Depression in pregnancy - antenatal depression
Pregnancy can be a time of emotional highs and lows. For some women, however, the lows are persistent and interfere with daily life. Depression during pregnancy (or antenatal depression) is an under-recognised condition experienced by approximately 9% of women at any given time during pregnancy. The symptoms of antenatal depression are no different to the symptoms of depression at other times during one’s life, but can be compounded by the fact that women may also be experiencing other physical symptoms as a result of being pregnant.
Symptoms of antenatal depression
Depression can start at any time during pregnancy and can come on suddenly or develop gradually. It may persist for many months.
"I was excited to be pregnant. I didn’t expect to feel so down."
A number of antenatal services now screen for depressive symptoms using a short questionnaire to help detect depression during pregnancy.
The symptoms of depression include:
A. Feeling sad or unhappy most of the day.
B. Loss of pleasure or interest in most activities most of the day.
C. Significant weight loss or gain, or decrease or increase in appetite, unrelated to pregnancy.
D. Difficulty sleeping or over-sleeping.
F. Feeling restless or slowed down.
G. Fatigue or loss of energy.
H. Feelings of worthlessness or excessive or inappropriate guilt.
I. Difficulties thinking, concentrating or making decisions.
J. Recurrent thoughts of death or suicide.
Not all symptoms are always present, but experiencing several of these symptoms (and at least one symptom is A or B) nearly every day for at least two weeks, may indicate clinical depression.
What about anxiety?
Anxiety often occurs with depression and women may find themselves worrying excessively about their health, the pregnancy, how they will cope with labour, becoming a mother and so on.
What causes antenatal depression?
There is no one definite cause of antenatal depression; however, some of the factors that can increase a woman's risk of developing antenatal depression have been identified. These include: a history of depression, high levels of anxiety during pregnancy, low self-esteem, limited social support, major life changes or events, childhood history of abuse, young age, low income, lower educational attainment, and a history of miscarriage or pregnancy termination. Women may have all of these risk factors and may be coping well or may have none and be feeling down. There is no direct causal relationship. This makes it hard to focus on who might need help.
Effects of antenatal depression
Having antenatal depression can make women vulnerable to postnatal depression. Many women believe that they will feel better once baby is born and some women do, but many don't and go on to have postnatal depression. Depression is a treatable condition and there are a range of treatment options available. Getting help early is of most benefit as antenatal depression affects not only the woman's own health and well-being, but can also affect her developing baby. Antenatal depression can also put stress on a woman's relationship with her partner.
While taking the first step to seek help can be difficult, additional support at this time is helpful for many women. Letting someone know how you are feeling is a really important first step.
Psychological therapy is an effective treatment for depression, particularly Cognitive-Behavioural Therapy and Interpersonal Psychotherapy. A rebate can now be claimed from Medicare for treatment with a registered psychologist (individual and group sessions) when a patient is referred by a General Practitioner (GP) or Psychiatrist.
Antidepressant medication is also an effective treatment for depression; however, many women are concerned about taking medication for depression during pregnancy because of the possible risk to the unborn baby. This is an important consideration and should be discussed with a GP or Psychiatrist who will weigh the risks of taking the medication with the risks of untreated depression.
There are many other options for obtaining support during this time: for example, self-help books, telephone counselling and support, and internet resources. These can be helpful and sufficient for some women depending on the severity of their symptoms.
Taking the first step to feeling better
For some women, admitting they are struggling can be the hardest part in the process to recovery from depression because they believe that they should be happy and positive about being pregnant.
"I couldn’t wait to have a baby and my partner is so excited. I shouldn’t be feeling so unhappy."
"I should be able to cope on my own."
If you think you may be depressed, the first step to getting help is to tell someone how you are feeling. This person may be your partner, a family member, friend, or a health professional you feel comfortable with (e.g., your midwife, GP, or obstetrician). Investigate treatment options (or ask this support person to help you) and find what works for you.
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