Identifying Prenatal Depression & Treatment Options

Depression During Pregnancy
A Public Health Risk & What To Do About It

Pregnant women and their loved ones are becoming more aware of the negative consequences of non-psychotic postpartum depression on infant and child well-being, on the mother's and father's subsequent mental health, and on the quality of their relationship. However, expectant mothers may not be well informed about the negative effects of depression during pregnancy on fetal and newborn development and on their own mental health after the baby is born. A series of studies have shown, for example, that depression during pregnancy is associated with higher anxiety or stress levels that, in turn, predict low birth weight and prematurity.

Further, depression during pregnancy is likely to lead to postpartum depression in the mother. A large number of studies have demonstrated that prenatal depression is one of the strongest predictors of postpartum depression. Once a woman has postpartum depression, she continues to be vulnerable to depression in her childbearing years. Maternal postpartum depression has been found to pose serious risks for the quality of mother-child interaction, interfering with the ability of the mother to bond with the infant and for the infant to form a secure attachment with the mother.

What are the signs of depression during pregnancy? Fleeting moments of feeling sad and blue or depressed are part of the human condition. These mood changes are normal and tell you that something is not quite right in your life and they usually pass. Clinical depression is different. It is persistent, impairing and includes a range of symptoms such as sadness, disturbance in sleep and appetite, changes in weight, agitation or feeling sluggish, a decrease in energy, feelings of worthlessness and guilt, having trouble concentrating or thinking, thoughts of death, feeling life is not worth living, and loss of interest or pleasure in usual activities or things you used to enjoy such as food, sex, work, your family and friends. In addition, depression during pregnancy is usually associated with a great deal of stress.

Evidence suggests that approximately 10% - 26% of women have been found to be depressed during their pregnancy and as poverty increases, so does the rate of depression during this time. Pregnancy is also known to be an opportune time for suggesting health interventions and pregnant women may be unusually open to making changes to improve their mental health before their baby is born. In order to alleviate depression during pregnancy and prevent postpartum depression, it is imperative that patients, doctors, nurse clinicians, and social workers be provided with evidence regarding the effective treatments for depression during pregnancy. The good news is that depression during pregnancy is a treatable medical illness for which there are a number of effective treatments. Depression is not the pregnant woman's fault, but there is something she can do about it, if she seeks help.Antidepressant medications (mainly selective serotonin uptake inhibitors or SSRIs) have been found to be effective for reducing non-psychotic, unipolar depression during pregnancy and have demonstrated relative safety during pregnancy and the postpartum period. On the other hand, many pregnant or breastfeeding women are reluctant to take and doctors are reluctant to prescribe antidepressants because absolute safety (e.g., low risk of birth defects) cannot be assured. Thus, pregnant women may prefer treatment for depression with psychotherapy.

Recent evidence suggests that two types of psychotherapy may be effective for alleviating depression during pregnancy. The first type of psychotherapy, interpersonal psychotherapy, helps the depressed woman feel better by addressing and better managing the interpersonal difficulties most connected to her depression, including 1) learning to identify and take care of her own needs, 2) learning to rely less on an unsupportive boyfriend, 3) increasing her social support from available, reliable people in her network, 4) resolving a dispute with a person important to her, 5) enabling her to talk about her negative (and positive) feelings about the pregnancy without fear of judgment, 6) adjusting to and planning for the upcoming birth.

The second type of psychotherapy, cognitive behavioral therapy, helps the depressed woman feel better by encouraging her 1) to increase pleasurable activities weekly, 2) to give herself credit for her accomplishments, 3) to develop more realistic and helpful thinking, 4) to address and resolve step-by step the problems most currently linked with her depression, and 5) to adjust to and plan for the upcoming birth.
You can feel better before your baby is born! To seek help for depression during pregnancy, talk to your nurse, social worker or your physician, or call your local community mental health center.

Editorial provided by Nancy K. Grote, Ph.D., MSW, Director, Promoting Healthy Families Program, School of Social Work, University of Pittsburgh, Pittsburgh PA.

References: Grote, N.K., Swartz, H.A., Bledsoe, S.E., & Frank, E. (in press). Feasibility of providing culturally relevant, brief interpersonal psychotherapy for antenatal depression in an obstetrics clinic: A pilot study. Research on Social Work Practice.

Article found at http://www.expectantmothersguide.com/library/pittsburgh/depression.htm