Pregnant depression

What is depression during pregnancy?

Pregnant depression, or prenatal depression, refers to depression that occurs during pregnancy. It is a form of clinical depression that can affect expectant mothers at any time during pregnancy.

Like other types of depression, it is characterised by feelings of sadness, anxiety, emptiness, and a loss of interest in previously enjoyable activities. Depression in pregnancy can have a major impact on the pregnant woman, the development of the fetus and later attachment, making it important to identify and treat the condition.

In a landmark study published in 2022 of Irish maternal mental health conducted by Trinity’s School of Nursing and Midwifery, one in seven women reported moderate to severe depression symptoms (first year postpartum).

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What causes depression in pregnancy?

Depression in pregnancy can be caused by a mixture of hormonal changes, genetic factors, personal stressors and health problems. Hormonal shifts that occur during pregnancy can affect mood, and women with a history of depression or a family history of mental health conditions are particularly vulnerable.

Stress related to pregnancy, financial worries, relationship problems, as well as health complications for both the mother and the fetus, can also play a role. Lack of social support, previous experiences of abuse or trauma, and negative feelings about body changes and self-image can increase the risk.

Early detection and treatment, which may include psychotherapy and, in some cases, medication, is important to support the wellbeing of both mother and baby.

Symptoms of depression during pregnancy

The symptoms of depression in pregnancy can be similar to those of clinical depression, but they occur specifically during the pregnancy period. It can be particularly difficult to identify depression in pregnancy because some symptoms, such as fatigue or changes in sleep and eating patterns, can resemble normal symptoms in pregnancy. However, here are some specific signs and symptoms that may indicate depression during pregnancy:

• Persistent sadness, anxiety or “emptiness”: Feelings of hopelessness and helplessness that don’t go away and affect daily activities.
• Loss of interest or pleasure: A noticeable decrease in interest or pleasure in activities that are normally satisfying, including lack of interest in the pregnancy.
• Changes in appetite and weight: Significant weight loss or gain not directly related to pregnancy, or changes in eating behavior.
• Sleep problems: Difficulty falling asleep, sleeping through the night, or excessive sleepiness.
• Increased irritability or frustration: even over small or insignificant things.
• Feelings of worthlessness, guilt or self-criticism: Particularly, guilt about pregnancy or being a good parent.
• Loss of energy and fatigue: Feelings of exhaustion and lack of energy for daily tasks, beyond what can be expected from pregnancy.
• Difficulty concentrating, remembering details or making decisions: Cognitive changes that affect work and daily activities.
• Recurrent thoughts of death, suicidal thoughts or suicide attempts: Thoughts of harming oneself or the baby.

It is important to distinguish between common pregnancy symptoms and signs of depression. If a pregnant woman experiences any of the above symptoms to a degree that affects her quality of life, it is important to seek professional help. Treatment for depression during pregnancy can include psychotherapy, support groups and in some cases medication, all under the close supervision of a health care provider.

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PTSD

Pregnancy can trigger or worsen post-traumatic stress disorder (PTSD) in women with a history of trauma, such as sexual or physical violence. Hormonal changes, increased stress, and fear of childbirth can intensify PTSD symptoms such as flashbacks, avoidance behaviours, negative thoughts, and increased irritability. Interactions with hospitals or other healthcare settings can also trigger traumatic memories. Treatment is important for the health of both mother and child and may include psychotherapy, such as cognitive behavioral therapy or EMDR, and possibly medication after risk assessment. Early intervention with healthcare providers is crucial for a safer pregnancy and delivery.

Postpartum psychosis

Postpartum psychosis is a rare but serious mental illness that occurs in women shortly after childbirth, usually within the first two weeks. This condition is characterised by extreme mood swings, confusion, hallucinations, delusions, anxiety and difficulty sleeping. The risk of postpartum psychosis increases with factors such as genetic predisposition, hormonal changes after childbirth, lack of sleep and a history of mental illness. Treatment, which usually requires hospitalisation, may include antipsychotic and mood-stabilising medications, as well as supportive psychotherapy and family support. Early treatment is critical to recovery, and most women recover fully with the right care. If you have symptoms of psychosis, you should contact 112 or the nearest emergency room.

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Treatment of depression during pregnancy

Treatment of depression during pregnancy includes psychotherapy, such as cognitive behavioral therapy and interpersonal therapy, while drug treatment with antidepressants, especially SSRIs, may be carefully considered by the treating physician. Lifestyle changes such as exercise, good sleep, a nutritious diet and stress management are also important. Early intervention and collaboration between the pregnant woman, her family and health care providers are essential to ensure effective treatment and protect the health of both the mother and the baby.

Depression in family members during pregnancy

Expectant fathers and other family members can also become depressed during pregnancy. It can be triggered by emotional stress, financial worries, concerns and fears about the future and parenting, and lack of support. The symptoms are similar to typical depression symptoms and treating this form of depression often involves therapy and sometimes medication, with an emphasis on the importance of communication and lifestyle factors. Recognising and managing paternal prenatal depression is crucial to giving both expectant mothers and fathers the support they need during pregnancy.