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Kavita Thanky, a Bengaluru-based travel and real estate consultant in her early 30s, suffered multiple miscarriages, each time in the first month of pregnancy. After several rounds with fertility experts, when she was successfully pregnant again, extreme paranoia and depression set in. She worried that she would not be able to go through the pregnancy. Thanky, who was otherwise outgoing, felt melancholic all the time—people around her could not understand why. Her gynaecologist told her she might be depressed. And even though she visited a psychologist for counselling, the depression continued into the post-partum period. It took her a long time to recover.

According to a study published in the journal Clinical Obstetrics And Gynaecology in 2014, 10-15% of women worldwide experience depressive episodes at some point during pregnancy While gestational diabetes is far less common than depression during pregnancy, women are screened routinely for the former, but not for depression, any psychiatric illness, or even stress.

Bengaluru-based independent consultant psychiatrist Ashlesha Bagadia says: “As more and more women are juggling their homes, careers and inevitably strained relationships, the incidence of emotional disturbance during the perinatal (during pregnancy and post-partum) period is on the rise, even among women with no prior history of mental illness. While the awareness of post-natal depression is improving in India, anxiety and depression during pregnancy is not talked about and is hardly even screened for, even by obstetric health services."

Worry is common during pregnancy: for instance, stressing about the change in the role of the woman (becoming a mother, putting work on hold), changes in relationships, anxiety about being a good parent, fear of problems with pregnancy or of childbirth, lack of support, and being alone is common. Pregnant women also face a host of emotions caused by hormonal swings. Bouts of crying, sadness and tiredness are common, but when these emotions become overwhelming, it can be a sign of depression or an anxiety disorder.

Rathna Isaac, a clinical psychologist at Richmond Polyclinic, Bengaluru, says: “Anxiety is more common during pregnancy, with worries about labour or caring for the child later. Symptoms range from difficulty in sleeping, loss of appetite, low mood, crying spells—more than usual. If these low moods interfere with daily tasks, in spite of reassurances, then it is a sign of depression and it is best to seek professional help."

Biological problems like a thyroid disorder, anaemia, vitamin B and D deficiencies, high blood pressure, diabetes and hereditary risk of depression or mental illness can increase the risk of depression in pregnant women. External factors, such as relationship problems, lack of social support (living in a nuclear family, migration to another town), a history of trauma or abuse, ongoing violence or abuse, work and financial stress, add to the issue.

“Anxiety during pregnancy leads to increased levels of the stress hormone (cortisol) in babies. They are more likely to have low birth weight, be born prematurely; they are more fussy, have reduced facial responses and are less alert. Mothers with untreated depression symptoms during pregnancy have a higher chance of getting post-natal depression. And the mother has a higher chance of problems in the next pregnancy, repeating the cycle all over again for the next infant," says Bagadia.

A study published in the Industrial Psychiatry Journal in 2013 found that in a tertiary care hospital in Navi Mumbai, depression during pregnancy co-related significantly with depression during the post-partum period. Prenatal depression has also been associated with shorter gestation and low birth weight, which can have adverse effects on the infant’s development.

Depression during or after pregnancy can lead to difficulties in babies bonding with the mother. It can also affect the baby in other ways, such as the baby getting distressed easily, or in long-term development outcomes, adds Bagadia.

A community-based study published in the journal JAMA Psychiatry in 2013 found that children of women who experience depression during pregnancy face an increased risk of depression as adolescents. The researchers concluded that children born to depressed mothers were, on an average, 1.5 times more likely to be depressed when they were 18.

Treatment options, of course, vary depending on the cause of depression. “For clinical depression, medicines may or may not be prescribed depending on risk factors. Psychological therapy, either individual counselling, couple counselling or online support, is highly recommended. Relationship problems, such as an abusive spouse or critical in-laws, will have to be addressed separately. Looking after health, well-being and nutrition also plays a huge role towards mental health wellness," says Isaac.

So antenatal detection of depressive symptoms and intervention before childbirth has huge importance in prevention.

Keep depression at bay

Some tips to reduce the risk

u Look after yourself; self-care, both physical and emotional, is vital even when there are no problems. Eat a healthy, balanced diet. Find some time each week to do something you enjoy—it improves your mood and helps you relax. Get adequate sleep.

u Be open-minded about options of delivery: C-section or normal; epidural or not; breastfeeding or not. Studies have shown that in the long run, especially when it comes to the baby’s emotional development, the choice doesn’t really matter; what matters is the mother’s emotional state and comfort with the choice she made.

u Be wary of family members and friends ready with critical or commanding unsolicited advice.

u Increase positive influences. Find online support or spend time with friends who are supportive, helpful and offer constructive criticism, if any.

u Exercise alone can reduce the risk of emotional disturbance by 30%. Mindfulness (focusing all your attention on one activity instead of multitasking) on a daily basis has been shown to significantly curb anxiety and depression.

u Do not try to do everything yourself. Let family and friends help you with housework, shopping, etc.

u Discuss any worries you may have with your family, your physician or a gynecologist.

Source: Ashlesha Bagadia

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