Pre-baby blues: fac­ing de­pres­sion dur­ing preg­nancy

Anx­i­ety and pres­sure can prove too much, with many un­aware of an­te­na­tal de­pres­sion

The Irish Times - Tuesday - Health - - Parenting Pregnancy - Michelle McDon­agh

While most peo­ple have heard of post­na­tal de­pres­sion, there is very lit­tle aware­ness of de­pres­sion dur­ing preg­nancy (an­te­na­tal de­pres­sion) which is just as com­mon, but of­ten goes un­de­tected.

The find­ings of the first sur­vey of an­te­na­tal de­pres­sion in Ire­land sug­gest that an­te­na­tal de­pres­sion is at least as preva­lent as, if not more than, com­pa­ra­ble ju­ris­dic­tions in the EU. Al­though com­mon, an­te­na­tal de­pres­sion may evade de­tec­tion by staff be­cause of mul­ti­ple cul­tural and health ser­vice is­sues in­clud­ing lack of aware­ness and pres­sure on re­sources.

Veron­ica O’Keane, pro­fes­sor in psy­chi­a­try, Trin­ity Col­lege Dublin, and lead re­search in­ves­ti­ga­tor on the sur­vey, points out that screen­ing for an­te­na­tal de­pres­sion is not rou­tine in ma­ter­nity hos­pi­tals in Ire­land, and our peri­na­tal men­tal health ser­vices are grossly un­der-re­sourced in re­la­tion to other com­pa­ra­ble EU coun­tries.

“The find­ings in­di­cate that peri­na­tal men­tal health ser­vices need to be pri­ori­tised in the Na­tional Ma­ter­nity Strat­egy, and more fund­ing sought to de­velop these ser­vices across the coun­try. Women should be screened for de­pres­sion early in their an­te­na­tal care plan and en­cour­aged to seek help,” she says.

De­pres­sion dur­ing preg­nancy has been shown to lead to in­creased risk of poorer ob­stet­ric out­comes, and, in the baby, may lead to neu­rode­vel­op­men­tal and be­havioural dis­ad­van­tage dur­ing in­fancy and an in­creased risk of psy­chi­atric dis­or­der in child­hood and later life.

Screen­ing tool

Some 5,000 preg­nant women dur­ing all stages of preg­nancy from five ma­ter­nity hos­pi­tals through­out the Re­pub­lic of Ire­land were sur­veyed us­ing the Ed­in­burgh Post­na­tal De­pres­sion Scale (EPDS) as a screen­ing tool. The sur­vey re­vealed a 16 per cent rate of an­te­na­tal de­pres­sion, which is higher than the rates found in the UK and com­pa­ra­ble EU coun­tries.

Rates of de­pres­sion were shown to in­crease as the preg­nancy ad­vanced. The sur­vey in­cluded women af­fected by first-time and re­cur­rent de­pres­sion.

De­spite hav­ing the sec­ond-high­est birth rate in Europe, there was no data avail­able on preva­lence rates of de­pres­sion among women giv­ing birth in Ir­ish ma­ter­nity hos­pi­tals prior to this study which was com­piled by the Re­deem re­search group, based at the Trin­ity Col­lege In­sti­tute of Neu­ro­sciences (TCIN), and the na­tional ma­ter­nity ser­vices around Ire­land.

The preva­lence sur­vey is a pre-cur­sor to a longer term re­search study be­ing un­der­taken by the Re­deem group in­ves­ti­gat­ing the ef­fects of de­pres­sion on preg­nant women, the foe­tus and the in­fant.

O’Keane says women may be re­luc­tant to seek help for de­pres­sion dur­ing preg­nancy ei­ther be­cause they are un­able to iden­tify that they are un­well, or be­cause of the guilt and shame that is ex­pe­ri­enced by those who suf­fer with men­tal ill­ness be­cause of so­ci­etal stigma. This stigma is likely en­hanced dur­ing preg­nancy, a time that is con­ven­tion­ally as­so­ci­ated with happy an­tic­i­pa­tion.

“Our ma­ter­nity ser­vices are very stretched and al­though de­pres­sion is as com­mon dur­ing preg­nancy as di­a­betes, there is not the same level of aware­ness or re­sources. The ex­pec­ta­tion of preg­nancy to be a happy time is not chal­lenged much and de­pres­sion dur­ing preg­nancy is not talked about.”

Big con­cern

O’Keane ex­plains that al­though stan­dard Prozac-like an­tide­pres­sants do not seem to in­fer risk on the foe­tus when taken by the mother dur­ing preg­nancy, it is a big con­cern for many women.

“The fear of an­tide­pres­sants needs to be coun­ter­bal­anced with the risk of un­treated de­pres­sion dur­ing preg­nancy, which is very well es­tab­lished. There is an in­creased risk of ba­bies born pre­ma­turely, or smaller for dates, and de­pres­sion in the mother dur­ing preg­nancy leads to dis­ad­van­taged de­vel­op­ment of the baby.

“De­pres­sion does not just evap­o­rate af­ter birth; it gen­er­ally de­te­ri­o­rates as there are more stresses on the mother try­ing to care for a new­born.”

O’Keane is keen to stress that she does not want to make moth­ers with de­pres­sion feel guilty about hav­ing this com­mon ill­ness or about any po­ten­tial im­pact on their ba­bies, but says it is an is­sue that needs to be high­lighted so that there is a higher radar for de­tec­tion of de­pres­sion dur­ing preg­nancy.

“Hor­mones def­i­nitely con­trib­ute to the de­vel­op­ment of de­pres­sion dur­ing preg­nancy, there is no doubt about that. There was a greater fo­cus on the sex hor­mones, but we are now look­ing at the stress hor­mones as the con­di­tion of preg­nancy in­creases se­cre­tion of stress hor­mones grad­u­ally and in­cre­men­tally as the preg­nancy ad­vances.

“We know that the stress hor­mones are high in peo­ple with de­pres­sion. We do need some sort of height­ened alert sys­tem dur­ing preg­nancy to warn us of any dan­ger to the foe­tus but, in some women, these hor­mones can lead to de­pres­sion.”

While low mood and anx­i­ety are ac­tu­ally quite nor­mal dur­ing preg­nancy due to the in­crease in stress hor­mones and the enor­mity of what is hap­pen­ing, O’Keane ad­vises women who are feel­ing de­pressed or very anx­ious to seek help from their mid­wife or doc­tor.

Hor­mones def­i­nitely con­trib­ute to the de­vel­op­ment of de­pres­sion dur­ing preg­nancy, there is no doubt about that

PHO­TO­GRAPH: ISTOCK

While low mood and anx­i­ety are ac­tu­ally quite nor­mal dur­ing preg­nancy due to the in­crease in stress hor­mones and the enor­mity of what is hap­pen­ing, Prof O’Keane ad­vises women who are feel­ing de­pressed or very anx­ious to seek help from their mid­wife or doc­tor.

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