Pregnancy is usually associated with an expectation of happiness. But while postnatal depression is widely reported, it's actually quite common to experience feelings of depression during your pregnancy too. It's normal to have many different emotions throughout the trimesters, but if you feel sad more than you feel happy, then you may be suffering from prenatal depression.
Dr Louise Wiseman looks at how pregnancy hormones can affect your mood and offers expert advice on how and when to seek help if you experience feelings of depression during pregnancy:
What is prenatal depression?
Prenatal (also known as antenatal) depression is when you feel sad all the time (for weeks or even months) during pregnancy. This is less publicised than postnatal depression which occurs after the baby has arrived. Prenatal depression affects about 10 per cent of pregnant women and varies from mild to severe.
At which stage of pregnancy is antenatal depression most likely? Symptoms may occur at any time during pregnancy, as all women can experience a rollercoaster of emotions at each stage. However different trimesters present varying hormone levels:
The first trimester (first 12 weeks)
In the first trimester mood swings are common alongside the large physiological changes that are occurring (eg tiredness, nausea, vomiting, breast tenderness). Alongside happiness and excitement, feelings of low mood can occur while experiencing the new pregnancy.
The second trimester (middle 12 weeks)
In the second trimester hormones stabilise and energy levels can increase (especially from around 26 weeks) making this a calmer time.
The third trimester (final 12 weeks)
In the final trimester anxiety around labour and delivery and caring for the new baby is more likely.
Prenatal depression symptoms
If you experience any of the following symptoms, speak to your midwife or make an appointment with your GP:
Not enjoying things that are normally fun
Problems with concentration
Finding it hard to make everyday decisions
Loss of appetite or overeating beyond normal pregnancy changes
Lack of energy
Not caring too much about personal hygiene
Avoiding family and friends
Feeling irritable or emotionally detached
Feeling guilty or like a failure
Thoughts of self harm or suicide
Many of the above symptoms can occur during a healthy pregnancy and not be a problem. But if they continue for more than two weeks at a time or interfere with your ability to function in daily life, then you should make an urgent appointment with your GP to discuss prenatal depression treatment options.
⚠️ If you are pregnant and experience thoughts of suicide or self-harm seek urgent medical help from your midwife or GP.
Prenatal depression causes
Hormonal imbalance can cause prenatal depression but because all women go through the hormonal changes and not all become depressed, there are likely to be other risk factors involved. These risk factors are also important for health professionals to recognise so that they can identify women at risk as early as possible.
Risk factors for prenatal depression include the following:
A pre-existing mental health problem, for example depression, anxiety or bipolar disorder.
Previous difficult birth experience.
A pregnancy with medical complications.
Low self-esteem or a difficult childhood.
Isolation, lack of support and stressful living conditions.
Relationship problems including domestic violence or abuse.
Major life events such as bereavement or divorce.
Prenatal depression diagnosis
Telling your midwife or doctor how you feel is important. Many women feel guilt at disclosing their symptoms when everyone around seems to be experiencing joy. Medical professionals will not judge you and will be keen to diagnose and treat this important mental health condition. This will then allow you to enjoy your pregnancy and feel well enough to care for your new baby.
Discuss any existing or past mental health problems at your antenatal booking appointment. If you are already seeking help it is important that medication for depression taken prior to pregnancy is not simply stopped – it may be necessary to change dosage or medication for safety in pregnancy but simply halting medication without a plan can make symptoms worse.
In all cases a ‘personalised care plan’ will be made with the help of the psychiatry team and you will be assessed at regular intervals during you pregnancy and have easy access to expert help if you are struggling.
Prenatal depression treatment
Treatment for prenatal depression consists of a combination of self-help, talking therapy and medicine.
Your GP, antenatal team and midwife will work together to decide on the best treatment. A referral to a prenatal mental health specialist will be made if they are not already involved. At all stages the risks and benefits of any medicine treatment will be explained to you, so that each decision is informed.
The choice of treatment will be determined by severity of symptoms, stage of pregnancy, any risks to the baby during or after delivery and whether it will be safe to breastfeed.
Prenatal depression medication
Doctors prescribe medication carefully during pregnancy following NICE guidelines. Therapy and self-help may be tried first or medication immediately prescribed.
Medications include Selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants (TCAs) and serotonin-norepinephrine reuptake inhibitors (SNRIs). These do have some rare risks associated but are generally considered safe during pregnancy. This will all be discussed with you and your partner/support as appropriate.
Prenatal depression and talking therapy
Sharing your feelings is important and speaking to a trained counsellor is an ideal way to do this without judgement. Access to talking therapies varies around the country but pregnant or postnatal women experiencing depression are usually given high priority.
Therapists will look at the possible causes of depression and address how and why you feel this way. Other talking therapies such as Cognitive Behavioural Therapy (CBT) can also help you to understand why you feel the way you do and teach you how to alter your thinking.
The community mental health team may organise therapy or patients may seek their own from recognised organisations such as British Association for Counselling and Psychotherapy (BACP) and United Kingdom Council for Psychotherapy (UKCP).
Prenatal depression prevention and self-help
If you are feeling low or have any concerns about your mental health during pregnancy, there are a number of self-help measures you can take:
✔️ Talk to someone you can trust such as your partner, friend or a family member about your feelings.
✔️ Prioritise self-care, including showering and dressing even on days when you don't go out.
✔️ Keep moving and active.
✔️ Eat well even on days when your appetite is low.
✔️ Avoid alcohol, smoking and drug use.
✔️ Read about pregnancy and planning for birth – and seek advice from your midwife if needed.
✔️ Join antenatal or peer support groups such as MIND.
❗️ Avoid taking St John’s wort; an over the counter herbal remedy that is not known to be safe to use during pregnancy.
Prenatal depression recovery
Support and treatment should enable you to enjoy your pregnancy and the arrival of your newborn baby. Care will be continued and you will be carefully monitored at each stage by the antenatal and postnatal team.
For future pregnancies, discuss your mental health experiences with the GP prior to conception or early on in your pregnancy so any mental health problems can be minimised.
Further help and support
For additional help with anything related to parenting and your mental health try one of the following resources:
Pre and Postnatal Depression Advice & Support: support for families.
Samaritans: free, 24/7 emotional support to anyone in distress.
Tommy's: support for parents-to-be providing info and research.
Cry-sis: support for parents with crying and sleepless babies
NCT: charity for parents through your pregnancy, birth and beyond.
Last updated: 11-11-20
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