Antenatal Depression is Common, But We’re Not Talking About It
If you think there isn’t enough said about postpartum depression, just wait until you’re searching for information and answers about antenatal depression.
Antenatal depression occurs in pregnancy and can happen at any time during the 40 week gestation period. The symptoms – like insomnia, lack of appetite, anxiety, restlessness, loss of interest and feelings of total overwhelm – are the same as postpartum depression.
For many women who experience antenatal depression talking about it and trying to find help can be very difficult. Pregnancy, like new motherhood, is supposed to be a joyful time. It’s filled with anticipation, excitement and preparation in advance of the new little person that you’re about to bring into the world.
If you’re feeling anything but happy, even if your pregnancy isn’t smooth sailing, it’s often looked at as if there’s something wrong with you. After all you don’t have to look after your baby yet – so why would you be depressed?
Physical Changes & Shifting Hormones
Consider just the physical changes that women’s bodies go through during pregnancy and those alone may be enough to trigger depression in some, but there is also a dramatic shift in hormones that can lead to changes in mood.
Levels of progesterone begin to increase during the latter half of a woman’s menstrual cycle in preparation for a possible pregnancy. These levels then continue to increase as the egg implants itself in the uterus and the pregnancy progresses.
Research shows that progesterone can increase feelings of depression, irritability, and anxiety. It can also lead to sleeplessness, stress and that chippy feeling you get where you want to bite someone’s head off.
Progesterone levels drop off sharply immediately following labor and delivery. Again, these shifts can have a significant impact on mood, mental health and brain function. If a woman is particularly hormone sensitive or has a history of PMS or PMDD, this can strap you in for a particularity rough ride.
Understanding the Risk Factors
With a history of depression and anxiety I was a prime candidate for antenatal depression, but I didn’t know this at the time. When my pregnancy was first confirmed, naturally I was overwhelmed and quickly became anxious – like many of us do – as I started to process what it meant.
Initially, I worried about the viability of the pregnancy and Googled all the possible ways that something, anything could go wrong. I read up on possible genetic conditions, worried about Autism and wondered if I was at risk for miscarriage.
All that changed when I saw my son bouncing around my uterus at our 12 week ultrasound. Seeing him on that tiny screen erased all my ‘what-ifs’ and catastrophic thinking, and I went on with what was a relatively uneventful pregnancy.
I assumed that everything would be okay and I had nothing to worry about, but that changed around week 34 of my pregnancy. My husband and I had started prenatal classes a few weeks earlier and I found my anxiety increasing after attending each class. The reality of labor and delivery and the uncertainty of what my experience would be like quickly became the subject of my nightmares.
Late one night as I was struggling to find a comfortable position in bed, I had my first of many panic attacks as I contemplated giving birth and then found myself unable to sleep. I began pacing my upstairs hallway, trying to calm down with the help of my husband, and this lasted for the better part of two hours.
Antenatal Depression Can Be Debilitating
Anxiety and insomnia became my constant companions. I couldn’t get any quality sleep no matter what I did. Any rest that did come felt superficial and as if I was hanging out between being awake and asleep – still aware of what was going on in my bedroom, but also experiencing strange dreams and other inputs from my subconscious.
Within days I felt completely disillusion from the lack of sleep. Despite going to see my doctor right away my symptoms weren’t taken seriously and I continued to struggle. The response I got felt patronizing and it minimized my feelings.
A follow up visit the next week was met with more compassion and understanding. I quickly broke down sobbing, trying to relay the depth of my exhaustion, panic, and fear. Then familiar feelings of hopelessness and depression were settling in, and I was absolutely terrified at the thought of trying to give birth to a baby in my condition.
My doctor was hesitant to give me any medication for either the depression or anxiety because I was ‘so close’ to end of my pregnancy. I needed a heavy dose of Xanax and a week of sleep, but instead was told to try deep breathing and to distract myself with calming music. As a result I had no choice but to take maternity leave early because I was unable to function.
The Stigma of Antenatal Depression
It was a struggle to find someone to understand what was going on with my mental health while I was pregnant. The lack of knowledge among the many medical professionals I interacted with who work exclusively with pregnant women is in retrospect, completely alarming.
Despite research that suggests approximately 15% of all pregnant women struggle with symptoms anxiety and depression enough to impact their daily function, routine screening is not part of the current standard of care. Like most, my doctor was much more interested in my weight, the size of my belly and blood sugar levels.
While these are important focusing on my physical health pushed my underlying mental illness concerns aside, preventing me from getting help. Pregnancy is hard and completely draining, and the misconception that we should be happy and shouldn’t talk about our mental health only makes it more difficult.
The only way we challenge the stigma related to antenatal depression is by talking about it – bringing it into the light and inviting others to be honest with their stories. With so many women struggling during pregnancy, we need to pay more attention to our shared lived experience for the sake of our health and that of our children.
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Shannon Hennig is the Program Director of the Maternal Mental Health Research Collaborative.