Shama, 27 years old, started feeling low and irritable during the fifth month of her pregnancy. Her doctor had informed her that her pregnancy was progressing well. So, she attributed her mood change to the fact that her husband had long working hours and was away most of the time.
Gradually these difficulties worsened - she started feeling tired and would get up later in the morning hoping that rest would help her to feel better. She visited her gynecologist who examined her and informed her that physically all was fine. She was reassured, but the change in mood and fatigue persisted.
Over the next few weeks, she started neglecting self-care and food intake saying that she had lost all her interest in activities and had no appetite. This got her husband worried and he took leave to be with her. Following this, he was at home most of the time, but they got into frequent arguments over trivial matters. Realizing that there was a marked change in Shama’s behavior and mood, the couple again went back to the gynecologist. This time the doctor arranged for a psychiatry consultation.
The psychiatrist examined Shama and made a diagnosis of Depressive Disorder. He explained how Depression can affect pregnancy.
The perinatal period, he told them, is the period from conception to one year after the birth of the baby. Women are at higher risk for mental health disorders during this period. The perinatal period is a critical period for everyone - the mother, baby and the rest of the family. Mental health disorders in this period can result in prolonged negative effects on everyone.
The mother can develop negative views about motherhood and this can affect how she looks after herself during pregnancy and the baby later. She can also feel negative about herself as mother – a loss of confidence in managing the baby and her life in general. She may start feeling her baby’s behavior as difficult and react accordingly. She may not recognize the baby’s cues and respond appropriately – this can compromise the baby’s development.
The doctor described that it has been observed that depressed women often breastfeed for a shorter period of time. They are also more likely to use alcohol, cigarettes or other substances.
Depression before delivery increases a risk for depression after delivery. There is also an increased risk of future episodes of depression and other mental health disorders.
The psychiatrist mentioned how babies born the mothers who are depressed are quicker to cry and cry longer and louder. These babies spend less time in the ‘quiet and alert’ state when they learn more about the environment. These babies often walk and talk later than babies born to mothers who were not depressed. Research has shown that babies of depressed mothers have more difficulty having social relationships and are socially withdrawn.
The doctor then told that depression in mothers during pregnancy also has an impact on other family members. Often relationships are disrupted. Partners are also known to get depressed. A depressed partner can also have an impact on the mother and the baby. Similar issues can be seen in other family members also.
After educating them about Depression in pregnancy he advised them regarding treatment options – Psychological Treatments, Medications or both. The couple preferred psychological treatment and the doctor referred them to a clinical psychologist. The psychologist started Cognitive Behavior Therapy (CBT). Shama found it very helpful and there was significant improvement initially, but the depression gradually worsened and the couple discussed the option of starting medications with the doctor. Following this, Shama requested the doctor to add antidepressants.
Subsequent to starting antidepressants, there was significant improvement and this persisted in the phase following delivery also.
To conclude, early diagnosis and management of prenatal mental disorders can lead to significant benefit for the mother, her baby and her family.
Please note that the information in this case study should not be considered as medical advice for an individual’s condition. If anyone shows or feel symptoms of a possible medical condition, we strongly encourage you to seek advice from your primary physician or a mental health professional for an evaluation as soon as possible.
The names been changed to protect the privacy of individuals.