Depression during pregnancy affects 30-40% of South African moms-to-be, says Dr Bavi Vythilingum, a specialist psychiatrist at the Rondebosch Medical Centre.
Unfortunately, antenatal depression can go undiagnosed as the symptoms are often dismissed or overlooked, adds registered counselling psychologist Tamara Zanella. “This is because pregnant women go through a great deal of adjustment and change, and many of the symptoms of depression, – such as changes in sleeping or appetite, difficulty concentrating and lack of energy – are frequently attributed to pregnancy.
“If depression during pregnancy is not treated,” Tamara continues, “there are risks not only for the mother, including utilising unhealthy coping behaviours such as smoking, drinking alcohol or eating an unhealthy diet, but for her unborn child too. Research indicates that women who are depressed during pregnancy have slower foetal growth compared to women who are not depressed, as well as a higher incidence of premature delivery and babies with low birth weight. In addition, studies have found that newborn babies of depressed moms can be more stress reactive and challenging to care for and soothe. This can lead to a negative cycle for new mothers and increased risks of postnatal depression and anxiety.”
The warning signs
Dr Vythilingum suggests asking yourself the following questions. Have you:
- Felt down for most of the day, nearly every day, for the last two weeks?
- Felt flat, low or unmotivated with no pleasure from or interest in anything?
- Been overwhelmed or anxious and felt that you can’t cope?
- Felt scared or panicked for no reason?
- Been blaming yourself when things go wrong?
- Had thoughts of harming yourself?
If you’ve answered yes to several of these, and particularly if you’ve had thoughts of harming yourself, seek immediate help. The South African Depression and Anxiety Group has a 24-hour helpline, while someone you’re comfortable with, such as your GP, midwife or gynae, can refer you to a psychologist or psychiatrist.
Both psychotherapy and antidepressant medication can be used to treat depression during pregnancy, but it’s important not to self-medicate, explains Tamara. “This is because the safety of some remedies are not yet known and are not an effective substitute for professional help.”
In addition, Tamara advises, “You need to take it easy during your pregnancy and ask for practical help when you can. It’s also important to engage in emotional support from your partner, family and friends. Try to manage your stress as much as possible and discuss any concerns you have with the people in your life as well as the professionals involved in your prenatal care.”
Although many moms-to-be may be reluctant to take antidepressants for fear of harming their unborn baby, research suggests that the risks to the baby if the mother’s mental illness is not treated are, in most cases, greater than the risks associated with commonly prescribed antidepressants, according to the Perinatal Mental Health Project, based at the University of Cape Town. “Most antidepressants are safe for use when you’re pregnant,” adds Dr Vythilingum. “Selective serotonin reuptake inhibitors (the most commonly prescribed antidepressants) have been shown to be low risk in pregnancy.
However, the choice of treatment should always be made on an individual basis, as part of an informed and collaborative decision between you and your doctor, weighing up the risks of untreated depression against any risk of medication during pregnancy.
“Remember that antidepressants must be taken for at least six to 12 months once symptom control has been achieved to prevent a relapse, and there’s no reason why you shouldn’t continue taking them after your baby’s birth – even while breastfeeding. Antidepressants are excreted in breast milk in extremely small quantities, and studies investigating the exposure of infants to antidepressants through breastfeeding report no difference in developmental milestones.
“There’s a stigma of mental illness, particularly when it comes to mothers,” continues Dr Vythilingum. “For far too long, women have either avoided seeking treatment, or not taken medication due to the fear of being seen as bad mothers. It’s time to stand up and change this.”
Could you be at risk?
A number of factors may predispose you to depression or anxiety during pregnancy, says Tamara. “It’s important to consider your personal and family history of depression or anxiety as this could put you at a higher risk. Even if
there’s no history of full-blown depression or anxiety, but you tend to get down or anxious during stressful or uncertain times, you could be susceptible. Other contributing factors include stressful life events, difficulties in your relationship, a high-risk or unplanned pregnancy, and a history of abuse, as well as being young and single.”