Depression and Anxiety During Pregnancy

A. What is depression and anxiety

Pregnancy brings about a mix of many feelings, and not all of them are good. If you're feeling worried, you're not alone. Worry is very common, Most especially during a woman's first pregnancy or even an unplanned one. It can be even be harder if you're dealing with depression and/or anxiety.

For your health and that of your little one's, please take care of yourself as much as you can. Be sure to eat well/healthy, exercise, get enough sleep each day, and take your prenatal vitamins.

If you're feeling worried, sad, or nervous/scared, talk to someone about it — and if you don't know where to go or who to talk to, then talk to your primary care provider or support network and they will help you to know when and where to reach out for help.

Mood swings are absolutely normal during any pregnancy. But if you feel nervous or down all the time, it could be a sign of something deeper. Stress over being pregnant, changes in your body through the pregnancy, and everyday worries can take a toll.

Some pregnant women may have depression or anxiety:

Depression- is a sadness or feeling down or irritable for weeks or months at a time. Some women may have depression before even getting pregnant. But it can also start during any point in pregnancy for any number of reasons — for example, if a woman isn't happy about being pregnant or is dealing with a lot of stress at work or at home.

Anxiety- is a feeling of worry or fear over things that might happen. If you worry a lot anyway, many things can stress you out during pregnancy. You might worry that you won't be a good mother, or that you can't afford to raise your little one.

Pregnant women may have other mental health issues, such as:

• bipolar disorder (episodes of low-energy depression and high-energy mania)

• post-traumatic stress disorder (PTSD)

• panic attacks (sudden, intense physical responses with a feeling of unexplained and paralyzing fear)

• obsessive-compulsive disorder (OCD)

• eating disorders (like bulimia or anorexia nervosa)

It's important to treat mental health concerns during pregnancy. Mothers who are depressed, anxious, or have another issue may not get the medical care they need. They may not take care of themselves, or may use drugs and/or alcohol during the pregnancy. All of these things can harm a growing little one.

If you have a mental health issue, talk with your doctor so you can get the help you need during and after your pregnancy.

B. How is it different from postpartum depression

Can depression start before your little one arrives, in short? absolutely, though we hear alot more of postpartum "blues" or mood swings than we do of maternal people becoming depressed before giving birth. the name for this is Perinatal Depression and it is very similar to PPD in terms of the symptoms you feel and the treatment you might need.

C. Signs and symptoms of depression and anxiety during pregnancy

During pregnancy, your body goes through many changes. You could experience a lot of different emotions throughout pregnancy — sometimes carrying you up the emotional roller coaster, and even down. It’s totally okay to feel all of these different emotions. However, if you find you’re having any of the following symptoms during your pregnancy, it could be depression and you should reach out to your healthcare provider right away.

Signs of depression during pregnancy can include:

• Having recurrent thoughts of death or suicide.

• Having a depressed mood for most of the day, nearly every day, for the last two weeks.

• Feeling guilty, hopeless or worthless.

• Having difficulty thinking, concentrating or making decisions.

• Losing interest or pleasure in most activities during the day, nearly every day, for the last two weeks.

If you have any of the above symptoms your provider may ask you the following questions:

-Over the past two weeks, have you felt down, depressed or hopeless?

-Over the past two weeks, have you felt little interest or pleasure in doing things?

If your answer is yes to either of these questions, your healthcare provider will ask you more questions during a more in-depth depression screening test.

D. When to talk to your provider

Sometimes it is hard to know if or when you’re struggling with depression or anxiety, or if you’re feeling the symptoms of pregnancy. The symptoms can both be similar and confusing.

Talk to your health care provider about how you are feeling. You may have to talk about your feelings several times.

Make sure to talk about:

• -how strong your emotions are (for example, how sad you feel)

• -how often you have these emotions (for example, how often you cry)

• -how your emotions are affecting:

1. .your life

2. .your ability to take care of yourself

3. .your home or work

4. .your interactions with your partner, family and friends

• -how much you are sleeping or eating, which can be not enough or too much

• -if you have had any feelings of hopelessness and suicidal thoughts

• Tell your health care provider everything about:

• -what you do

• -how you feel

• -what you think

Especially if your thoughts and actions scare you, share them with your health care provider. If your health care provider is not around, go to the closest emergency medical center to talk to someone.

E. Will the risk for depression and anxiety increase after birth

There have been many studies done to determine if this can happen and studies have shown it can vary depending of certain risk factors, for eg, if you have a positive previous history of depression and anxiety, you may be at a higher risk for postpartum depression and the history between both has been reported in many studies which has been referred to as powerful factors in PPD, the occurrence of mental health disorders such as depression during pregnancy is a powerful factor in predicting PPD but not the only one.

There is evidence in explaining these relationships suggesting that women with a positive history of depression are more susceptible to hormonal changes. In support of this finding, it is reported that a history of moderate to severe premenstrual syndrome (PMS) is a factor affecting the onset of postpartum depression. In women with severe PMS, the serotonin transport system will change while the serotonin transporter polymorphism area is associated with major depression. High serotonin polymorphism may lead to tryptophan depletion and induction of postpartum major depression.

In addition to previous depression history, negative attitude toward the recent pregnancy, number of life events, and a history of sexual abuse in the past were a predisposing risk factor of postpartum depression. Furthermore, the reluctance of the little one's gender and having low self-esteem with the impact on parenting stress are factors that contribute in the development of postpartum depression.

Assessing the relationship between the number of deliveries and postpartum depression has been associated with conflicting results. A report of postpartum depression is more prevalent in multiparous women than in nulliparous women have had conflicting results. Furthermore, in a study conducted by Matsin in 2013, on 86 participants within 6 weeks after delivery, it was found that having two or more children and due to a higher psychological burden is more likely to be associated with the occurrence of depression. The discrepancies between the results of all these studies suggest that the number of childbirth alone is not an independent factor for developing postpartum depression and the development of pathological conditions for the occurrence of the illness is caused by psychosocial conditions that the multiplicity of delivery creates for the women.

A high risk pregnancy is also associated with an increased risk of postpartum depression. These risks include conditions that can lead to performing an emergency c- section or hospitalization during pregnancy. Postpartum complications are also effective on the incidences of postpartum depression as much as during labor complications such as meconium passage, umbilical cord prolapse, and obstetric hemorrhaging. Mothers with the birth of an infant with a weight of <1500 g are at a 4–18 times greater risk for postpartum depression more than others.

The mismatch between expectations of mother and pregnancy events as factors that affect the occurrence of depression. It's been reported that women with strong desire to have natural childbirth during the perinatal period, but delivery was done by c- section are more prone to be at risk for postpartum depression than others. Spending the course of pregnancy in a natural state from excitement from complications during pregnancy and preparedness for the delivery seem to be conditions effective in the prevention of postpartum depression. It has been reported that the use of epidural anesthesia during childbirth, attending in childbirth preparation classes during pregnancy, and continued breastfeeding after childbirth were associated with a reduced risk of postpartum depression. However, insomnia during pregnancy can lead to the risk of recurrent postpartum depression in women with a previous history of the disease.

The inverse association between breastfeeding and postpartum depression shows that breastfeeding is associated with a reduction in the rate of postpartum depression. It has been reported that women exclusively breastfeed their infants in the first 3 months after childbirth show lower values of Edinburgh Postnatal Depression Scale. In a study conducted by Hamdan and Tamim, it was found that breastfeeding during the first 4 months after delivery reduces the risk of postpartum depression. Although no causal relationship has been established for the relationship between breastfeeding and postpartum depression, breastfeeding increases the interaction between mother and little one and that may affect the health of the mother.

A relationship has been observed between low hemoglobin concentration at day 7 after delivery (<120 g/L) and postpartum depressive symptoms at day 28 after childbirth. An effective correlation has been seen between homocysteinemia in the 1st week and 6 weeks after delivery and depression. but, there is not enough evidence in this regard that postpartum anemia can cause postpartum depression or complications of the pregnancy period associated with the postpartum anemia may lead to increased risk of the disease.

F. Prevention and Treatment

Treatment for perinatal depression is important for the health of both the mother and the little one, as perinatal depression can have serious health effects to both. With proper treatment, most women feel better and their symptoms will improve.

Treatment for perinatal depression often includes therapy, medications, or a combination of the both. If these treatments do not reduce symptoms, brain stimulation therapies, such as electroconvulsive therapy, may be an option to explore. your health care provider can help you choose the best treatment based on your symptoms.

there are different therapies like cognitive behavioral therapy( CBT), interpersonal therapy (IPT) and medication

G. Resources: Local and online

there are many great online resources for perinatal depression and many facebook groups that will help you see your not alone in this, as well as your provider can help get you in touch with many local avenues.