Depression in Pregnancy - Mother Mental Health Toolkit

Hello, I'm Dr. Joanne McDonald and I work at Dalhousie University and the reproductive

mental

health

service in Halifax, Nova Scotia, Canada, welcome to one of a series of our video learning models on maternal

mental

health

, maternal mental health

mother

s. Today I start talking about

depression

and

pregnancy

. It is a time of tremendous change and it is important to consider this when we think about the things that may contribute to the risk of any mood problems, but particularly

depression

in

pregnancy

. Pregnancy is a time of physical changes, emotional changes, role changes in particular, and often a relationship change.

So a woman may have a different relationship with her family and a partner with her friends with her employer and in some ways a different relationship with herself as she considers what it means in her life to become a

mother

and she is also the relationship that will come with it. to the fetus, so depression in this environment, which already presents many changes, can be an unexpected experience for the woman and her family. I would like to get you thinking about what you suppose the rate of depression during pregnancy would be: 3.5% 10% 25% or 48% of pregnant women, well the answer is that it is the 10% of pregnant women who have symptoms of a moderate to severe nature that we would consider consistent with a diagnosis of major depression, sometimes that is a much higher rate than people realize and it really highlights the fact that you are just as likely to experience major depressive illness in this period nine months of pregnancy as you would in any other nine month period if you were a non-pregnant woman of the same age and circumstances.

What are some of the typical symptoms of major depression that we see when they occur during pregnancy? Well, they are actually very similar to depression as we see it at any other time in life and in any gender, however, it can be a bit difficult at times. to distinguish what the symptoms of depression are from the normal types of discomforts and changes that can occur particularly physically, but someone in terms of thinking about the energy level is something like a normal change in pregnancy, but we look for changes in the sleep patterns, changes in appetite, energy, mood. ability to cope with stress speed of thinking and if your daily thoughts are more negative or fearful or guilty or irritable or some combination of all of these and your sense of connection with people or your roles with them change will often tell if they are the same as always and That often requires some prior knowledge from the woman, but that's where her family and friends, the usual caregivers, can be very medically students and know if they're seeing a fundamental change and the way the woman thinks. , it feels and works.

How do we recognize depression? Then, from those common changes in pregnancy, we see that fatigue, speed of thought or response, and increased intensity or expression of emotions can come with the hormonal and physical changes of pregnancy, but should improve with the rest and support, do not last long and do not really interfere with function, so these last three elements are modifiable by reducing stress. They are good for taking a break. They rest more intensely. Know? Are they really severe and persistent? Are they getting progressively worse? in terms of function or there is one thing, I am tired but I can still go ahead and continue doing my usual activities, depression is a more likely possibility than normal changes in pregnancy if the symptoms persist and worsen, emotions and thoughts are increasingly negative.

The experience is not typical for this particular woman and the feelings don't seem to fit her situation, so you know if everything is going pretty well, there are no problems in the pregnancy, there are no major stressors, but the woman is starting to think every once again. She is pessimistic about her future and doesn't see any kind of value or pleasure in the light of every day. What are some of the risk factors for depression and pregnancy? Well, any history of major depressive episodes in the past alerts us that this could be possible for this woman.

She had a history of mood sensitivity with hormonal changes, for example, premenstrual does not necessarily predict that she will have depression and pregnancy or after childbirth, but it may put her in a slightly higher risk category if she has unusually high levels of current stress, things that are inevitable and difficult to change, have you had a loss of significant supports right around the time you became pregnant or at some point during the pregnancy and do you have a lot of co-existing physical pain and complications during the pregnancy? Things are considered physical and emotional challenges that can reduce her natural resilience to regulate and stabilize mood.

What are some protective factors? Well, if the stress has been recent and is not necessarily continuous and does not accumulate on top of each other. and become cumulative, that's a little bit of a better situation because you can give the woman time to just create a strategy to deal with the things that are in front of her and then regroup with her again like always, did you have a good time dealing with the things that are in front of her? difficulties? In the past, does she have strong support systems that will help her tremendously and does she have the ability to increase her self-care strategies in common but still extremely important ways during pregnancy?

Can she get out of wet rest if she eats properly? address any health problems that arise? Does she know how to deal with stress or difficulties as they arise? Does she have a pre-existing psychological view of herself and her coping style? Does she have the skills for resilience? and do you have a strong desire and motivation to be a mother because certainly if a pregnancy is unplanned or occurs in a circumstance of conflict trauma or if you cultivated the woman's perfect perception of her pregnancy experience as well as her ability to sustain herself herself through difficulties?

What the intervention addresses in depression and pregnancy, both interpersonal and cognitive behavioral, may be clearly different. Sarah, the psychotherapist, can be very effective as an intervention or stand-alone treatment for those with mild to moderate symptoms and the woman can avoid the use of medication in pregnancy, however, untreated severe depression is associated with very poor outcomes for the mother , both obstetric Lee, in terms of the risk of chronicity of depression or other psychological illnesses for her and also in the continued development, both emotional, physical and cognitive, of her fetus, so medications are generally reserved. for severe symptoms, but is used with trials based on evidence and knowledge of the safety and relative risks for that particular woman and should be used with the supervision of a doctor who is comfortable and familiar with the evidence on safety of medications during pregnancy, family and friends, although you can never do so.

We must underestimate the importance of their support and participation both in terms of practical care for the mother and reducing the stigma for her around having spoken to see the evaluation of treatment for depression at a time when most Families hope that it will be a happy event in pregnancy, but also support her when it comes to weighing the risks and benefits and decisions about intervention and treatment. What is the outcome for pregnant women with a depressed mood or depressive illness? Well, not all women get postpartum depression, in fact it seems like a small proportion of cases. improve with childbirth itself, so the increased hormonal load of pregnancy appears to be the trigger for those particular women, but safe and successful treatment of depression during pregnancy will certainly limit the risk of later deepening depression postpartum or, for women, the risk of a new illness in the postpartum period People are sometimes tempted to receive treatment until their symptoms barely reduce and then stop the medication sometimes abruptly, but this practice can lead to higher risks of relapse and recurrence. mood disorder both during pregnancy and during the postpartum period, but also throughout life, so, again, a considered decision about treatment, good follow-up and safety considerations will predict the success of the mother and the baby.

The treatment that we know also improves the woman's function during labor and postpartum attachment, so Depression in pregnancy You really know that we have a series of objectives which are that the mother has a successful experience and that this adaptation is successful in this important moment of life. Some general considerations and treatment are that we should try to reduce stressors whenever possible. rest engage in moderate exercise as appropriate for your medical condition and nutrition provide practical and emotional support seek a mental health assessment where available consider psychotherapy again when possible and discuss the benefits and risks of any recommended medications recommended risks and benefits a resource important to anyone in the community and to women and their families is a mothers' risk organization, which is a source at a sick children's hospital in Toronto, Canada, of any type of medication that a mother may be exposed to during pregnancy and has the latest research results on what the relative The risks and safety are of any given substance, including psychiatric medications, so a few points to remember our pregnancy does not protect women from depression.

Self-care and psychological strategies are key medications that can be used in severe cases with safety and monitoring, and we have resources to evaluate the safety of medicating any medication a mother may be exposed to during pregnancy and the successful treatment of depression. and pregnancy are essential for the new mother's functioning when the baby is born. Thank you again for viewing our learning module. It is one of a series developed by the Mothers' Mental Health Toolkit project. Here in Halifax, Nova Scotia, our goal is to promote maternal mental health awareness and advocacy through frontline support and service providers.