Mood Disorders and Depression During Pregnancy

We used to think of pregnancy as a time of joy and bliss, when the expectant mother is protected from illness and especially from mental illness. In recent years, however, it has become clear to clinicians and researchers alike that pregnant women can develop disorders like depression, anxiety or panic, and obsessive-compulsive disorder.

 

In fact, 12% of pregnant women will develop a mood disorder, which is equivalent to the prevalence in the non-pregnant women population. Certain difficulties and challenges are very common among pregnant women, such as nausea and vomiting, eating problems, sleep disturbances, fatigue and mood swings. These problems, albeit discomforting, are usually manageable and temporary and do not require any particular treatment.

 

However, some women experience more serious symptoms like depressed mood, extreme anxiety or intrusive upsetting thoughts and/or compulsive behaviours. Because of the overlap between normal difficulties in pregnancy and symptoms of depression, it is very easy to miss a diagnosis of depression during pregnancy. Indeed, many pregnant women are dismissed by health care professionals when they complain about their symptoms.

 

It is extremely important, though, to diagnose and treat depression in pregnancy because untreated depression at the time of pregnancy may lead to severe postpartum depression and may adversely affect the health of both mother and baby. The symptoms of depression during pregnancy are very similar to those of depression in non-pregnant women. They are:

  • Depressed mood and/or lack of interest
  • Significant sleep disturbances
  • Loss of enjoyment in previously favoured activities
  • Marked decrease or increase in appetite
  • Feelings of worthlessness, guilt
  • Lack of energy, exhaustion
  • Uncontrollable crying spells
  • Feelings of hopelessness and doom
  • Withdrawal from people and activities
  • Suicidal ideation

 

About 30% of women who develop depression during pregnancy also develop an anxiety or panic disorder, and another 30% may develop Obsessive-Compulsive Disorder (OCD). To read more about anxiety, panic and OCD click here. If symptoms persist for over 2 weeks and seriously affect the woman’s sense of well-being and quality of life, treatment is essential.

For more information, contact Dr Regev at her Vancouver office on West Broadway Tel: 604-671-7356 Email: michal@drregev.com

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What Causes Mood Disorders in Pregnancy?

Unfortunately, there is no definite answer to this question. One might assume that because of the dramatic hormonal changes during pregnancy, that hormones are to blame. The fact is, however, that no relationship has been identified between hormonal changes and mood disorders in pregnancy. After all, every pregnant woman goes through hormonal changes but only 12% of them get depressed.

 

Scientists are actively looking for a genetic explanation for depression. However, the current consensus among clinicians and researchers alike is that mood disorders in pregnancy are brought about by a combination of physiological, psychological and social factors. Thus, a woman may be at risk for developing a mood disorder during pregnancy, especially if one or more of the following risk factors affect her:

  • She has had previous episodes of depression or another type of mental illness
  • She has an immediate family member who has had depression or another type of mental illness
  • She did not want the pregnancy
  • Her perceived level of everyday stress is very high
  • There is distress in her relationship with her partner
  • She is a single mother
  • She doubts she would be a good mother
  • She has low self-esteem
  • She has been sexually abused or has gone through other trauma
  • She has serious financial worries
  • She has little support from family and friends

Treatment Options

Psychotherapy – Most pregnant women are reluctant to take medication for fear of compromising their baby’s health. Therefore, the treatment that most women prefer is psychotherapy.
Cognitive – Behavioural Therapy and Interpersonal Psychotherapy have been found highly effective in treating pregnant and postpartum women with depression. Therapy should always be provided by a certified and experienced mental health professional, who is familiar with the unique issues pertaining to mood disorders in pregnancy.

Medication -In recent years there has been a growing body of studies that looked at the effects of medication on babies who have been exposed to them in utero or through breastfeeding. Results are encouraging about certain medications such as the SSRIs (Paxil, Zoloft, Prozac).

 

Researchers have not been able to find a difference between groups of babies who had been exposed to medication and groups of babies who had not been exposed, in terms of birth defects rate or developmental abnormalities. Still, women and their partners are often uneasy about taking medication during pregnancy. However, in cases of severe depression, and especially when a woman is suicidal, medication may be the treatment of choice, even for pregnant women.

 

Before going on an anti-depressant medication, a woman should always discuss the pros and cons of taking the medication with her doctor. Once a woman has started taking medication, she should be under the supervision of a physician. In many cases a combination of medication and psychotherapy is appropriate, especially in case there are identifiable challenges and issues of concern in the woman’s life.

Further Readings

  • Curham, S. (2001). Antenatal and postnatal depression. Trafalgar Square.
  • Misri, S. (1995). Shouldn’t I be happy? : Emotional problems of pregnant and postpartum women. New York, NY: The Free Press.
  • Sichel, O. & Driscoll, J. (2000). Women’s moods: what every woman must know about hormones, the brain and emotional.