Are you suffering from depression? CAUSES History of depression or substance abuse Family history of mental illness \ Little support from family and friends Anxiety about the unborn child Complications with previous pregnancies or births Marital or financial problems Age of mother SYMPTOMS >• Feeling restless or irritable > Feeling sad, hopeless and overwhelmed >• Crying a lot >• Having no energy or motivation * Eating too little or too much *• Sleeping too little or too much >• Trouble focusing, remembering or making decisions *• Feeling worthless or guilty *• Loss of interest or pleasure in activities *• Withdrawal from friends and family *• Having headaches, chest pains, heart palpitations or hyperventilation
YP Talking Point ~sss==srjr! isa had an ideal life. At 37 she was happily married, financially comfortable and fulfilled running a charity organisation. "Everything was just great and I was going to be the perfect earthmother," recalls Lisa. Little did she know at the time, that falling pregnant would also mean her world would fall apart. Lisa, the strong, confident woman with the can-do attitude would be hit with a depression so severe she would even briefly consider terminating her pregnancy.
"Before, I enjoyed life and could take a bad situation and turn it into a positive one. But there was no positive in this depression - I was ready to abort if it meant feeling better." According to the Massachusetts General Hospital Centre for Women's Mental Health in the US, one out of every 10 pregnant women will face one of their biggest struggles as they are crippled by depression. While postnatal depression has become a widely publicised phenomenon, depression during pregnancy is still generally an under-recognised and under-diagnosed condition. In the past it was believed that women couldn't get depressed during pregnancy because the high levels of oestrogen (a hormone associated with mood enhancing qualities) produced during pregnancy would protect them from developing the condition. "But when a lot of women who had been diagnosed with postnatal depression were researched more closely, up to 40 percent described their symptoms as beginning during pregnancy," explains Dr Dora Wynchank, a Johannesburg-based psychiatrist who specialises in depression. What makes diagnosing depression during pregnancy difficult is that the symptoms of depression and pregnancy often overlap.
"At first I didn't realise I was depressed. I was just a loose cannon emotionally but I thought that was normal for pregnancy. But then I got terribly anxious and one night I started having heart palpitations and thought I was going to die. That's when I knew something was wrong," explains Lisa. Pregnancy brings with it emotional, financial and health concerns, so a certain level of anxiety is to be expected. Also, changes in appetite, sleep and energy levels are not uncommon. But if these symptoms become severe or last for longer than two weeks it's a good idea to seek help. "I became very claustrophobic, I felt like the world was coming down on me and I 'choked' on everything. My worst was the noise of the watercooler in the kitchen, I felt like I was drowning in the noise. I couldn't live in my body, my mind was racing with weird thoughts and I didn't sleep for days on end," she remembers.
Who's susceptible? From a psychiatric point of view, depression during pregnancy is no different to depression at any other time in your life although pregnancy presents some unique triggers, like worrying about the health of your baby (especially if you struggled to fall pregnant), your relationship with the baby's father or the financial implications of having a child. Dr Andy Taub Da Costa, who has been treating perinatal depression for the past 10 years, suggests that some women's brains are more sensitive to hormonal changes than others and this is why women who tend to suffer from PMS are more likely to develop depression and anxiety.
A personal or family history of depression can also make pregnant women more susceptible to depression although that is not always the case. Some women, like Lisa, report that they never suffered from depression before their pregnancies. "I wasn't an anxious person and had never had a panic >
Point attack. I was actually quite strong, so it really shook my confidence to think I wanted to go to work but I couldn't even get up." Medicate or not? Because all psychiatric medication has to cross what's called the blood/ brain barrier in order to get to the brain, it will, by definition, pass through the placenta as well. This means that the medication you'd be taking will, to some extent, be absorbed by your baby.
Dr Wynchank believes that for this reason, "Even if they recognise that a person is depressed, many clinicians would prefer to try non-medication routes first, like using psychotherapy before prescribing antidepressants." Lisa remembers her struggle with taking medication while pregnant, "Initially I was completely against taking antidepressants, I thought I'd poison myself and my baby.
I resisted my gynae's recommendation until I had a major breakdown and realised that unless I took the pills I wouldn't get better. But once they started kicking in - I could actually enjoy my pregnancy." No pharmaceutical company will claim that antidepressants are safe during pregnancy, largely because the effects (including long-term) of the medication on the foetus have not yet been clearly established. So when it comes to taking antidepressants during pregnancy you're faced with the same dilemma as you'd be when considering taking any medication during pregnancy. You have to weigh up the advantages versus the risks. It's natural that most mothers would resist medication to protect their unborn child from the risks. But these risks are twofold. "The consequences of leaving a severely depressed mother untreated can be detrimental to both mother and child," warns Dr Wynchank. It falls to you and your doctor to gauge your state of depression and treat accordingly.
Don't be afraid of getting a second opinion. What can you do? Dr Costa suggests implementing the HEART programme, a holistic system aimed at supporting pregnant moms suffering from depression. Each letter in the acronym represents an aspect you can engage in. H stands for Healthy Vessel. "There is no doubt that a strong, fit, well nourished body is better able to cope emotionally," says Dr Costa. Regular exercise, eating well, resting when you need to and staying away from substances that are harmful to your foetus and could exaggerate your depression (like alcohol and cigarettes), makes a "There is no doubt that a strong, fit, well nourished body is able to cope emotionally" tremendous difference. Touch therapy such as massage or reflexology have also proven to be very effective stress relievers and relaxation techniques, such as meditation, can help lower blood pressure and calm an anxious mind. E stands for Essence. This entails being aware that this has possibly come your way to grow you as a person. Being faced with depression meant that Lisa had to ask for and accept help from others for the first time in her life. A stands for Awareness.
This awareness works on two levels. Firstly, being aware of your condition and empowering yourself with knowledge about it - knowing that depression during pregnancy exists, knowing the facts about the condition and what your treatment options are. And secondly, being aware of yourself, how you react to your environment and what your individual needs are, so you can make an informed * ' decision about structuring your treatment.' I R is about having healthy relationships / to support you. Relationships and . : support during this time are of the utmost importance, this includes knowing (who to inform about your condition. DnCosta advises that you are selective in who you tell. "Not because you're ashamed,' but because you don't want to frianage another's discomfort with the condition," and to ensure the people who do know are understanding and supportive. Individual therapy or support groups can also prove to be an invaluable help. Zane Wilson, founder of The South African Depression And Anxiety Group, says,
"Support groups allow people to talk about what they are going through in a non-judgmental atmosphere. A group setting helps ease isolation and with individual therapy, is very/effective." Partners can also be hit hard as it's a big shock for them to see their pregnant spouses so different and this often makes them feel helpless and frustrated. Joint counselling can help your partner gain an understanding of what you're experiencing and help him support you. T stands for developing the ultimate trust in yourself. Depression can heavily knock your self-esteem, so it is important to trust yourself as an adult, as an able, decision-maker who can manage her condition. This includes finding a suitable therapist and a course of treatment that you're comfortable with. YP Get help If you suspect you may be suffering from depression speak to your doctor or caregiver who should be able to help or refer you to someone. For support groups, contact: The South African Depression And Anxiety Group 011 262 6396. Postnatal Depression Support Association of SA 082 882 0072