Up to 15% of pregnant women will develop or experience a form of mental health challenge during or post birth.
I see in my practice much anxiety and depression in both pre- and post-birth. Mental health issues are often unfortunately put in the closet. This may be because of outward fear or rejection of having issues, shame and fear of change in relationships or status as a coping and capable person. Untreated, there is the chance of interference with many of life’s experiences and also with relationships with those who are close.
What causes depression?
There are many things that can contribute to, or make you vulnerable to depression, including:
- a history of depression or anxiety
- family members who have had or have depression or anxiety
- stress during your pregnancy
- If your expectations of motherhood are unrealistic, and you can’t meet them
- a traumatic or complicated birth
- Living away from your extended family
- relationship/marriage difficulties
- lack of social support
- your baby is sick or unsettled
If you have depression or anxiety prior or during pregnancy, you are more likely to have postnatal depression. It is important to get professional help and treatment during pregnancy, rather than leaving it until after your baby arrives.
Risk Factors for Depression
Past history of mental health issues
Often, showing problems from teenage years, such as eating disorders, relationship difficulties, or receiving treatment for anxiety, panic attacks, depression, bipolar disorder or borderline personality disorder, may be signals for increased risk of perinatal mental health issues. Neglecting to discuss these previous problems is quite common, and it misses an opportunity to open a forum for closer observation of the pregnancy and postnatal periods.
Currently treated mental health issues
Around 5% of my patients currently take medication such as antidepressants for mental health issues, and many more have seen psychologists and GPs for help in this area. The vast majority of these women feel much more stable and in control of their health because of this help.
They are very sensible and almost always continue current treatments all the way through pregnancy and the postnatal period. In conjunction with their other treatment professionals, we aim to keep stability through the somewhat frequent emotional challenges of pregnancy. Taking medication is always considered a risk, but in particular, most of the more frequently prescribed antidepressants have a low risk profile.
Evolving or new mental health issues
Through the course of the year, I see people from pre-conceptual right through until the first two months postpartum; it is common that mental health problems are discussed.
Either evolving known or unrecognised issues or new challenges may present themselves, and we will need time and attention to deal with them. Sometimes lifestyle, work or social circumstances need addressing, and sometimes more issues need to be sorted when they may have been longstanding and unrecognised.
I frequently engage the patients’ general practitioner or one of a group of very respected and experienced psychologists that I have worked with. Occasionally psychiatrists may be consulted, but the vast majority don’t need their help in the first instance.
More severe situations, especially in the postnatal period may need inpatient care and attention from excellent services. They play a crucial role in helping the people most affected by mental health challenges.
Treatment for depression
The first step to getting treatment is to see your GP. Initially, your GP may do some blood tests to rule out any medical illnesses that mimic depression, such as iron deficiency, anaemia or thyroid problems.
They can then tailor a management plan according to the severity of your illness. Mild to moderate depression can be improved with psychological treatment and increasing the supports around you.
In some cases of more severe depression, you may need to take antidepressants. There are antidepressants that are quite safe when you are pregnant and when you are breastfeeding.
If you are already taking antidepressants when you get pregnant, you will need to talk with your GP about your ongoing treatment. If you stop taking your antidepressants when you discover that you are pregnant, it can cause a relapse of your symptoms.
Herbal and complementary treatments such as St John’s Wort may not be safe in pregnancy or may interact with other medicines.
Anxiety and Pregnancy
As many as thirty per cent of pregnant women will experience some level of anxiety. A smaller number of women will have more severe symptoms and will be diagnosed with an anxiety disorder.
Anxiety disorders are categorised according to their symptoms. These include:
- generalised anxiety disorder
- obsessive compulsive disorder (OCD)
- post-traumatic stress disorder (PTSD)
- panic disorder
- agoraphobia
- social phobia
Most women have symptoms or a diagnosis of a particular disorder before they get pregnant. Some women will develop symptoms for the first time during pregnancy. Some symptoms will worsen with pregnancy.
Symptoms that are common to each disorder include:
- worry, stress or being on edge most of the time
- muscle tension and difficulty staying calm
- difficulty sleeping
- recurring worrying thoughts that will not go away
- panic attacks
What causes anxiety?
You may be genetically predisposed to worry and anxiety, or you may have been subject to a stressful event. When the anxiety is pregnancy-related, it is likely that you have an anxious temperament and a general tendency to worry.
Your anxiety will be focused on the baby’s health, fear of the birthing experience or concern about your weight gain and body shape.
Women who are victims of sexual assault may also have anxieties during pregnancy. For this group of women there is also likely to be anxiety in the lead-up to the birth and further anxiety about being a parent.
Women who have been sexually assaulted can find it very difficult to be touched. Medical check-ups can be very stressful, especially check-ups that involve the vagina.
This group of women can also be very fearful of the birth process; they can suffer from muscle tension during the birth, which in turn can impact their ability to manage the pain of labour.
Women who have different kinds of pre-existing anxiety disorders can find pregnancy challenging for any number of reasons. Pregnancy and the birth experience can put women into situations outside their comfort zones, which can induce anxiety.
There are also symptoms that women may have in late pregnancy, such as shortness of breath, dizziness, an increased heart rate and feeling hot and sweaty, which can be mistaken for panic attacks or, in some instances, can lead to a panic attack.
It is important to seek treatment early during pregnancy so that your experience of pregnancy and motherhood is positive rather than filled with dread, and also so that you can get quality antenatal and postnatal care for you and your baby.
Anxiety is effectively treated with psychological therapies. These include relaxation training, cognitive behavioural therapy, and mindfulness practice. Lifestyle modifications such as stress reduction and exercise are also helpful. Sometimes in more severe illnesses, medication may be needed, preferably in conjunction with psychological therapies.
Postnatal ‘blues’, adjustment and depression (PND)
Baby blues are very common, affecting up to 80 per cent of new mothers.
Women will experience symptoms three to five days after the birth, such as mood swings, teariness, feeling overwhelmed and/or anxious.
It’s not really understood why women experience baby blues, but it is thought that it may be due to rapidly changing hormone levels after the birth. The birth experience may also play a role in baby blues. Tiredness is a major contributing factor.
If you have the baby blues, it may be reassuring to know that symptoms usually go away after a few days without needing to be treated. However, support and affirmation from your partner and others around you will be very helpful.
If your symptoms don’t shift after a few days, it is important to let your health professional know, as it may be a sign of developing depression or anxiety.
Sometimes it can be hard to know if you are experiencing symptoms of depression. Some women simply take it for granted that having a new baby is hard work and feeling a bit low and a bit overwhelmed is all part of being a new parent. If you’re not sure, try talking to someone about it. Depression and anxiety will need specific treatment for your own well-being and that of your baby.
I commonly see on day 3 post-delivery the previously unexpected tears that flow with the slightest provocation in otherwise normal women after birth. This is the culmination of hormonal changes, sleep deprivation, and the challenges of a newborn baby. They usually settle, and the seemingly heavy drain on the emotions usually slows. It doesn’t mean that postnatal depression (PND) is underway.
The changes in lifestyle, sleep patterns, and relationships over the upcoming weeks present challenges for all parents, and the mental adjustment is considerable. For some people this adjustment presents an enormous strain and may present itself in many ways. It is not depression in itself but a normal response when life was so different only a few months ago. With support and help from family and friends and some positive lifestyle efforts such as exercise, it can be turned around.
Postnatal depression usually takes months to evolve and, as such, usually presents to GPs or maternal and child health care nurses much later after the birth. I often see people with many risk factors, and I talk to them about trying to recognise the signs early and seeking help to avoid the potential damage that it has on them and on those around them. Men are of course also at risk of a similar process, with nearly ten per cent getting some symptoms of depression after becoming a new father.
Signs of postnatal depression are:
- Feeling agitated
- Obsessive fears of wellbeing of yourself or your baby
- Panic attacks
- Obsessive patterns of behaviours
- Sudden mood swings
- Excessive exhaustion
- Little interest in things that normally bring happiness
- Excessive sleeping or, conversely, marked insomnia
- Withdrawal of interaction with family and friends
- Having thought of harming your baby or yourself
If somebody you know is showing these signs, then discuss it with them and ask them if they need help. If you are feeling that it is getting difficult after the birth of your baby and can see some of these things in yourself, then talk to somebody close and ask for help early.
