According to the World Health Organisation as many as one in five new mothers will experience depression just before or after giving birth.
And while it was previously thought that psychiatric medication was harmful to the unborn child, there is growing scientific evidence of the safety of antidepressants in pregnancy and that stopping medication may in fact cause more harm to both mother and baby.
“The risks posed to a fetus from antidepressants are consistently overestimated, while the risks of untreated depression are consistently underestimated because of the pervasive stigma against mental illness,” warns specialist psychiatrist Dr Bavi Vythilingum and member of the South African Society of Psychiatrists (SASOP).
The Real Risks
The sad reality is that depression in pregnancy is often undiagnosed, because the focus is primarily on the physical health of mother and baby but left untreated depression can lead to premature labour, low birthweights and developmental delays.
The World Health Organisation notes that postnatal mental illness, which mainly occurs as depression and anxiety, is second only to malnutrition as the biggest risk factor for poor development in newborns and young children which in turn impacts on their own mental and physical health, intellectual abilities and future potential.
Dr Vythilingum says life changes around pregnancy make women more vulnerable to mental illness, and women who have been diagnosed with depression before or during pregnancy are at higher risk of developing postnatal depression.
“Depression and anxiety cause significant suffering and disability – leading to a higher risk of substance abuse and suicide, hampering the mother’s ability to bond with and care for her child, and disrupting family and partner relationships,” she explains.
A Major Public Health Challenge
Maternal mental health is considered a major public health challenge both locally and globally.
South Africa’s national Health Department has maternal and child health as one of its key priorities for the health of the nation, while reducing maternal and infant mortality leads the targets of the United Nations Sustainable Development Goal 3 to ‘ensure healthy lives and promote well-being for all, at all ages’.
Dr Vythilingum says virtually all women can develop mental disorders during pregnancy and in the first year after delivery, but pre-existing mental illness, alcohol or substance abuse, a lack of social support, poverty and unwanted pregnancies put them at greater risk, along with exposure to extreme stress or domestic, sexual or gender-based violence.
She notes that pregnant women or new mothers experiencing symptoms of depression – including sleeping difficulties, feelings of inadequacy, helplessness or panic, lack of motivation, or feeling like crying for no reason – should consult their doctor, obstetrician or psychiatrist to develop an individual treatment plan.
“While these are all common symptoms of depression, women and their partners should also look out for feelings of detachment from the baby, feeling like she doesn’t love the child as she should, and thoughts of harming herself or the baby,”she adds.
Turning to treatment, Dr Vythilingum notes that psychotherapy is always the first line of treatment, along with mobilising family support, especially by the father or significant partner, and community resources such as antenatal and baby clinics.
Medication such as antidepressants could be prescribed, depending on the nature and severity of the condition, and after weighing up the risks and benefits of medication for both mother and baby.
“Clinicians should weigh the growing evidence of detrimental and prolonged effects in children due to untreated antenatal depression and depressive symptoms during pregnancy against the known and emerging studies on the safety of in-utero exposure to antidepressants,” she says.
Dr Vythilingum advises women who fall pregnant while taking antidepressants not to stop taking the medication, but rather to consult with their doctor or psychiatrist, to determine whether the specific medication should be continued, changed or stopped.
She adds that the SSRI (selective serotonin reuptake inhibitors) class of antidepressants are the most well-researched and safest for use in pregnancy at relatively low risk to the unborn baby, but stresses that any decisions on medication should be made in consultation with the patient’s psychiatrist and obstetrician.