Antenatal depression

Pamela Wilson
Monday, March 13, 2006
Ask any pregnant woman how she feels and often the answer will be one of exasperation. "Ugh, I feel fat; I'm so tired; I'm over it; I'm so hormonal and moody."

Everyone has bad days, especially during the long nine months of pregnancy. But for as many as 20 percent of pregnant women this normal mood shift can become a serious case of the pre-baby blues. Fortunately, there are many things women can do to boost their mood and enjoy their pregnancy.

The statistics vary, but it is believed that antenatal depression affects between seven and 20 percent of pregnant women. And it is as common as the wider known condition, postnatal depression.

"Traditionally we have talked about post-natal depression and in the last five or so years … researchers like ourselves have become aware that a lot of the depression really is starting in pregnancy," explains Associate Professor Marie-Paule Austin, who heads the Royal Hospital for Women's Perinatal* Mental Health Clinic in Sydney. (*Perinatal is the umbrella term for both antenatal and postnatal depression).

Because depression can creep up gradually and many of its symptoms, such as fatigue, are common during most pregnancies, it can be difficult for health professionals and the women themselves to see it coming.

"It can be quite insidious and people just think they are tired or putting on weight or are a bit hormonal," explains Assoc Prof Austin, who is also affiliated with the depression research and education group the Black Dog Institute.

It is important to identify depression early because, without treatment, it can lead to postnatal and ongoing depression. In fact, up to 40 percent of women who experience antenatal depression develop postnatal depression if they don't receive treatment.

Risk factors
While certain experiences may make some women more susceptible to the blues than others, antenatal depression can affect anyone, says Nicci Blount, from Post and Antenatal Depression Support and Information Incorporated (PANDSI). "There is certainly no one particular group of women that it can affect," she says.

The following experiences can place women at a greater risk of developing anxiety and/or depression during pregnancy:

  • difficulty becoming pregnant;
  • unwanted pregnancy;
  • anxiety about their ability to cope with a child;
  • inadequate support from their partner, family and/or friends;
  • past history of depression;
  • low self-esteem and history of abuse;
  • previous miscarriages or stillbirths that cause anxiety which can lead to depression.

What to watch for
Because pregnant women are in frequent contact with health professionals monitoring their antenatal care, this is a good time for the women and their doctors and midwives to look for signs of depression.

"It's an ideal time to pick up whether the mother is having problems with depression whereas, postnatally, it can be missed because they are no longer in that much regular contact with the health services," explains Associate Professor Austin. She suggests that pregnant women who have any concerns during their pregnancy should flag the issues as soon as possible with their doctors and midwives. This way their mental health can be monitored from an early stage and they can be referred to the correct support services if necessary.

Signs to watch for include:

  • a persistent feeling of dread;
  • anxiety, feeling overwhelmed or having concerns that you won't be able to cope with a baby;
  • a sense of hopelessness;
  • the inability to enjoy the pregnancy and/or activities that would normally be welcome;
  • significant changes in appetite and sleep, beyond the normal changes that pregnancy can bring about;
  • fatigue;
  • lack of motivation;
  • substance abuse;
  • uncontrollable crying.

Beating the pre-baby blues
These days, the incidence of depression is widely known and there are lots of resources and treatment techniques available to sufferers. Treatment ranges from simple measures such as increasing your level of self-care to medications in the case of severe depression, says Blount. She adds that research shows there is usually very little, if any, affect of certain medications on an unborn child. She offers the following tips to help you feel well again.

Start with yourself:

  • eating small regular meals can stabilise blood sugar levels and increase your energy and, therefore, your moods;
  • avoid foods that contain aspartame, like diet foods and diet soft drinks, because they can block the body's formation of serotonin, which is a naturally-occurring mood lifter,
  • avoid high-fat foods and caffeine;
  • try acupuncture and acupressure;
  • increase self-care with relaxation activities such as yoga, baths and time for yourself;
  • try to fit in plenty of pregnancy friendly exercise such as walking and swimming;
  • get as much rest as possible;
  • look for support people, such as family and friends, and ask them for help;
  • if you feel you are taking antenatal health messages and warnings to the extreme, talk to your doctor or midwife who can give you realistic medical facts and advice.

Professional support might include:

  • learning cognitive behaviour therapy, which helps to modify negative thinking patterns;
  • face to face, or group support sessions with support people, psychologists or psychiatrists;
  • learning anxiety-modifying and relaxation techniques such as meditation;
  • medications in more severe cases of depression.

Where to get help

  • The Black Dog Institute is an educational, research and clinical group with expertise in depression. It is attached to the Prince of Wales Hospital and affiliated with the University of New South Wales in Sydney.

  • Beyondblue is a national, independent, not-for-profit organisation that specialises in depression and anxiety.

  • PANDSI is the Post and Antenatal Depression Support and Information Incorporated.

  • Black Dog and Beyondblue both have depression self-test resources available on their websites. The Black Dog's test is specific to perinatal depression.

  • The Black Dog Institute also lists perinatal depression contacts around the country.

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