understand or talk about how she feels. This makes it more important for those who are providing her antenatal care and for her partner, friends and family to watch her and support her in seeking help. The first and most important step to managing antenatal depression is accurate assessment of the symptoms and diagnosis as early as possible. To assist this it is important to identify some of the factors that may be contributing to the depression.

Pregnancy hormones may contribute to feelings of depression. While hormonal ups and downs affect all pregnant women, some feel the swings more intensely. However many other factors can contribute to the development of depression during pregnancy. A pregnant woman may be experience some uncertainty about the pregnancy, feeling perhaps that the timing is wrong, that career or long-term goals may need to be delayed or that there might be financial problems. She may also feel uncertain about her new role as mother, fears about carrying the pregnancy, as well how she will cope with labor and delivery. She may also feel guilty about being unhappy because everyone expects her to be content and blooming.

Some of the factors that might contribute to antenatal depression include:

Family or personal history of depression. If depression runs in the woman’s family, or if she has had past episodes of depression, she may be more likely to become depressed.

Relationship difficulties. If the woman and her partner or extended family are experiencing difficulties and the woman is afraid of a lack of support when her baby is born, this can have a major impact on her emotional well-being.

Stressful life events. Any major life change, such as a move to a bigger home in anticipation of the baby’s arrival, divorce, or job loss, can contribute to depression.

Problems with the pregnancy. A troubled pregnancy such as one that causes severe morning sickness or concerns about the development or viability of the baby can take its emotional toll, especially if it involves high degrees of monitoring or immobility.

Infertility or previous pregnancy loss. If the woman has experienced difficulties trying to get pregnant, or have had a miscarriage in the past, she may find herself worrying about the safety of this pregnancy.

Past history of abuse. Pregnancy can trigger painful memories in women who have survived emotional, sexual, physical, or verbal abuse.

Lack of social support. All people need to feel supported by those around them, and especially when a woman is facing the changes that parenthood will bring. Social isolation can contribute to the possibility of depression.

Financial difficulties. Financial problems can significantly increase the amount of stress during pregnancy.

Treatment of Antenatal Depression

Following diagnosis it is really important for the woman to seek support and treatment for how she has been feeling as early as possible, including:

Talking about how she has been feeling with a trusted person will allow her friends and family the opportunity to be supportive. If the woman has a partner, she might need to try to communicate with him to gain his support, he can only give this if she is open with him. Talking to her doctor or antenatal carers about how she has been feeling is also important for seeking help. Once you start talking you will be surprised at how many people have had similar experiences.

Take it easy. A woman might feel that she needs to set up the nursery, clean the house, or work as much as she can before she goes on maternity leave. It might be more important for her to make some time for herself, read a book, have breakfast in bed, or go for a walk. If she already has children, arranging for family or friends to look after them can allow time to herself. Taking care of herself is an essential part of the woman taking care of her baby.

Consider therapy or counselling. If the woman has tried to work through things on her own but nothing seems to work, seeing a therapist or a counsellor may help. The woman may also benefit from antidepressants – some of which are safe for pregnant women. Talk to her doctor or midwife about this.

When the woman needs to seek help quickly: If she is suicidal or feeling disoriented and unable to handle daily life, or if she is having panic attacks, talk to her doctor or midwife immediately. Seeing a therapist or psychiatrist is not a sign of weakness. It’s a sign that she is taking the steps necessary to keep herself and her baby safe and healthy.

What will happen after the baby is born?

Depression during pregnancy does not mean that a woman will have postnatal depression, however about fifty per cent of women suffering from severe depression during pregnancy go on to develop postnatal depression. Therapy during pregnancy can reduce the chances of developing postnatal depression dramatically. Putting in place a support network of family, friends, the doctor, and therapist and support groups before the birth will make the period following birth much easier.

This article was reproduced with permission from PANDA (Post and Ante Natal Depression Association).

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