During pregnancy, symptoms of depression such as changes in sleep, appetite, and energy are often difficult to distinguish from the normal experiences of pregnancy. The course of depression varies throughout pregnancy: Most studies report a symptom peak during the first and third trimesters and improvement during the second trimester. Depression is the most common psychiatric disorder associated with pregnancy. Pregnant women may also suffer from anxiety disorders, such as panic disorder, obsessive-compulsive disorder, and eating disorders. While it is rare for women to experience first-onset psychoses during pregnancy, relapse rates are high for women previously diagnosed with some form of psychosis.
Risk factors for Depression:
Several risk factors and psychosocial correlates have been identified as contributing to depression during pregnancy. The most clearly identified risk factors include:
Previous history of depression
Discontinuation of medication(s) by a woman who has a history of depression
A previous history of postpartum depression
A family history of depression.
Several key psychosocial correlates may also contribute to depression during pregnancy: a negative attitude toward the pregnancy, a lack of social support, maternal stress associated with negative life events, and a partner or family member who is unhappy about the pregnancy.
Depression in Pregnancy:
Depression that is left untreated in pregnancy, either because symptoms are not recognized or because of concerns regarding the effects of medications, can lead to a host of negative consequences, including lack of compliance with prenatal care recommendations, poor nutrition and self-care, self-medication, alcohol and drug use, suicidal thoughts and thoughts of harming the fetus, and the development of postpartum depression after the baby is born. An additional and important implication of untreated maternal depression is the psychological effect that the depression may have on the fetus. The relationship between maternal depression and early childhood problems may be part of a sequence that starts with depressive symptoms during pregnancy.
Treatment of Depression in Pregnancy:
Treatment of depression in pregnancy relies on the same therapies used for depression at any time in life, with the added need to ensure the safety of the fetus. Psychotherapies that have been recognized as effective treatment for depression include cognitive behavioral therapy and interpersonal psychotherapy. Education and support are also important, particularly as pregnancy is a unique experience for women, some of whom may not know what to expect. Pharmacological therapies are also recognized as effective treatment for depression. However, the full disclosure of both the risk and benefits of various antidepressant medications should be made to the patient and, if possible, her partner prior to starting any pharmacological treatment.