Sunday 23 April 2017

Pre-natal depression: Baby blues are just as likely to occur during pregnancy

The baby blues are just as likely to occur during pregnancy as they are afterwards

Baby blues can occur during pregnancy
Baby blues can occur during pregnancy

Tanya Sweeney

Ordinarily, being pregnant is a time of euphoria and hope for many mums to be. Yet for around 10-20pc of expectant mothers, prenatal depression means that instead of being excited and happy, they feel despair and dread as they count down to their big arrival.

Singer Natasha Hamilton, formerly of Atomic Kitten, revealed how she was floored by pre-natal depression, even before she knew she was pregnant with her baby Ella. After a series of panic attacks, pregnant Natasha started to recognise the feelings she had when she experienced post-natal depression with her first pregnancy 13 years previously.

"It was extremely difficult," she says. "I found myself starting to become isolated, which is exactly what you shouldn't do. The constant worry was exhausting. I remember one day being in the shower just crying my eyes out. I'd been in bed all night worrying and I was exhausted."

Pre-natal depression may seem like an unlikely condition, yet it's more common than meets the eye.

As a Galway-based yoga teacher, Emma (not her real name) has made well-being her livelihood. Yet when she fell pregnant in 2013, the woman who spent her days helping others feel good found that she was far from her own happy place.

"First I thought it was just tiredness in the first trimester, but then I noticed my motivation for work going, and anxiety creeping in," Emma, 38, recalls. "I couldn't go to meetings. In fact, I dreaded going in. The easiest of tasks were becoming very difficult. I couldn't get myself out of bed. I wanted to sleep all the time and I made excuses not to see people."

As her own yoga practice diminished, Emma found she was lacking the tools she needed to feel better. And things got very serious, very quickly.

"Suicidal thoughts were coming in and this was very frightening," she recalls. "I felt I couldn't tell anyone. I tried to hide it and this took all the energy I had."

Adding insult to injury, Emma was feeling another kind of pressure: "It was 'meant' to be a happy time and people were very happy for me. This had a negative effect on me as I felt ashamed and guilty," she admits.

"I wanted to connect with the baby and be excited, but I couldn't as I was just full of fear and anxiety. As it was my third pregnancy, I knew it was not the usual new baby fear.

"I realised it wasn't just pre-baby anxiety when my boss noticed that there was something wrong and my enthusiasm for the job wasn't there," she adds. "One day I broke down crying in work and had a major panic attack. I couldn't stop crying. I phoned my partner David (not his real name) and he phoned the antenatal ward. He made me phone them, and they asked me to leave work and come in straight away."

While post-natal depression is openly talked about, depression during pregnancy is a little known and rarely discussed condition. Despite the conspiracy of silence, studies show that a woman is as likely to be depressed during her pregnancy as she is eight weeks after her baby is born.

"About half of the women who get a diagnosis of post-natal depression will have experienced depressive symptoms in pregnancy," observes Prof John Sheehan, consultant psychiatrist at the Rotunda Hospital, Dublin. "This can often mean that post-natal depression can affect 10-15pc of pregnant women.

"While depression in pregnancy can be sometimes hormonally related, those with a history of depression may be predisposed to depression in their ante-natal and post-natal period. One of the difficulties with a diagnosis is that if you think of the common symptoms in pregnancy, the sickness and extreme fatigue, these can often be symptoms of depression. Often a woman will put this down to simply being pregnant and a depression can be masked," he says.

Other factors can act as 'triggers' for depression during pregnancy. Women can be more at risk if they're from a young age group, if the pregnancy is unplanned or is a multiple pregnancy.

"There are a lot of different factors, but the strongest indicator is a past history of depression," observes Prof Sheehan.

Emma had never experienced depression before, and was in a loving relationship when she fell pregnant with her third, longed-for baby.

According to Prof Sheehan, it can be particularly frustrating if a mum to be thinks, 'Why do I feel so bad if I'm doing everything properly?' "Society tells these women that they should be happy, yet while everyone is congratulating them, they feel numb," he says. "There's a loss of confidence and a lot of self-blame, as well as a feeling that they've done the wrong thing."

Other symptoms of this depression include guilt, low self-esteem and a sense of hopelessness, poor sleep and low energy. Other women worry that they won't be a good parent, even if the baby has been longed for.

"I've had women who have gone through several cycles of IVF and wondered why they're feeling so low," notes Prof Sheehan.

Left unaddressed, the 'before-baby blues' can have significant consequences on both mother and child. Several reputable studies show that women with unchecked depression or anxiety during pregnancy have babies with low birth weight, higher rates of C-section, pre-eclampsia, hypoglycemia and respiratory distress. Women who experience pre-natal depression can also be at risk for pre-term labour, post-delivery difficulty and poor bonding with their baby.

As with all other kinds of mood disorders, women experiencing pre-natal depression are treated using a wide variety of treatments.

"The first step would be a lifestyle or counselling approach," says Prof Sheehan. "Counselling and supporting works in 50pc of cases. A lot of women find pregnancy yoga and mindfulness helpful.

While professionals often hope to treat pre-natal depression with non-pharmacological treatments, there are a small number of cases in which medication is prescribed. In each case, the risk and benefits to both mum and baby are weighed up. As psychotropic medication goes through to the placenta, a baby would also be exposed to medication. Yet professionals find that SSRIs are the anti-depressant that women tolerate best.

"International guidelines would recommend that we treat women in pregnancy," notes Prof Sheehan. "Untreated depression not just has implications for mum, but also potential implications in terms of the emotional, cognitive and social development of their baby.

At 18 weeks' pregnant, Emma was referred for a psychiatric assessment by her GP. Initially, her team decided on a course of counselling, but it soon became clear that a course of medication was a better option.

"Prozac is what they prescribed as it is the safest," says Emma. "It did help that I was on the lowest dose, but I found that my mood stabilised."

Last July, her healthy son Finn (not his real name) was born: "The depression went away, and I knew in my heart that it would. I had to stay on the medication for a couple of months after Finn was born, as I would be more susceptible to post-natal depression. The birth was fine and doctors told me I was able to breastfeed on that medication."

The good news is that pre-natal depression has come to the wider attention of GPs, midwives and health visitors.

Recently, the Rotunda Hospital has received funding to provide ante/post natal depression screening in maternity units in Drogheda and Cavan. And psychological experts are also attempting to unravel the mystery: Trinity College's Institute of Neuroscience is about to publish the first survey of the prevalence of pre-natal depression in women.

"The best and simplest approach is not to ignore it," says Prof Sheehan. "Get help. Talk to your midwife or GP. Treatments are widely available and quite effective, and they give your baby the best chance and start in life."

Thanks to a team of health professionals, Emma and her son Finn are proof that there's light at the end of what can often be a dark, despairing tunnel.

"Even now, I still look out for the warning signs and look after myself well, through diet, exercise and yoga," says Emma. "I'd advise everyone in a similar situation to talk about it to someone you trust and understand, and not to feel ashamed. Go to your doctor or hospital and ask all the questions you want. It is a scary time, but it is more common than people think."

Pandas Foundation (Pre- and Post-Natal Depression Advice and Support) offers phone and email support and an online community at pandasfoundation.org.uk. More information on post-natal depression can also be found via PND Ireland (pnd.ie)

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