DEPRESSION OCCURS IN 10 to 15% of pregnant women but it’s often misdiagnosed as symptoms are attributed to the pregnancy itself.
Many women who are experiencing depression in pregnancy believe their low mood is a result of common pregnancy symptoms such as fatigue and nausea.
Others are afraid of being judged due to the stigma sometimes attached to ill mental health, one expert has said.
Professor John Sheehan, a perinatal psychiatrist at the Rotunda maternity hospital in Dublin, said depression is “just as frequent in pregnancy as after delivery” but that many people don’t realise this.
“People will say they’ve heard about postnatal depression but most people will say they haven’t heard about depression in pregnancy … Many women say to me, ‘I never knew I could get depressed while pregnant.’”
Sheehan said many people still look at depression in pregnancy or depression at any time “as a weakness”.
“Depression is a condition, not a weakness. It is not a sign of being inadequate or being no good. Depression itself makes women feel inadequate or no good,” he told TheJournal.ie.
Sheehan said many pregnant women don’t realise they are depressed as they frequently attribute how they feel to pregnancy symptoms such as vomiting and fatigue.
“It’s rationalisation. Clearly vomiting and fatigue can affect your mood, there’s no question about that, but if you have a persistent low mood for weeks, that’s what would make one suspect.
It’s important to know that depression can occur during pregnancy, and not to dismiss it as, ‘Ah sure wouldn’t anyone feel like that.’
Sheehan said pregnant women should speak to their GP or midwife if they think they may be depressed, noting that a range of supports are available.
During pregnancy, the most common cause of maternal death is cardiovascular disease. Suicide, although very rare, is the leading cause of late maternal death (up to six weeks after birth).
Reluctant to take antidepressants
Sheehan said most women who are depressed respond to psychosocial measures such as counselling, anxiety management and mindfulness. However, about 3% will require medication.
He told us many women are very reluctant to go on medication while pregnant, fearing it will harm their baby.
A woman is thinking, ‘I want to do everything right for my baby.’ She may research the potential impact of medicine on her baby, but she may not research the effect of stress, anxiety and depression on her baby, the effect on bonding, the effect on the baby’s development.
“It’s very important to consider the potential effect of medication but also why someone is taking it,” Sheehan said.
“The outcome for both mother and baby should be considered. Women are so focused on doing the right thing … the woman should think, ‘My baby does best when I’m well.’”
Sheehan said only a small percentage of pregnant women need antidepressants, adding that those who do should feel no shame in taking them. He said some people are “heroically struggling” but “get to the stage where they can’t look after themselves, let alone the baby”.
Some women also need antidepressants after giving birth and the medication is compatible with breastfeeding, disputes fears to the contrary.
Sheehan said, in his experience, some women who chose not to take antidepressants during a previous pregnancy seek medication in a later pregnancy because they realise it is necessary.
Overall, the prognosis for depression in pregnancy is good and most women recover within six months.
Bipolar disorder
Maternity hospitals take steps to prevent depression and mental illness both during and after pregnancy, where possible.
“At the Rotunda, during a woman’s first visit we ask her if there is a history of depression or bipolar disorder in her family,” Sheehan explained.
Pregnancy and birth hormones can trigger a woman’s bipolar disorder and, if this happens, she will need medication.
Sheehan said some women who have bipolar disorder and are planning to conceive take part in preconception counselling, noting: “They have read about the risks and want to know what all the options are … the pregnancy doesn’t stop you from getting sick.”
Sheehan said if a woman has bipolar disorder, “her risk of getting sick after delivery is 50-50, so it’s one in two”.
We want to identify women to preemptively help them – knowing there is such a huge risk of a woman getting sick after delivery, we put in place measures to help prevent her getting sick.
He said about one in five women who attend the Rotunda engage with a mental health midwife, who will refer the woman to a psychiatrist if necessary. Sheehan said waiting lists to see a perinatal psychiatrist are generally quite short thanks to recent investment in services.
Sheehan will deliver a talk entitled ‘Managing depression and bipolar disorder in pregnancy and the postpartum period’ at Aware’s conference ‘The Future of Depression & Bipolar Disorder’ in University College Dublin on Saturday 12 October. More information can be read here.
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