Antenatal depression, also known as depression during pregnancy, is a serious and potentially life-threatening condition for women. Symptoms may include sadness, sleep problems, fatigue, appetite changes, irritability, and difficulty concentrating.
Worldwide, about 10 per cent of pregnant women and 13 per cent of women who have just given birth experience a mental disorder, primarily depression. In developing countries, this is even higher, for example, 15.6 per cent during pregnancy and 19.8 per cent after childbirth. In severe cases, mothers' suffering might be so severe that they may even commit suicide, according to the World Health Organization (WHO).
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Janvier Muhire, a clinical psychologist at mHub Clinic, Kicukiro, said depression is an illness that affects the way people think, act, and feel, stressing that women are more at risk of depression when pregnant, and during the weeks and months after having a baby.
During pregnancy, hormonal changes can affect the brain's chemicals and cause depression. Sometimes, pregnant women don't realise that they are depressed--they may think that they have symptoms of pregnancy, he said.
Muhire explained that the factors that increase the risk of antenatal depression include, poverty, lack of education, and younger maternal age, to mention a few, stressing that exposure to domestic violence also increases the risk of developing antenatal depression.
"Women with poor social support, unplanned pregnancy, and who are single or young, are also more vulnerable to antenatal depression."
Muhire said there are many causes for the increased prevalence of depression during pregnancy, for example, life stress (like demands at work or experiences of past trauma), and women who cope with other more chronic life stressors may find the additional stress of pregnancy.
The biological changes during pregnancy also have a direct effect on mood state. The concentration of female-specific sex steroids is raised during gestation and modifies parts of the brain involved in mood regulation, he added.
How depression affects mother and baby
Mothers who are depressed may have trouble caring for their children. They may be loving one minute and withdrawn the next. They may negatively respond to their child or not respond at all. Their feelings and behaviour will affect their ability to care for their children.
Muhire said depression can also affect attachment, which is important for the child's development. Attachment is a deep emotional bond that a baby forms with the person who provides most of their care.
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"A 'secure attachment' develops quite naturally. A mother responds to her crying infant, offering whatever they feel their baby needs--feeding, a diaper change, or cuddling. Secure attachment helps protect against stress and is an important part of a baby's long-term emotional health. It makes babies feel safe and secure and helps them learn to trust others. How a mother's depression affects her child depends on the child's age," he said.
Muhire explained that babies who don't develop a secure attachment may have trouble interacting with their mother (they may not want to be with their mother, or perhaps be upset when with them), have problems sleeping, may be delayed in their development, have more colic, be quiet or become passive, or develop skills or reach developmental milestones later than other babies.
More depression indicators
Providence Umuziga, a psychiatric nurse and lecturer at the University of Rwanda, explained that there is no single cause of depression in pregnancy, there are interconnected factors. However, different causes associated with antenatal depression include lack of partner support and social support, history of abuse, intimate partner violence, exposure to stressful life events, young age, and old age.
She noted that the main signs and symptoms include crying, sleep problems, fatigue or loss of energy, appetite disturbance, irritability, poor concentration or indecisiveness, difficulty remembering things, feelings of worthlessness or guilt, loss of interest in caring for oneself, not feeling up to doing everyday tasks, and insomnia or hypersomnia. These symptoms must be present for at least for more than two weeks.
Risk factors, consequences
"Literature and some studies conducted previously in Rwanda noted that poor partner support or friend support can lead to antenatal depression, unwanted or unplanned pregnancy, gender-based violence, history of mental illness, low income, low level of education, low self-esteem, difficult birth experiences, stressful events and so forth," said Umuziga.
Mothers affected by depression during pregnancy experience, most of the time, consequences like poor personal hygiene, and lack of appetite which can lead to poor nutrition, some may develop suicidal thoughts and risks for some cardiovascular diseases and poor relationships with people around them. Additionally, there is a risk of preterm delivery and low birth weight, she added.
When to see the doctor
According to Umuziga, most of the time, mothers don't recognise that they are sick, and people around them realise the changes and connect them to pregnancy complications and think that will be resolved with time.
She recommends consultation if one detects any symptoms, especially when their mood changes, for example, if they feel sad, depressed, and short-tempered for more than two weeks, if their appetite changes, and when the symptoms start interfering with their daily activities, or they develop suicidal ideas or completely refuse to eat.
Depression can disappear even before giving birth if a woman is helped, or can continue after giving birth once they don't receive any support.
The treatment of depression can be considered in three dimensions such as natural (providing medication, ensuring good nutrition, and having enough sleep), psychological (through psychological support, well treated by people around, preventing any psychological harm), social (increasing support from people around these women such as partners, relatives, neighbours), providing them with all necessaries like food security, and all the requirements to prepare them for childbirth, Umuziga stated.
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She added that all medications can be prescribed with caution as they may not be safe for both the pregnant woman and the unborn baby, which is why they need to be treated with a multidisciplinary team (psychiatrists and gynaecologists)--but medication is not always the first choice.
According to Muhire, healthcare professionals can discuss with patients the treatment options and highlight the risks and benefits of all options. They can recommend what is best for one's stage of pregnancy, and point out any risks certain medications may pose.
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Treatment for depression tends to involve self-help, therapy or cognitive behavioural therapy, and medicines.
"If a woman decides to take medication when pregnant, she should be offered what carries the least risk for her and the baby. A doctor should advise on other treatment options that can include social support, family therapy, and individual therapy which may involve a one-on-one with a family doctor, psychologist, psychiatrist, social worker, or other professional," Muhire urged.
