Symptoms and treatment of antenatal depression

Mental health has quickly become one of the most important aspects of pregnancy. Whilst we all have good and bad days, if you have ongoing feelings of sadness, feeling down and/or have lost interest or pleasure in everyday life, then you may be experiencing depression.

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Depression is the second most common mental health condition that can affect you at any time of life, but the likelihood increases during pregnancy, with up to 10% of women (1 in 10) experiencing depression during pregnancy (‘antenatal depression’).

Like anxiety in pregnancy, signs of depression may be attributed to other things, like hormones, tiredness and feeling uncomfortable, and hence, the opportunity to get on top of the depression early and before the baby arrives has passed.

Depression may develop gradually or within a short period of time and may go on for weeks, months or even years, if not treated. If it develops during pregnancy, it is likely to continue following the birth of your baby, so getting help before the baby arrives is a good idea.

Symptoms of antenatal depression

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• Feeling low or numb – some people describe feeling nothing at all
• Loss of confidence, feeling helpless, hopeless and worthless
• Feeling teary and emotional, angry, irritable or resentful towards others
• Changes in sleep – not being able to sleep, even when you have the opportunity or, conversely, wanting to sleep all the time
• Changes in appetite – accompanied by weight loss or weight gain
• Lack of interest and/or energy
• Difficulties concentrating, thinking clearly or making decisions, which could also result from lack of sleep
• Feeling isolated, alone and disconnected from others
• Having thoughts of harming yourself, baby and/or other children
• Finding it difficult to cope and get through the day

Admittedly, sleep will become a foreign concept over time. However, if these changes are also accompanied by negative thinking and feelings about yourself, it is important to consider whether you may be experiencing antenatal depression and the need to discuss this with your health professional.

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Treatment of antenatal depression

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Whilst feeling like this presents a very uncomfortable mix of feelings, the good news is that there are safe and effective treatments that can combat and manage both conditions at the same time, during pregnancy.

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Psychological treatment

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1. Cognitive behaviour therapy (CBT)

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This can help you to identify the negative thinking that is likely to be affecting your mood and behaviour.

The cognitive aspect of this treatment helps you to identify this negative thinking style and begin to challenge your negative thoughts by looking at the evidence for them and rationalising them. For example, a person with antenatal depression may perceive that they will not be a good mother; they may lack confidence in their ability to cope. However, when challenging these thoughts or beliefs, you can begin to see that they are not really founded or logical.

The behavioural aspect of this treatment involves doing things that you have avoided or are no longer doing. Being forced back into activities you once enjoyed will lead you to set small and reachable goals for yourself. Although they may seem hard to do at first, as you recover, these will become easier and give you the opportunity to experience pleasure again – thus playing an important role in your recovery.

2. Interpersonal Psychotherapy (IPT)

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As depression may be associated with past losses and/or changes, this type of therapy aims to resolve these losses, changes or manage conflicts that may be contributing to your experience of depression.

If your depression is more severe, however, and you are finding it difficult to get through the day and even small things seem too hard, it might be time to consider medical treatment for your depression.

Medical treatment

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Antidepressant medications

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Antidepressant medications are most commonly used for the treatment of depression. There are antidepressants that are safe to use during pregnancy, as they are not associated with any birth defects. The medications that are available now are safe, effective and not addictive. If you are considering this form of treatment, reach out to your GP to find the right one for you.

Luckily, medication can help you arrive at a place where you can develop strategies to get on top of depression. Trying to engage in these therapies with severe depression is likely to be too difficult, as severe depression can be so debilitating. Thus, medication is recommended as the first step, followed by psychological treatments, to the road to recovery.

Electroconvulsive therapy (ECT)

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This type of treatment is only used in pregnancy for the treatment of severe depression when other treatments are not having any effect and the risk of not treating symptoms (such as suicidal thoughts) outweighs the risk of the treatment itself.

As this is a specialist treatment, it can only be prescribed by a perinatal psychiatrist who generally performs the treatment alongside your obstetrician and a specialist obstetric anesthetist.

Feeling low and unlike yourself during pregnancy is completely normal. However, you don’t have to remain in this fog; treatment is readily available. Reach out to your friends and family for support and then to your GP to get your treatment plan on track. Getting back to yourself is the ultimate goal and taking the first step is the biggest accomplishment.

Head to cope.org.au for access to further information and support for antenatal depression or if you can contact Lifeline 24/7 on 131114.

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