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    Antenatal Depression

    Overview
    Causes
    Symptoms
    Risk Factors
    Prevention
    Diagnosis
    Treatment Options
    Where to Seek Treatment
    KK Women's and Children's Hospital
    Contributed by Dept of Psychological Medicine

    Overview

    Pregnancy and childbirth are special times in the lives of many women. But sometimes, instead of being excited, joyful and in the brink of good health, you can find yourself struggling to cope with 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.


    Causes

    It is often an interplay of various factors that led 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:

    • if the pregnancy was unwanted or unplanned.
    • if you have had a difficult relationship with your own mother. The unresolved emotional conflicts will be awakened as you prepare to be a mother.
    • 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.
    • 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:

    • Having a complicated pregnancy
    • Fetal abnormalities
    • If you have previous episodes of depression

    The same factors that contribute to depression at any other time in a woman’s life will similarly affect her during her pregnancy:

    • Marital difficulties
    • Interpersonal problems
    • Financial and occupational problems
    • Lack of social support
    • Loss of a loved one
    • 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.


    Symptoms

    The symptoms of antenatal depression are:

    • Low mood
    • Irritability
    • Loss in interest
    • Poor sleep
    • Poor appetite
    • Loss of concentration
    • Loss of energy
    • 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.


    Risk Factors

    Women facing high stress, such as a number of the causative factors as listed in point 2 are particularly at risk. Also, women with a pre-existing depressive illness are also a risk of a relapse of depression during pregnancy, especially if their antidepressants are discontinued.


    Prevention

    Recognising and managing your personal levels of stress is particularly important at this time of transition into motherhood. For women with pre-existing depression, antenatal care planning, and early recognition of relapse symptoms is important. Support measures are particularly helpful, whether from your husband, family, friends or healthcare professionals.


    Diagnosis

    The diagnosis of Antenatal Depression is based on the criteria listed in point 3. Symptoms, with symptoms lasting two weeks or longer, interfering in your ability to function.

    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. With early recognition and treatment, chance of recovery can be good. The goal for early detection and treatment is to enable you to have the wonderful experience of caring for your baby.


    Treatment Options

    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, unless the mother’s depression is severe. 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.

    Where can you seek support?

    The Perinatal Depression Support Group at KK Women’s and Children’s Hospital  provides support for mothers who experience depression and anxiety during pregnancy and the postnatal period. It provides mothers with an opportunity to share their experiences and practical information about the condition, and offers tips on coping.

    Sessions are conducted in English and are facilitated by case managers. It is held on the 1st Tuesday of the month. For more information, please call 6394 2205.

    References
    Pregnancy blues: what every woman needs to know about depression during pregnancy by Shaila Kulkarni Misri; New York - Delacorte Press 2005 (618.76 MIS - [HEA])

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