Recently a 26 year old pregnant woman came to my clinic with the symptoms of depression. She could not understand why she was feeling low and felt like crying all the time. She said everyone around her expected her to be extremely happy and jolly since she was pregnant. Even she was confused about why this was happening to her in her pregnancy. On further case-taking I found out that there was tension between the husband and wife due to the other family members even before the she got pregnant. Most people know about how some mothers go through slight depression after they have delivered their babies. However depression during pregnancy or Antenatal depression is not something we hear about commonly.

This is because not enough women understand what is going on and they feel embarrassed to seek treatment since everyone thinks they should be happy. Antenatal or depression during pregnancy is in fact very common and the research shows that 1 in every 10 pregnant woman experiences this problem. This is especially seen during the first and third trimester of the pregnancy.

WHO IS MORE LIKELY TO GET DEPRESSION DURING PREGNANCY?

In many cases the reason for getting this depression is not apparent and the woman just cannot understand why she is feeling this way. But there are certain underlying causes that may be making her more vulnerable to getting depressed which she may not even be aware of. In other cases the factors for this mental state may be very apparent. Here are a few conditions and factors that might make a woman more prone to developing depression during pregnancy.

1. One of the most common condition is if the pregnancy was unplanned or unwanted. That means if the woman has got pregnant by accident and does not really want the baby. This creates a conflicting situation within her because though she is pregnant she was not prepared to have this child.

2. The relationship between husband and wife may not be strong and there may be lots of doubts in her mind. There may be lack of confidence in the relationship.

3. The woman herself may be very young or old and lack confidence in her own self. She questions her own ability to bring up a child.

4. The pregnancy may be a result of a rape or unintended sexual encounter in an unmarried female.

5. The pregnancy may be a result of pressure from family members or others.

6. Physical problems and poor health during the pregnancy may give rise to depression.

7. If the pregnancy is a result of months of fertility treatments, the woman may have constant fear of loosing the child.

8. Past negative events like miscarriages, abortions or tubal pregnancy can play on her mind and cause anxiety.

9. Another important aspect is if the couple is facing financial difficulties. The to be mother will worry about the well being and the care needed for the child. These constant worries are known to cause depression.

10. If there is lack of emotional support from the family or husband it can cause lot of stress on the pregnant woman.

11. It is important to know whether the woman has suffered from depression or any other psychological problems in the past like eating disorders. All these factors and situations can make an already vulnerable woman prone to develop Antenatal depression. She feels helpless, confused and thinks that things are not in her control.

WHAT CAUSES THIS DEPRESSION?

All the points written above make the pregnant woman more susceptible to getting depression but they are the not cause. Also in some cases there is none of the above factors and the woman may have a perfectly planned conception and yet may be depressed. Till now no physician can say for sure why pregnant woman get depressed but there are some theories. The most convincing and possible theory is that of the hormonal changes.

Many physicians blame the depression on the hormonal changes taking place in the woman’s body during pregnancy. The levels of these hormones seem to affect the levels of neurotransmitters in your brain. The brain is the main center for mood regulation and hence the change in the levels of the neurotransmitters causes disturbances in the mood leading to depression.

These changes seem to be more pronounced during the first 6 to 10 weeks of pregnancy and then in the last 3 months. Also noticed by physicians is that the hormonal changes makes the woman more anxious and even this may add to the depression.

WHAT ARE THE SYMPTOMS OF DEPRESSION?

How does a pregnant woman know that she is feeling depressed? There are many signs and symptoms, which can suggest this. Here are the most common ones observed in practice. If you are pregnant and have more than 2 or 3 of the symptoms listed below you need to consult your physician.

1. The most common symptom felt in pregnant woman is anxiety. They seem to get anxious over very small and insignificant things.

2. If you have trouble concentrating or focusing on things then your might be going through depression.

3. There may be a continuous low feeling all the time. Nothing seems to excite and the woman does not feel like doing anything or going out anywhere.

4. The woman has lack of confidence in herself and a low self esteem. Feels worthless and thinks she cannot do anything.

5. There is a sense of lack of control over her life and a numb empty feeling.

6. Some pregnant woman may become extremely irritable and impatient unlike. This may be unlike their actual nature before the pregnancy.

7. There may be frequent mood swings with lots of highs and lows.

8. Sleeping may be a problem for some woman. The sleep pattern gets very disturbed and causes problems.

9. There may be a loss of appetite contrary to what is expected in pregnancy.

10. A sense of tiredness and fatigue all the time may worry the pregnant woman and relatives. There may be no desire to do anything. These are some of the common signs and symptoms which indicate that everything is not alright and there may be underlying depression.

If you are experiencing more than 2 of the points written above and are pregnant you need to go to your physician and seek help.

DOES THIS HAVE AN IMPACT ON THE BABY?

This is one of the most common question I am asked when I get such a case in my clinic. The effects of post natal depression have been documented where the mother does not care for her child and the baby is neglected. The child may develop certain insecurities and behavioural problems. However the effect of Antenatal depression have not been documented. Nobody knows for sure what exactly are the adverse effects of depression in the mother during pregnancy on the baby. Some physicians say that depression in the last few months of pregnancy can cause pre-term delivery. Others believe that this affects the heart rate patterns of the foetus. However these are all assumptions and theories, none of this has been proven as yet. What has been proved is that a woman suffering from depression during pregnancy is at a higher risk of developing postnatal depression too, which is known to have an adverse effect on the child.

TREATMENT FOR DEPRESSION DURING PREGNANCY

If you are pregnant or you know of someone who is pregnant and going through depression do not take it lightly and think that it will pass off. If not addressed it can become progressively worse and lead to bigger problems in the future. Please consult your physician about the necessary treatment and counseling required. Counseling is an important aspect of the treatment and the root cause of the depression should be tackled.

The entire family must be supportive of the pregnant woman and be there for her when she needs them. The husband is the most important person and he must go with the pregnant woman for counseling as well. He must take part in her daily activities like go for walks together and to the Gynaecologist for check ups.

Depending on the severity of the depression the treatment should be selected. It is best to avoid anti-depressant drugs and mood elevators prescribed normally in depression. The effect of these drugs on the growing foetus is not good and can cause certain birth defects. It is safest to resort to Homoeopathy in these cases. In our system of medicine the remedy is selected based on the symptoms and constitution of the patient. Therefore it is not possible to write about the remedies. However here are a few medicines which have proven effective in some cases.

CIMICIFUGA RACEMOSA

I had a very interesting case of a 30 year old woman who was pregnant for the third time. However her earlier two conceptions ended in spontaneous abortions before three months were over. This time after much difficulty and complete bed rest she had passed her third month. Due to past experiences she was all the time worried and anxious about losing this baby too. She told me that she felt as if there was darkness surrounding her and she felt confused all the time. Sleep was difficult as she kept thinking negative thoughts as if something wrong was going to happen. Her husband told me that her moods were constantly changing. She kept sighing loudly without knowing this. I gave her Cimicifuga 200, 5 pills daily to help her throughout her pregnancy.

NATRUM MUR

Another case of a pregnant woman going through depression was given this remedy. This lady had been trying for a child for years and had tried several fertility treatments without success. Then she conceived naturally but started going through depression. The family could not understand this because they thought she should be happy. She told me that she just wanted to be alone by herself and felt like crying all the time. Her mind would keep thinking about past negative events that had happened to her. This lady described herself as being sad but did not want sympathy from others. Natrum Mur 200, in constitutional doses was give to this pregnant woman, which made her feel like her normal self again.

PULSATILLA

This Homoeopathic remedy is well known as a female remedy. Pulsatilla is often used in problems pertaining to the female sexual system where the symptoms correspond. It is also very useful in treating emotional problems like depression especially during pregnancy where the woman is most vulnerable. This patient will weep easily even while narrating her symptoms. She will not like to be alone and will want someone around her all the time. Even darkness causes uneasiness. This uneasiness and anxiety is better when she is in open air and when consoled. This remedy is also often used in post partum depression where the mother weeps every time the child breast feeds. Give Pulsatilla 200, 5 pills 4 times a day to help improve her emotional and mental state.

I have written this article in order to make people aware of depression during pregnancy. We think that this is rare and uncommon because most women feel to ashamed and embarrassed to speak about it and express themselves. This can cause harm both to the mother and the child inside her.

If you are suffering from this or know of someone who is please consult your physician and do not try to self medicate.