"During my first pregnancy, I remember one day thinking that I should just drive into the car in front of me."
Eight years ago Samantha* (32) from Cape Town, mother of two, thought she just had the ‘baby blues’ after her son was born – but her mother, who had suffered from postnatal depression when Sam was born, could see that something was not right.
“She kept saying that I was crying excessively, but I didn’t take much notice. The midwife at my gynae’s practice said I just had cabin fever and should get out of the house. So my mom took me shopping to get new bras. While I was leaning down to put my wallet in the pram I took too long and a woman purposefully rammed her trolley into my back. I just sat down on the floor at the till. That’s when my mom and husband frogmarched me to the doctor.”
“I told my doc, who is lovely and I know well, that my mother had insisted I see her but there was nothing wrong. She asked if I was falling back to sleep again after feeding my son. I realised that I
wasn’t and was sitting up all night. Then she asked how I had felt in my pregnancy, and it all came out.”
What is perinatal depression?
Perinatal depression is more than the baby blues, and should not be confused with postnatal depression, which can manifest after baby arrives. It’s a clinical condition that sets in during pregnancy and encompasses a wide range of mental health issues.
As Samantha points out, perinatal depression can be hard to diagnose: “I had been telling my gynae about my excessive emotional responses at every appointment, but he said it was normal to be a bit weepy and feel down during pregnancy. I had also vomited excessively throughout my first trimester.”
Scientists are still uncertain about what actually causes perinatal depression, and many studies have tried to establish a link between the upswing of hormones produced during pregnancy and the chemical imbalances that generally trigger depression.
Some of the biological factors are a personal or family history of depression, anxiety or panic attacks or another mental health disorder. Women who suffer from aggravated premenstrual mood syndrome (PMS) or have experienced symptoms of depression when using certain hormonal contraceptives are also susceptible.
But those who are the most at risk are mothers who were diagnosed with depression or postnatal depression during a previous pregnancy or after the birth of a child.
The Perinatal Mental Health Project (PMHP) is the only project of its kind in South Africa and one of only a handful in the developing world. Based at the University of Cape Town and recognised by the World Health Organization, the project is helping the Department of Health to integrate mental health care with maternity services.
“Motherhood can be a wonderful experience. When poor women are denied this because of mental ill-health, I feel this is an infringement on a very basic human right,” says Dr Simone Honikman, director at the PMHP.
The project has startling statistics on the prevalence of perinatal depression in our country: One in three women in poverty in SA will suffer from some form of mental health problem during pregnancy. Most recent evidence shows that this statistic is closer to one in two.
Some of the key factors that increase a woman’s risk experiencing a mental illness during pregnancy are genderbased violence which surveys show increases during pregnancy, HIV/ Aids, teenage pregnancy (which carries an increased risk of maternal suicide), refugee status, and substance abuse.
I’ve been diagnosed- Now what?
The most commonly prescribed treatment of perinatal depression is counselling, which is sometimes combined with an antidepressant. “Counselling offers distressed women an opportunity and a safe space to tell their stories without fear of being blamed or judged. In a time of crisis, counselling gives women the opportunity to contain their distress, highlight their priorities and identify possible resources.
This support empowers women to take the lead in managing their own problems in the future,” says Dr Honikman.
Which antidepressants are safe?
A very pertinent question is: what about taking antidepressants during pregnancy; are they safe for baby?
The PMHP says that while almost no medication is 100 percent safe in pregnancy, the risks to the baby of untreated mental disorders are greater than the potential risks of the commonly used medications.
If you were already on antidepressants when you fell pregnant, don’t abruptly stop taking them for fear of harming the foetus. Remember that what circulates through your blood, also circulates through your baby’s – this means that both of you will experience withdrawal symptoms if you aren’t properly weaned off them. Going off your meds could also trigger a relapse.
Rather make an appointment with your GP, gynaecologist or psychiatrist to discuss what current medications for the treatment of depression you are taking, and if necessary, you might need
Drugs considered safe during pregnancy and breastfeeding are the family of antidepressants called the SSRIs or selective Serotonin Reuptake Inhibitors, which include Fluoxetine (Prozac), Cipramil and Zoloft. The commonly used tricyclic antidepressant, Amitryptaline, is also considered safe.
Soon after having her first baby, Samantha was prescribed medication to help treat her perinatal depression: “Initially the doctor prescribed Eglynol which is not an antidepressant, but did seem to even out my mood a bit. (Eglynol stimulates lactation and is a mild mood elevator). I was less weepy on this, but still over-sensitive and grumpy. “After about six weeks I went back to the doctor as I wasn’t feeling any better. She tested my thyroid and put me on Cilift which is the generic of Cipramil.”
The Perinatal Mental Health Project reminds pregnant women that antidepressants may take up to six weeks to have an effect and you’ll see the most benefits of these meds if they’re taken continuously for at least six to twelve months.
What about relapse?
“By ensuring adequate treatment for depression in the first pregnancy, one can significantly reduce the chances of recurrence in a subsequent pregnancy. Relapses may be able to be prevented by ensuring that vulnerable women are as mentally well as possible before they conceive,” advises the PMHP.
When Samantha’s son turned five, she and her husband were ready to try for another baby. At the time she was taking Cipralex when she fell pregnant again. “I found a lovely gynae near to where I
work who practices at a great hospital. He said I could continue on the medication and that the risk of complications from taking the meds during pregnancy was less than the risk of harm to me and baby from having depression.
I said that I could tell him at any point that I was having problems and he would make a special note on my file and keep an eye on my emotional state very closely.
“In my eighth month of pregnancy I began feeling annoyed, angry and just generally off. I told my gynae, who asked me to take an additional antidepressant pill every second day. The increase helped a lot and I stopped biting my colleagues’ heads off.
On day three after the birth of my daughter I only had a few moments of weepiness. It was such a different and joyful experience.”
Some tips to prevent a relapse of depression in pregnancy are:
- Speak to your GP or gynae about any medications or antidepressants you’re taking, and if they are safe to take during your pregnancy.
- If switching to a new antidepressant, allow six weeks for it to take effect properly. Do not stop taking your medication abruptly when you realise you are pregnant.
- Learn to know the signs of clinical depression, as well as how your own personality profile changes when you are depressed.
- Ensure that you have a support system in place, be it your partner, family, friends or a psychologist.
- Identify any other triggers from your first experience of perinatal depression (i.e. stress at work) and avoid or address them before they strike again.
Although there is a high risk of a relapse of major depression in your next pregnancy (one Cambridge study pegged it at 80 percent), you can still enjoy a happy maternity period and birth. “The second time around has been such an amazing experience that we have not gone ahead with having my tubes tied as we had planned,” says Samantha.
“Although we don’t plan on having a third baby, if we win the Lotto, we don’t want to have closed that door, so to speak!”
To get in touch with the Perinatal Mental Health Project, visit www.pmhp.za.org or call 021 689 8390. You can also follow them on Facebook and Twitter.