Postpartum depression is a topic that is often discussed and causes anxiety and fear for many pregnant women. Less is said and written about prenatal depression, but, nevertheless, both expectant mothers themselves and specialists who are in one way or another associated with the period of bearing a child know about the emotional problems of this period. In this article I would like to answer several questions: “Is depression so terrible, and what does it actually express itself in?”, “Is it possible to avoid depression?”, “Are pre- and postpartum depression somehow related to each other? "
What are the dangers of depression during pregnancy?
Depression is a psycho-emotional disorder characterized by apathy, constant low mood, inability to rejoice and changes in thinking. A depressed person begins to think only about bad things, without perceiving anything good. A pregnant woman, on the contrary, needs to receive as many kind, joyful emotions as possible. But this is not the only danger of depression during pregnancy. As a result of this mental disorder, a person may begin to have thoughts of suicide. Instability of the emotional background can lead to addiction to alcohol and psychotropic substances. All this negatively affects the health of both the child and his mother.
Taking antidepressants - pharmacotherapy during pregnancy
Mild depression can be treated with psychotherapy, but if symptoms are moderate or severe (for example, suicidal thoughts), pharmacology is also necessary.
Antidepressants used during pregnancy are selective serotonin reuptake inhibitors (SSRIs) or serotonin norepinephrine reuptake inhibitors (SSRIs). Such medications should absolutely not be taken without the permission of a gynecologist!
Symptoms of depression
If you notice a couple of symptoms, you shouldn’t panic right away. You can assume the presence of a depressive disorder if five or more symptoms persist in you or your loved one for quite a long time, from two weeks or more. Signs of depression in pregnant women can be observed as follows:
- the woman feels depressed, her sadness is unfounded, she is apathetic
- you notice a person’s weakness, lethargy
- irritation
- negative vision of the future, feelings of hopelessness, tearfulness
- feeling of guilt, constant lack of self-confidence and the correctness of one’s choice
- feeling of helplessness and worthlessness
- Digestive problems: loss or increase in appetite
- insomnia, drowsiness, nightmares, sleep inversion
- various fears
- indifference to one's health
- reluctance to communicate with relatives and friends, with her husband.
Psychotherapy during pregnancy
Currently, the most recommended form of treatment for mood disorders is cognitive behavioral therapy. During subsequent sessions, the expectant mother learns to correctly interpret various life situations and respond to them appropriately, due to which her level of anxiety decreases.
Cognitive behavioral therapy focuses on the “here and now”—during meetings with a psychotherapist, a person does not dwell on events from the past. You should also know that this is short-term therapy - most often it ends after about twenty consultations.
What are the characteristics of depression during different periods of pregnancy?
A pregnant woman does not immediately get used to the idea that she is now a mother and that her life will change a lot. In the early stages of pregnancy, she may forget about her situation, to the point that, for example, she makes grandiose plans for the near future, without taking the child into account. Depression during pregnancy at this stage can occur due to the woman’s unwillingness to part with her favorite job, growing career, study, or usual way of life. It also happens that a woman has been waiting for a child for a long time, she previously had miscarriages, a frozen pregnancy, or she simply could not get pregnant, and now, when this finally happened, she begins to be overcome by fears. She fears for the baby's health because she doubts her ability to give birth to a healthy baby. In this case, if it has not reached the point of depression, you can simply get yourself and your child examined to calm down.
In the second trimester, depression in pregnant women appears for other reasons. The woman is already aware of her position, moreover, it in itself becomes more noticeable both to her and to those around her. Experiences associated with this and with the child’s future can give rise to depression.
In the later stages of pregnancy, a woman becomes increasingly frightened by the inevitably approaching birth. At the same time, a pregnant woman may worry not only about herself, but also about ensuring that the baby is not harmed during childbirth. They begin to be overwhelmed by thoughts about how difficult it will be with a child, fears that the woman herself will not be able to raise a child.
Depression undoubtedly has a negative impact on the health of mother and child.
Late antenatal depression
The next three months are the time when a pregnant woman normally no longer denies her condition. In other words, her psyche has accepted the fact that there will be a child, but what she still cannot fully agree with is that with the birth of the baby, the usual way of life will come to an end. In psychology, the name of this period is quite complex. I'll voice it and then decipher it. So, this stage is called the period of “searching for a replacement for the lost object.” The lost object in this case is a familiar life, a life with a certain rhythm of work, leisure, with established relationships in the family and with friends. Gradually realizing that with the birth of a child she will have to give up a lot, the woman begins to look for a replacement for what she has lost. The classic reasoning of a pregnant woman at this stage is as follows: “Yes, I will have to leave my job, which means my career growth will stop. What a horror! But my colleagues will remain where they are, and I will be hopelessly behind them! No problem, now is the time to take a Chinese course! Relations with China are very promising, the baby will grow up, I will go to work in a new direction with a good knowledge of the language!” Thus, the second trimester becomes the most active. And indeed, the woman usually feels well, the nausea has already passed, and the stomach is not yet bothering her. And wherever expectant mothers go during this period! As they explain: “So as not to waste time.” It happens, and not rarely, that it even comes to driving courses. "Why not? The baby will be born, I will need mobility, but I still don’t have a license!”
However, this period is also ending. It is followed by the last, coinciding with the third trimester of pregnancy, which, unlike the previous one, in psychology is simply called the period of depression. That is, that same prenatal depression sets in. In the psyche there is a full awareness of what happened, and the process of saying goodbye to the past begins: “What Chinese?!” What career?! Perhaps I will never be able to work as before, but will forever be tied to pots and pans!” In the three months remaining before giving birth, at times (of course, not 24 hours a day), a woman is faced with feelings of loneliness, hopelessness and despondency. Sometimes this results in streams of tears, sometimes in irritation, resentment and anger. You can be offended and angry with your husband, whose life does not change so dramatically, and he, of course, “doesn’t understand anything and doesn’t support much.” On the mother-in-law, who always interferes with her advice and stupid purchases for the baby. For friends who are not at all interested in your belly or your child, they only care about rags, men and work. You never know what can upset a pregnant woman. All this is normal, there is no need to be afraid of your own experiences. Respect your condition and, most importantly, do not try to avoid it.
This is where we, in fact, come to the main practical conclusion. Pregnancy is not all about the joy of waiting nine months. This is the time when not very pleasant feelings and emotions are appropriate, especially in the last three months. There is no need to feel guilty, let alone shame, if in the first trimester you sometimes forgot about the baby, and sometimes even thought that it would be good if pregnancy occurred not now, but at another time.
And one more very important point. Take maternity leave on time. The fact is that the working rhythm helps a woman’s psyche stay in the first or second stage and thus not experience depression. By remaining in a familiar work environment, a woman protects herself from an acute confrontation with the awareness of drastic changes. But you can’t run away from the truth, the time will come, the baby will be born, and she will still have to understand that her old life is over forever, only this process will no longer be called pre-, but postpartum depression, and it will be harder and longer.
Although giving advice is often useless, and from the point of view of the science of psychology, it is simply unacceptable (a psychologist should help each person find their own path, draw their own individual conclusions from the current situation), I will still take the liberty of giving a few recommendations to pregnant women or already pregnant women. women who have given birth and are experiencing depression.
Depression and Anxiety During Pregnancy and After Birth: Frequently Asked Questions
Depression and anxiety that occur during pregnancy or any time during the first year after giving birth are medical conditions. These feelings are not caused by something you do or don't do. And they can be cured if you seek help.
What are depression and anxiety?
Depression—feeling sad, empty, and/or “down”—and anxiety—feeling nervous, restless, and/or afraid—are serious medical conditions that affect the brain and can occur during pregnancy or after childbirth. These feelings go beyond what people might experience when they're having a bad day or are nervous about an upcoming event. There's also more to it than just being in a bad mood or the baby blues.
Depression and anxiety can make it difficult to do everyday activities, such as caring for yourself and your baby. They are long-lasting and do not go away on their own. But they are treatable, which is why it is so important to get help.
Are you talking about postpartum depression?
Postpartum depression is another name for depression and anxiety that can occur during and after pregnancy. But maybe that's not the best way to describe what women feel. The word “postpartum” means “after birth,” so “postpartum depression” only refers to depression after the birth of a child. For many women, this term is true: they begin to feel depressed sometime during the first year after giving birth.
But research shows that some women begin to experience depression during pregnancy.
You may hear the term "perinatal depression" to describe this situation. The word "perinatal" describes the time during pregnancy or immediately after birth. Researchers believe that depression is one of the most common problems women face during and after pregnancy.
We now know that women can also experience anxiety during pregnancy, beyond just nervousness about having a baby. Anxiety during and after pregnancy is as common as depression, and can even occur at the same time as depression. That's why you may also hear "perinatal depression and anxiety" or "perinatal mood and anxiety disorders" to describe all the things women may be feeling. No matter what you call them, depression and anxiety that occur during pregnancy or after childbirth are real medical conditions and they affect many women.
What are some signs of depression and anxiety?
Women with depression or anxiety during pregnancy tell us how they feel:
- Extreme sadness or anger without warning
- Fuzzy or difficulty completing tasks
- “Robotic”, as if they just do everything.
- Intense anxiety about the child and other children.
- Feelings of guilt and feeling that they are not coping with motherhood
- Unusual irritability or anger.
They also often have:
- Lack of interest in things they used to enjoy.
- Scary, upsetting thoughts that do not go away without leaving a trace.
What are the risk factors for depression and anxiety during pregnancy or after childbirth?
Depression and anxiety during pregnancy or after childbirth can happen to anyone. However, certain factors make some women more likely to have one or both of these conditions than others.
These risk factors include:
- History of depression or anxiety, either during pregnancy or at other times
- Family history of depression or anxiety
- Difficult experience of pregnancy or childbirth
- Having twins or other multiple births
- Problems with your partner
- Financial difficulties
- Receiving insufficient or no support from family or friends to help you care for your child
- Unplanned pregnancy
Depression and anxiety during pregnancy or after childbirth are not caused by something you do or don't do—it's a medical condition. Although we don't fully understand the causes of these conditions, researchers believe that depression and anxiety during this period may be the result of a combination of physical, emotional and environmental factors.
Can depression and anxiety during pregnancy or after birth affect my baby?
Yes - these conditions can affect your baby, but not directly. Early mother-child bonding is important for your baby's development, and bonding with your baby is an important part of that bond. If you have depression or anxiety during pregnancy or after giving birth, you may find it difficult to bond with your baby. You may not be able to respond to what your baby needs. And if there are older children in the house, they may also need your support.
Early treatment is important for you, your baby, and the rest of your family. The sooner you start, the sooner you will feel better.
Are there treatments for depression or anxiety during pregnancy or after childbirth?
Yes, there is treatment and it can help you feel better. Treatment may reduce symptoms or eliminate them completely. There are many treatment options for depression or anxiety during pregnancy or after childbirth. Some women may benefit from counseling ("talk therapy"), while others may need medication. There is no single treatment that suits everyone.
Your doctor may ask you a series of questions called a screening to find out more about how you feel. Together you can find the treatment that's right for you. Listed below are some treatments for depression and anxiety that occur during or after pregnancy.
Counseling (“talk therapy”)
Some women find it helpful to talk about their problems or feelings with a mental health professional. A doctor can help you find ways to cope with your feelings and make changes to relieve depression or anxiety.
Medicines
Some medications can effectively treat depression and anxiety and are safe for pregnant women, nursing mothers and their children. Talk to your healthcare professional about medications that may be right for you.
Is there anything I can do in addition to treatment?
Besides treatment, there are some things that can help you feel better.
- Connect with other moms. Find a mothers' group in your area or online. These groups can give you the opportunity to learn from other people who are going through or have gone through the same thing and share your feelings. Postpartum Support International (PSI) can help you find groups in your area. Postpartum Progress® offers a private online community so you can connect with other moms no matter where you live.
- Take time for yourself. Do something for yourself, such as getting out of the house or taking a hot bath without interruption. If possible, ask your partner, family member or babysitter to watch your child regularly while you go out to visit a friend or run errands.
- Do something you enjoy. Whether it's listening to music, reading a book, or watching your favorite movie, spend some time every day doing something you enjoy.
- Be realistic. You don't have to do everything. You don't have to have the "perfect" home. Just do what you can and leave the rest.
- Ask for help. Don't be afraid to ask family and friends for help, whether it's with childcare or housework.
- Rest when your child rests. Sleep is just as important for you as it is for your baby. Sleep when your baby sleeps, during naps and at night.
- Be with others. Seek out other adults, such as family and friends, who can provide comfort and company. Regularly set aside special time for you and your partner, or you and a friend, to be together.
Can I prevent depression or anxiety during pregnancy or after having a baby?
There is currently no known way to prevent depression or anxiety that occurs during pregnancy or after giving birth. But knowing what signs and symptoms to watch for during and after pregnancy can help you prepare and get help quickly.
Here's what you can do:
- Find out if you have factors that increase your risk of developing depression and anxiety during pregnancy and after your baby is born.
- Talk to a healthcare professional about depression and anxiety during pregnancy and find out what to watch out for.
- Learn as much as you can about pregnancy, birth and parenting so you know what to expect.
- Set realistic expectations for yourself and your family.
- Besides treatment, do things that can help you feel better.
- Plan ahead. While you are pregnant, think about who can support you and help you when your baby is born. Talk to this person about help so you can both prepare.
Remember that depression and anxiety that occur during pregnancy or after giving birth are not your fault, they are medical conditions that require medical attention.
Antidepressants and the risk of developmental defects
Treatment of depression with electroconvulsive shocks is not yet particularly popular. Psychotherapy is most often recommended for pregnant patients and, in some cases, antidepressants are prescribed. And here the question arises: can these drugs have a negative effect on the child?
Studies on the harmful effects of antidepressants on the fetus bring conflicting results - some indicate an increased risk of various types of defects in the child, others do not confirm such relationships. This explains why patients suffering from depression are most often advised to stop taking antidepressants before becoming pregnant, and if they become ill only during pregnancy, to try psychotherapy.
In situations where untreated depression poses a great danger to the mother and therefore to the child, medication is of course necessary. Currently, SSRIs (selective serotonin reuptake inhibitors) and SSRIs (selective serotonin and norepinephrine reuptake inhibitors) are considered the safest for the developing fetus and the woman herself. However, these are the most commonly prescribed drugs - except for paroxetine, which significantly increases the risk of heart defects in children.
Depression during pregnancy is much less commonly treated with tricyclic antidepressants, although most studies show no link between this type of drug and the risk of malformations (defects) in the fetus.
