Perinatal depression, which includes both antenatal (or prenatal) and postnatal depression, is a significant mental health issue that many women face during and after pregnancy. While postnatal depression often gets the spotlight, mood changes can start during pregnancy. Here, Professor Kelly Newell from the University of Wollongong helps us understand this important topic.
How pregnancy affects the brain
Pregnancy brings about substantial changes in a woman’s brain. Professor Newell explains that “there is documented evidence of a reduction in brain volume during pregnancy, although this can begin to recover in the postpartum period. This shrinkage, along with hormonal changes, leads to a reduction in the number of neurons and associated grey matter, which can take up to two years to fully recover.”1 This shrinkage, along with hormonal changes, leads to a reduction in the number of neurons and associated grey matter, which can take a couple of years to fully recover. These changes, according to Professor Newell, can increase the risk of mood disorders, including depression.
How common is depression in pregnancy?
Depression during pregnancy is more common than you might think. Professor Newell says that “approximately 10 per cent of pregnant women will experience depression during pregnancy”. It often comes with increased anxiety, difficulty sleeping, fatigue, and negative self-thoughts.
The risk factors
Several factors can increase the risk of depression, including a prior history of depression, family history, reduced social support, long periods of unemployment, and experiences of trauma or violence.
Recognising the symptoms of depression in pregnancy
It can be tricky to identify depression during pregnancy because its symptoms often overlap with normal pregnancy experiences. Key indicators include changes in sleeping patterns (trouble sleeping – insomnia or sleeping too much – hypersomnia), appetite changes (increased or reduced), negative self-thoughts, and some emotional disconnection with the pregnancy. Professor Newell emphasises the importance of seeking help if these symptoms arise, saying, “If you’re feeling unsure, your GP or a mental health specialist should be the first port of call.”
Treatment options for depression in pregnancy
There are various ways to treat prenatal depression. Psychological therapies, such as cognitive behavioural therapy (CBT), do help as can antidepressant medications, including selective serotonin reuptake inhibitors (SSRIs), if considered necessary by your GP.
Exercise during pregnancy can also be beneficial. National and international guidelines recommend that pregnant women, who have no medical reasons not to, engage in approximately two and a half hours of moderate-intensity exercise per week. This can help with various issues, including low back pain, diabetes, and mental wellbeing. Professor Newell reminds us that “it’s not the time of life to go from being a non-exerciser to a marathon runner,” but maintaining a reasonable level of activity definitely has pay-offs.
Overcoming stigma and seeking help
One of the barriers to addressing antenatal depression is the feeling of shame that can surround it. Professor Newell points out that “there’s a stigma associated with feeling sad or down or not connected with your pregnancy,” which can make it difficult for women to express their feelings or seek help.
One way to overcome this stigma is to have open and judgement-free conversations about mental health during pregnancy.
The bottom line
Up to one in 10 women may experience depression during pregnancy. By identifying the symptoms, understanding the risk factors, and seeking appropriate treatment, it can be managed effectively.
The associated shame often prevents us from seeking help but it’s important that we do. Professor Newell argues that “Expressing these feelings is essential for you to receive the necessary support you need to return to a healthy place.”
For more information and support, consult your GP or a mental health specialist.
Image credit: Pexels
Reference:
1. Hoekzema, E., Barba-Müller, E., Pozzobon, C. et al. Pregnancy leads to long-lasting changes in human brain structure. Nat Neurosci 20, 287–296 (2017). https://doi.org/10.1038/nn.4458
