Pregnant and depressed? It’s not unexpected

It was once thought that pregnancy hormones helped to protect against depression, with many women reporting a feeling of emotional wellbeing. But it is now known that the hormonal changes in pregnancy can actually contribute to the development of depression.

About one in 10 women suffer from the illness during pregnancy. With evidence showing that depression in the mother during pregnancy can have long-term consequences for the health of her offspring, it is vital that these woman are identified and treated, says Prof Veronica O’Keane, a lecturer at Trinity College Dublin’s department of psychiatry and a consultant psychiatrist at Tallaght hospital.

“Depression is there in 10 per cent of women during pregnancy, but it is often ignored because of the fear of giving antidepressants to pregnant women,” she says.

“However, depression itself is very damaging to women and this biological stress is being passed on to the baby so the pros and cons of treating the woman for depression must be seriously considered.”

Research project
O'Keane is heading up a major new Irish research project that she hopes will show that when women are treated for their depression during pregnancy, their baby's stress systems will normalise within the first year of birth.

Dr Carmine Pariante, head of perinatal psychiatry at the Institute of Psychiatry, King's College London, says depression during pregnancy can have specific long-term consequences for the baby that are separate from the effects of post-natal depression.

He spoke about his research in this area at a recent neuroscience meeting at University College Cork.

"There is something about the mother being depressed when the baby is in utero that makes the baby more vulnerable to developing depression as a young adult," he says. "Our research has shown that babies born to mothers who were depressed in pregnancy tend to be more irritable and reactive to stress.

“As children, they are more likely to be exposed to life stressors like bullying or maltreatment by others and, as adolescents and young adults, they are more likely to become depressed than babies born to mothers who were not depressed in pregnancy.”

Pariante highlights the need for a strategy to treat depression in pregnancy, arguing that by treating the depression, not only will the woman feel better, but there is the potential to prevent the child from developing depression in the future.

O'Keane started researching the subject during her time at King's College London. The new project, which is funded by the Health Research Board and involves TCD, the National Maternity Hospital at Holles Street, the Coombe and Crumlin children's hospital, is due to begin in November.

Cortisol levels
The researchers will follow 200 women – 100 of whom will be clinically depressed – through their pregnancies and will track the levels of cortisol (the main stress hormone in the body) of mother and baby for the first year of the baby's life.

“We know that women quite frequently get depressed during pregnancy. What we hope to show in our study is that when women who have been depressed are treated, the baby’s cortisol levels will come down and the baby’s stress response will be modified in the first year of their life when the baby is learning to be soothed by the mother,” says O’Keane.

“The baby’s stress system is still very malleable at this stage, which is why it is so important to treat depression in the mother so that this type of stress in babies does not remain permanent.”

While she understands the fear around prescribing antidepressants or any medication in pregnancy, O’Keane says that the SSRI (selective serotonin reuptake inhibitor) group of drugs used as the mainstay treatment for depression during pregnancy is associated with a very slight increase in the risk of cardiac defects in the newborn.

“The risk of a moderate depression in pregnancy, on the other hand, can be very significant on mother and baby and can also impact on the mother’s partner and other children in the family.

“If the mum is depressed, she is disengaged from the world and there is a high rate of marital breakdown following perinatal depression so it really is vital that these women get help.”

Medication advised
For a woman with moderate to severe depression in pregnancy, says O'Keane, medication is advised, along with psychological therapy where appropriate.

High-risk groups for depression in pregnancy include teenagers, women from racial minorities and women with “unwanted” as opposed to “unplanned” pregnancies.

“I see women coming in and giving birth and nobody has even known they were pregnant. These are not teenagers, they are grown women living desperate lives with no family or social support, particularly women who are refugees and socially isolated. I hope with the increased resources that are being put in place that women will have more psychological services available to them during pregnancy.”

Every week important
O'Keane notes that every week during pregnancy is so important for the health of the baby that psychiatrists prioritise women who present with depression in pregnancy and advise GPs to refer them to specialist services as early as possible.

“The message is that there is help for these women, their depression is treatable and it is manageable. We don’t just give people pills.

“In our service in west Dublin, we provide follow-up visits in their homes and our healthcare nurses work closely with the public health nurses.

“Not every area has this level of service but we need all the health services to work together to address this issue.”