How to Treat Depression During Pregnancy?

Pregnancy is often a time of joy and excitement while dealing with the symptoms of morning sickness and swollen ankles. However, for some women, the joy of pregnancy can get clouded over by depression, a condition that should never be taken lightly as it can put both the mother and child’s life at risk. Though the concept of postpartum depression is far more common and more information is available about feeling depressed after giving birth, there is a lack of awareness on perinatal depression. Perinatal depression is a collective term used to refer to depression during pregnancy and after childbirth as well. Such type of depression can make the pregnancy a tough time for any woman. Here’s everything you need to know about how to treat depression during pregnancy.

Causes, Symptoms, and Prevalence of Depression During Pregnancy

Mood disorders during and after pregnancy are more common than what was once thought. Today, the term perinatal depression is used to describe depression that occurs before and during pregnancy and after childbirth.(1,2,3) Generally, pregnancy is one of the happiest times in any woman’s life. However, at the same time, pregnancy plays havoc on your hormones and can create a lot of stress. It is believed that a combination of emotional and biological factors in expecting mothers can lead to anxiety and depression.(4,5) According to the American College of Obstetricians and Gynecologists (ACOG), it is estimated that nearly 10 to 20 percent of women have some type of pregnancy-related mood disorder, and 1 in 20 women in the United States go on to experience a major depressive disorder while they are pregnant.(6,7)

The normal signs of pregnancy often overlap with the symptoms of depression. For example, with both pregnancy and depression, you are likely to feel tired all the time, experience some insomnia, emotional changes, and weight gain. Due to this, many women fail to recognize the symptoms of depression as they are masked over by the signs of pregnancy.

To help recognize the signs of depression during pregnancy, it is best to talk to your doctor about any of the following symptoms:

  • Changes in appetite
  • Frequent crying
  • Fatigue or low levels of energy
  • Trouble sleeping but not because of frequent urination
  • Increased anxiety
  • Loss of enjoyment in activities you once enjoyed
  • Trouble feeling connected or bonded to the developing baby, also known as a poor fetal attachment(8)

There is also a more severe form of postpartum depression known as postpartum psychosis. This is a very rare condition that only affects around 1 or 2 women for every 1,000 women.(9) Some of the common symptoms of postpartum psychosis include:

Postpartum psychosis is a very serious condition that needs urgent medical attention. A mother may need to be hospitalized as well to ensure her own and her baby’s safety.

If you had depression before you got pregnant, it is likely that your symptoms will be more severe during your pregnancy than they were before.

How To Treat Depression During Pregnancy?

There are various treatment options available for treating depression during pregnancy. Most of them are the same treatments that are used for treating other forms of depression. The success rates of treating depression during pregnancy are much higher than normal depression. In fact, it is estimated that 80 to 90 percent of pregnant women and new mothers benefit by taking medications or going to talk therapy, or even a combination of both medication and talk therapy.(10,11)

Treating Perinatal Depression With Medications

The most commonly prescribed treatment for perinatal depression is taking antidepressant drugs. Doctors are likely to prescribe selective serotonin reuptake inhibitors (SSRIs), and your doctor will discuss how best to put you on an antidepressant while you are pregnant, after you deliver your child, or if required, in both circumstances.

Numerous studies have found that selective serotonin reuptake inhibitors are safer to be taken by pregnant women and women who are breastfeeding.(12) However, there is presently no evidence to show whether antidepressant drugs have any type of long-term adverse effects on a child when a mother takes these medications during pregnancy. There is a chance of observing drug withdrawal reactions in newborns that may include symptoms like irritability and jitteriness. In some rare cases, there is also a risk of seizures in newborns.(13,14)

Since pregnant women are usually concerned about their growing child being at any type of risk of side effects from taking antidepressants, most women tend to opt for other treatments instead of taking antidepressant medications.(15,16)

Treating Perinatal Depression With Talk Therapy And Alternative Treatments

Talk therapy is another effective treatment for depression during pregnancy. There are also some alternative treatments that have been found to be quite useful in helping women deal with perinatal depression. These include acupuncture and other forms of massage therapy.(17) In acupuncture, a specialist will insert tiny needles at specific parts of the body. A recent study found that over 60 percent of women who were given a depression-specific type of acupuncture during pregnancy responded well to the treatment.(18)

It is important to note that prolonged depression can cause more harm to the mother and her child than the side effects of any medications or treatments. This is why it is important to encourage early diagnosis, treatment and ensure proper care for depression during pregnancy.

Conclusion

If the depression gets so bad that a pregnant woman is not able to eat and stops gaining weight, then it needs to be treated urgently and aggressively to prevent any harm to the baby and mother. If you notice signs of depression during or after your pregnancy, it is important to discuss it with your doctor and find out about all the available treatment options. Your doctor will work together with you to help you make a well-informed decision about what treatment for depression is going to be the best for you and your baby.

With talk therapy and antidepressants, it is possible for a pregnant woman to overcome depression and go on to deliver a healthy baby while also enjoying the birth of their child. It is important to remember that the risk of taking antidepressant drugs during your pregnancy is small when compared to the overall threat that depression poses to both the mother and the child.

References:

  1. Bennett, H.A., Einarson, A., Taddio, A., Koren, G. and Einarson, T.R., 2004. Prevalence of depression during pregnancy: systematic review. Obstetrics & Gynecology, 103(4), pp.698-709.
  2. Llewellyn, A.M., Stowe, Z.N. and Nemeroff, C.B., 1997. Depression during pregnancy and the puerperium. The Journal of clinical psychiatry.
  3. Ryan, D., Milis, L. and Misri, N., 2005. Depression during pregnancy. Canadian Family Physician, 51(8), pp.1087-1093.
  4. Aktas, S. and Calik, K.Y., 2015. Factors affecting depression during pregnancy and the correlation between social support and pregnancy depression. Iranian Red Crescent Medical Journal, 17(9).
  5. Brummelte, S. and Galea, L.A., 2010. Depression during pregnancy and postpartum: contribution of stress and ovarian hormones. Progress in Neuro-Psychopharmacology and Biological Psychiatry, 34(5), pp.766-776.
  6. Acog.org. 2021. Management Of Depression During Pregnancy. [online] Available at: <https://www.acog.org/clinical/clinical-guidance/task-force-report/articles/2009/management-of-depression-during-pregnancy> [Accessed 21 January 2021].
  7. Bennett, H.A., Einarson, A., Taddio, A., Koren, G. and Einarson, T.R., 2004. Prevalence of depression during pregnancy: systematic review. Obstetrics & Gynecology, 103(4), pp.698-709.
  8. Lindgren, K., 2001. Relationships among maternal–fetal attachment, prenatal depression, and health practices in pregnancy. Research in nursing & health, 24(3), pp.203-217.
  9. Sit, D., Rothschild, A.J. and Wisner, K.L., 2006. A review of postpartum psychosis. Journal of women’s health, 15(4), pp.352-368.
  10. Goodman, J.H., 2009. Women’s attitudes, preferences, and perceived barriers to treatment for perinatal depression. Birth, 36(1), pp.60-69.
  11. Pearlstein, T., 2008. Perinatal depression: treatment options and dilemmas. Journal of psychiatry & neuroscience: JPN, 33(4), p.302.
  12. Sanz, E.J., De-las-Cuevas, C., Kiuru, A., Bate, A. and Edwards, R., 2005. Selective serotonin reuptake inhibitors in pregnant women and neonatal withdrawal syndrome: a database analysis. The Lancet, 365(9458), pp.482-487.
  13. Steg, N., 1957. Narcotic withdrawal reactions in the newborn. AMA journal of diseases of children, 94(3), pp.286-288.
  14. Fabiano, V., Mameli, C. and Zuccotti, G.V., 2012. Adverse drug reactions in newborns, infants and toddlers: pediatric pharmacovigilance between present and future. Expert opinion on drug safety, 11(1), pp.95-105.
  15. Predictable, S.E.A.U., 2006. Side effects of antidepressants: an overview. Cleveland Clin J Med, 73, p.351.
  16. Cookson, J., 1993. Side-effects of antidepressants. The British Journal of Psychiatry, 163(S20), pp.20-24.
  17. Deligiannidis, K.M. and Freeman, M.P., 2014. Complementary and alternative medicine therapies for perinatal depression. Best practice & research Clinical obstetrics & gynaecology, 28(1), pp.85-95.
  18. Pilkington, K., 2010. Anxiety, depression and acupuncture: a review of the clinical research. Autonomic Neuroscience, 157(1-2), pp.91-95.

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