Depression and Anxiety During Pregnancy and Following Birth
Pregnancy is often viewed as a time of much excitement and joy, yet many women experience depression and anxiety during and after pregnancy. Women may feel guilt and a reluctance to express to those close to them that they are suffering from these disorders.
However, the more open a mother can be about her depression and anxiety with her healthcare team of doctors and midwives, and also her partner and family, the better for the health of the mother and baby. Medical professionals can analyse risk factors early on and limit the likelihood of depression and anxiety.
Depression
Depression is a mood disorder that it more intense and long-lasting than the relatively common feelings of stress, sadness and being overwhelmed that almost everyone experiences from time to time. Symptoms of depression often continue for two weeks or longer. Antenatal depression that occurs during pregnancy and postnatal depression, after pregnancy, are estimated to affect one in ten women.
Long periods of depression are unlikely to go away without treatment but there are many effective options available. At its worst, depression can seem impossible to treat. With pregnancy-related depression, however, it is common for women to feel better after only a few months, and almost all feel back to normal within a year.
What makes depression during pregnancy and afterwards more likely? :
You or someone in your family has had depression before
Having experience of OCD, bipolar disorder, eating disorders
Not enough social support around you
An unplanned pregnancy
Issues with alcohol and drugs
Traumatic life events such as divorce or bereavement
A poor relationship with your mother
A traumatic childhood, often involving abuse (physical or sexual)
Experiencing family/partner violence
You can still be affected even if none of these factors above relate to you. Women from all walks of life, at various stages of their pregnancy and ages, are affected, so you are never alone.
Your doctor will examine and investigate other long-term medical conditions such as thyroid disorders and anaemia, which may be associated with symptoms of depression in pregnancy and following birth.
How can we identify the condition?
The signs and symptoms of depression in pregnancy and after birth include:
Loss of self-confidence, a feeling of worthlessness or guilt
Feelings of sadness, emotional irritability or tearfulness
Restlessness or difficulty concentrating
Difficulty caring for oneself or feeling unable to cope
Low energy or extreme fatigue that doesn't get better after rest
Loss of interest and pleasure in activities
Increased or loss of appetite
Poor sleep or increased sleep and loss of sex drive
If you have depression, you won’t necessarily experience all of these symptoms. Remember that difficulties with sleeping, changes in appetite, lower energy and loss of sex drive are normal symptoms associated with late pregnancy, breastfeeding and early motherhood.
When depression becomes more severe, it can be associated with having suicidal thoughts or wanting to harm yourself or your child. After childbirth, a very small number of women may develop psychotic symptoms, known as ‘postpartum psychosis’, which may include hearing voices, having hallucinations and irrational beliefs. This requires immediate assessment by your doctor.
What is anxiety?
Anxiety and motherhood are intertwined. All good mothers worry about how their life and choices will impact their babies. However, this anxiety becomes a problem when it continues for a long period, often called Generalised Anxiety Disorder, or there are sudden intense bursts of anxiety, known as panic attacks.
Like depression, anxiety can negatively affect the way that you think, feel and behave. It is also very common for depression and anxiety to happen at the same time, leaving women feeling sad, down and hopeless.
Anxiety can occur during or after pregnancy and affects over one in ten pregnant women. If you have had anxiety in the past, or consider yourself a ‘worrier,’ you are at a higher risk of experiencing or developing symptoms during pregnancy or for the year following birth and should consult a doctor as soon as you can.
What should I do?
If your experience symptoms consistent with depression and anxiety contact your midwife or doctor and explain how you feel. Remember that these feelings are normal and the health professionals will never judge you or make you feel guilty. Feeling like this is caused by an illness not a choice.
How are these conditions diagnosed?
The doctor will look to get a fuller picture of your situation and identify risk factors to depression and anxiety. Your doctor or midwife may ask you to complete a questionnaire called the Edinburgh Postnatal Depression Scale (EPDS). This can identify if you need further medical assessment for depression and/or anxiety.
This assessment may ask you about your feelings, any of the symptoms of depression and/or anxiety, your personal or family history of depression or stressful events, or your current social support network and relationships. Finally, a physical examination and blood tests may be recommend to check for other contributing causes of your symptoms.
The assessment may involve your partner and family (with your permission). Although it can be difficult to discuss with your family and tell them that you are struggling, it is important that you answer any questions relating to you and your baby’s safety honestly.
How is the condition treated?
The level of intensity of the symptoms and how much they impact your life will be important factors in how your treatment for depression and anxiety is assessed.
Mild symptoms may be managed through more regular contact with your doctor or midwife and you may benefit from general advice on lifestyle factors and extra support.
Specific 'talking treatments,' which focus on psychological-based therapy such as Cognitive Behavioural Therapy (CBT), may be offered if your symptoms are more significant.
Medication
Medicine, such as antidepressants, may be offered to combat depression in more serious cases. Treatment with medication is particularly common if you have had depression in the past.
Many women are concerned about taking medication when they are pregnant but you should never stop medication without consulting your healthcare team. Your doctor will carefully discuss with you the risk and benefits of taking antidepressants during and after your pregnancy, and to your partner or family with your permission. Medication may be continued if it poses less risk for you and your baby than the risk of being depressed.
There is considerable research into examining the safest options for antidepressant treatment. Your doctor can discuss this and appropriate treatment options with you. Be open about any concerns and doubts you have about medication and your pregnancy with your healthcare team, and where you feel confident, with your partner and family.
How can I help myself day-to-day?
Talk about how you are feeling, either to your partner, family or a friend
Try not to feel guilty or embarrassed.
Be aware of your mental health and learn to identify symptoms in yourself
Have a balanced diet and eat regularly even if you don’t have much appetite.
Do daily exercise – keeping active will release some feel-good endorphins.
Avoid alcohol, smoking and illegal drugs as these will affect your mood, leading to emotional lows, and risking your baby's development.
Don’t take St John’s Wort, despite some associated benefits with treatment of depression, it’s not safe for pregnancy.
Read as much as you can and plan ahead for emotional wellbeing after birth
What are the risks of not treating depression?
Research has shown that untreated depression during pregnancy may increase the risk of complications in pregnancy, and may also influence the longer term emotional development of your child.
What is the risk of it occurring again if I have another child?
Having previous depression or anxiety is the greatest risk factor to developing it again, with women who have had depression having around a 50% chance of getting postnatal depression a second time. However, awareness and intervention and many other strategies can prevent it happening in future pregnancies.
Telling somebody that you are struggling with depression can be very difficult, but there is an enormous sense of relief when you do this. Your partner, your family, or healthcare team can be a vital support in getting your problems recognised and addressed. It is far better for you and your baby if you ask for help whenever you can.