An Overview of Antepartum Depression

Antepartum Depression: Symptoms, Causes, Diagnosis, Treatment, and Coping

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Pregnancy is often viewed as one of the most joyful events in a woman’s life. And while the feelings of happiness that many moms-to-be expect to experience do occur, there can also be many more moments of sadness, loneliness, and hopelessness. While all of these emotions can be attributed to a healthy pregnancy, there are instances when these changes in mood may be reflective of something more serious.

Antepartum depression or depression during pregnancy, while quite common, is not discussed as much as postpartum depression, which can leave many women feeling isolated and alone. What makes this period of time even more complicated is the fact that several symptoms that point to depression — such as changes in sleep and appetite, mood swings, and worry — are similar to the various physical and emotional changes associated with pregnancy.

Talking with your doctor about any concern you have, both physical and emotional, is critical for your health and the health of your baby. 

Symptoms

The American College of Obstetricians and Gynecologists (ACOG) estimates that 14% to 23% of pregnant women will experience some symptoms of depression during pregnancy.  It’s natural to experience emotional ups and downs during pregnancy. After all, mild mood changes during pregnancy are common. However, if they persist or get worse, it’s time to talk to your doctor. Symptoms of antepartum depression include:

  • Persistent feelings of sadness
  • Feeling empty and hopeless
  • Frequent crying
  • Troubles with sleeping or sleeping too much beyond normal pregnancy sleep-related issues
  • Lack of enjoyment and pleasure in activities that you once enjoyed
  • Excessive anxiety about your pregnancy and baby
  • Persistent worry or concern about your ability to be a parent, low self-esteem
  • Poor adherence to prenatal care
  • Withdrawing from friends and family
  • Physical ailments such as headaches, fatigue, aches, and pains not related to pregnancy
  • Engaging in risky behaviors such as drinking alcohol, smoking, or using illicit drugs
  • Lack of appropriate pregnancy-related weight gain due to decreased appetite 
  • Thoughts of death or suicide 

In general, if feelings of depression or anxiety persist for a few weeks or interfere with daily activities, it is time to ask for help.

Causes

The causes and risk factors associated with antepartum depression stem from a variety of medical, social, and psychiatric impairments. While it may be difficult to pinpoint an exact cause, there are several risk factors to be aware of including:

  • Personal history of depression prior to pregnancy
  • Family history of depression 
  • Chronic medical conditions that cause pain or exhaustion
  • Maternal anxiety
  • Life stress
  • Lack of social or family support
  • Unintended pregnancy
  • Previous miscarriage or stillbirth
  • Smoking 
  • Poor relationship quality
  • History of physical or sexual abuse
  • Pregnancy complications
  • Shifting hormones during pregnancy

Additionally, women with current depression or anxiety that become pregnant should be closely monitored during pregnancy and the postpartum period. 

Diagnosis 

Diagnosing antepartum depression follows the same guidelines as diagnosing other forms of depression absent from pregnancy. If you were diagnosed with depression prior to pregnancy, your doctor would likely adhere to your current treatment plan. However, if the onset of symptoms is directly related to pregnancy, a full screening to determine antepartum depression is necessary.

Screening for and diagnosing antepartum depression is key to intervening early and reducing the chances of postpartum depression. 

While more women are beginning to discuss issues related to depression with their doctor, an analysis of delivery data found that between the years of 2000 and 2015, the rate of pregnant women with a depression diagnosis at delivery increased by seven times . 

Because early intervention is so critical to a woman’s heath, the ACOG recently issued a committee opinion that outlines recommendations on screening for perinatal depression, which includes antepartum depression.  The screening guidelines call for obstetricians-gynecologists and other obstetric care providers to screen women at least once during pregnancy using a standardized, validated tool. During this screening, your doctor will be completing a full assessment of mood and emotional well-being. This should be followed up by an additional screening during the comprehensive postpartum visit. 

The purpose behind these early interventions stems from evidence that screening alone can have clinical benefits and that treatment or referral to a mental health expert may result in maximum benefits. They also point out that women with current depression or anxiety, a history of perinatal mood disorders, or other risk factors associated with depression should be monitored closely during pregnancy. 

Treatment

Identifying and treating antepartum depression is critical since untreated depression during pregnancy can increase the risk of preeclampsia and eclampsia, as well as increase the risk of preterm labor and low birth weight in the baby. Additionally, the incidence of postpartum depression is higher in women who have depression during pregnancy, especially when it is not treated. 

The good news is, antepartum depression is treatable with a combination of different therapies, medications, and self-care. Since antepartum depression is part of the broader diagnosis of depressive disorders, your doctor will most likely follow the guidelines for treating depression. That said, special consideration needs to be given to antidepressant medications while pregnant.

If the results of your screening support a referral to mental health services, quite often, the first line of defense for women with mild to moderate depression will be psychotherapy.  During these sessions, you will develop strategies to help decrease the severity of the symptoms.

The goal of working with a therapist is to help you begin to understand your diagnosis and how it impacts your life.

There are several forms of psychotherapy, but two, in particular, have proven successful in treating antepartum depression. 

Cognitive-behavioral therapy (CBT) emphasizes the link between thoughts and feelings. This form of therapy has a high success rate in helping to reduce the symptoms of depression, with many experts recommending CBT when the use of antidepressants is considered a risk. During a CBT session, you will work to identify and reframe negative thinking patterns into positive thoughts. This can help you recognize how your thinking influences your emotions. Including mindfulness-based cognitive therapy (MBCT) is another promising intervention. One study found that MBCT helped reduce the symptoms of anxiety, worry, and depression in women who have anxiety disorders. 

Interpersonal therapy has also been successful in treating antepartum depression. During these counseling sessions, you will work with a therapist to identify negative interpersonal issues that may be causing an increase in the symptoms of depression. The goal is to improve your relationships with other people.

Your doctor may also talk to you about antidepressants, which are a group of drugs commonly prescribed for treating depression. They work by increasing levels of a group of chemicals in the brain called neurotransmitters (primarily serotonin, norepinephrine, and dopamine), which are involved in regulating mood. The most commonly prescribed antidepressants during pregnancy include selective serotonin reuptake inhibitors (SSRIs) and serotonin and noradrenaline reuptake inhibitors (SNRIs).

Approximately 2-3% of pregnant women take antidepressants during pregnancy. However, there are risks associated with prescription medication during pregnancy. Since the drugs pass through the placental barrier and the blood-brain barrier, many experts worry about harm to the baby. That said, experts also point out that untreated depression can adversely affect maternal health and the health of the fetus.

Talk with your doctor about risks associated with taking medication during pregnancy, as well as any risks associated with untreated depression. They can help you decide what’s best for you.

Finally, some studies point to the use of acupuncture and acupressure as an alternative way to manage the symptoms of depression during pregnancy.  The findings support acupuncture as a tool to help with symptom reduction, not as a treatment of antepartum depression. 

Coping

Managing the symptoms of depression while pregnant can feel overwhelming at times. In addition to any treatment plan that involves therapy or medication, there are some self-care and coping tips you can try in order to alleviate some of the symptoms.

  • Exercise and physical activity. Engaging in physical activity and regular exercise during pregnancy not only benefits your health, but it can also reduce the symptoms of depression.  Try to include some form of exercise most days of the week. There are several classes designed specifically for pregnant women including prenatal pilates, prenatal yoga, and prenatal water aerobics. Talk with your doctor if you’re unsure of the safety of a particular activity.
  • Adequate rest. Quality sleep and rest during pregnancy are critical to your health. It’s also a key factor in managing the symptoms of depression. That’s because insufficient sleep can make coping with the stressors of life more challenging. While sleep-related problems are very common during pregnancy, make it a goal to get seven or more hours of sleep each night, which is the recommended amount for adults. 
  • Healthy diet and nutrition. Your body needs additional calories and nutrients during pregnancy. To support overall health, focus on a diet full of fresh fruit, vegetables, healthy fats, complex carbohydrates, and lean protein. Consider working with a registered dietician to design a diet that meets your needs. 
  • Support groups. One way to help ease some of the stress and feelings of loneliness is to find your community. Whether it’s friends, other women going through the same thing, family members, or a support group run by a therapist, sharing this experience with others can help you feel supported and find new ways to cope. 

A Word From Verywell

Pregnancy is a unique time in a woman’s life that can result in a variety of emotions, including excitement, joy, sadness, anxiety, and fear. While all of these feelings are part of a healthy pregnancy, being overwhelmed by hopelessness, helplessness, and sadness may point to something more serious. If you’re experiencing any symptoms of antepartum depression, the most important thing to remember is that you are not alone. There are safe and effective ways to treat and manage the symptoms of depression. That’s why it’s important that you talk to your doctor right away. Asking for help is the first step to finding ways to feel better and enjoy this incredible time in your life. 

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Article Sources

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