Mental health problems and pregnancy

Mental illness can progress more rapidly during pregnancy, and if you stop taking prescribed medication without consulting your doctor when you become pregnant, this can make your illness return or become worse.
If you have a mental illness it may cause you to miss important antenatal care appointments. This could increase your risk of pregnancy-related complications that would otherwise have been picked up.
If you have already suffered from mental illness in the past you're more likely to become ill again in the first year following the birth, even if you have been well for years.
What care should you expect?
Because you may feel more vulnerable and anxious while you're pregnant and after the birth, your antenatal team should ask you about your mental health. This will give you the opportunity to talk about any concerns and to get help if necessary.
When you have your first antenatal appointment you should be asked if you have ever had problems with your mental health in the past. You should also be asked about this again following the birth of your baby. This is to allow your care team to pick up on any warning signs more quickly and to plan appropriate care for you.
Talk to your GP, midwife or health visitor if you have any concerns about your mental health during or after your pregnancy.
The 'baby blues' is a time when you may feel low and tearful, and it usually occurs in the first week after the birth. It's a result of the normal hormonal changes taking place in your body, and affects around 80% of new mothers. But for some women pregnancy and birth can trigger more serious depression.
Signs to watch for
Symptoms that may indicate you are depressed include:
Psychological symptoms include:

  • continuous low mood or sadness
  • feeling hopeless and helpless
  • having low self-esteem
  • feeling tearful
  • feeling guilt-ridden
  • feeling irritable and intolerant of others
  • having no motivation or interest in things
  • finding it difficult to make decisions
  • not getting any enjoyment out of life
  • having suicidal thoughts or thoughts of harming yourself
  • feeling anxious or worried

Physical symptoms include:

  • Moving or speeking more slowly than usual
  • change in appetite or weight (usually decreased, but sometimes increased)
  • constipation
  • unexplained aches and pains
  • lack of energy or lack of interest in sex
  • disturbed sleep (for example, finding it hard to fall asleep at night or waking up very early in the morning)

Social symptoms include:

  • not doing well at work
  • taking part in fewer social activities and avoiding contact with friends
  • neglecting your hobbies and interests
  • having difficulties in your home and family life

Managing depression
Because your GP will continue to treat you after your pregnancy is over, he or she will always be involved in your mental health care. However, if your illness is severe your GP will refer you to the local perinatal mental health team for specialist care. This team can help develop a care plan for you.
If you're taking antidepressants already, you should continue to take them. But consult your doctor or psychiatrist as soon as you decide to start trying for a baby, or as soon as you learn you are pregnant, to discuss any risks associated with taking your medication during pregnancy and while breastfeeding. You may need to change or stop the medication you're taking, but your doctor or psychiatrist should be able to help you make an informed decision.
If you have mild depression your doctor may suggest other treatments such as an exercise programme or counselling. These may also be offered if you develop depression after the birth.
Postnatal depression
Developing depression after your baby is born is called postnatal depression (PND). It usually begins sometime during the first six months after the birth and affects 10-20% of new mothers. PND can last for over a year if untreated, but the earlier it is diagnosed the quicker you will recover.
Who is at risk?
Depressive illness occurs in 10% of new mothers in the year following the birth of their baby. Most will only have mild depression, but half to one-third of these women will develop a severe depressive illness. Other mothers develop severe mental health problems such as puerperal psychosis (a rare psychiatric illness) and require specialist help.
Your health visitor should discuss how you're feeling after the birth, but warning signs to watch out for include:

  • feeling irritable and angry
  • crying or often being on the verge of crying
  • feeling unable to cope
  • worrying unnecessarily about things that wouldn't normally bother you
  • being afraid of being left alone with your baby
  • uncontrollable feelings of panic
  • overwhelming fears, for example fear of dying
  • dreams about harming your baby
  • sleeping problems
  • feeling exhausted and lethargic
  • lack of interest in your surroundings and appearance, or becoming obsessively tidy
  • trouble concentrating, and feeling distracted
  • gaining or losing large amounts of weight
  • loss of pleasure in activities you usually enjoy, including loss of libido
  • feelings of guilt that you're a bad mother

If you think you may be depressed, talk to your doctor, midwife or health visitor as soon as possible as they can arrange suitable care for you.
What you can do
Although the best way to treat depression is to seek help from a healthcare professional, there are steps you can take yourself to reduce your chances of developing depression and to help you recover once you've been diagnosed.
Try to:

  • look for the positive things in your life, however hard that may seem
  • involve your partner or someone you're close to in your pregnancy and baby
  • make time to relax
  • be open about your feelings
  • ask for help with practical tasks like grocery shopping and household chores
  • find out about local support groups (find mental health services near you)
  • make time to rest
  • eat well (find out more about healthy diet in pregnancy)
  • find time to have fun
  • organise small treats every day, such as a workout or a coffee with friends (find out about exercise and pregnancy and keeping fit and healthy after the birth)

Try not to:

  • do too much - cut down on other commitments when you're pregnant or caring for a new baby
  • get involved in stressful situations
  • drink too much tea, coffee, alcohol or cola, which can stop you sleeping well (find out more about alcohol, medicines and drugs)
  • move house
  • be too hard on yourself or your partner

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