Treatment of antenatal depression
If you are experiencing mild to moderate depression during pregnancy, emotional and practical help and support can be helpful to help you manage from day to day, whilst psychological treatment can be helpful for the treatment of antenatal depression.
There are two specific types of psychological therapy that have been proven to be effective for depression.
Cognitive behaviour therapy (CBT)
Cognitive behaviour therapy can help you to identify the negative thinking that is likely to be affecting your mood (feelings) and behaviour.
When a person is depressed, they see life in a negative way – as it reflects the way that they are generally feeling about themselves and/or life in general. The cognitive aspect of this treatment is, therefore, about helping you to identify this negative thinking style, and begin to challenge your negative thoughts by looking at the evidence for them and rationalising them. For example, a person with antenatal depression may perceive that they will not be a good mother. They may lack confidence in their ability to cope and worry that others may consider them inadequate. However, when challenging these thoughts or beliefs, you can begin to see that they are not really founded or logical.
The behavioural aspect of this treatment for depression may involve doing things that you have avoided or are no longer doing. As mentioned, when depressed, a person often doesn’t gain interest or pleasure out of things that they used to do, and so often stop doing these things – which takes even more pleasure out of life, can make you feel more isolated and robs you of the feeling of satisfaction when you achieve something. Therefore, often treatment also involves setting yourself small goals and, although they may seem hard to do at first, as you recover, these will become easier and give you the opportunity to experience pleasure again – thus playing an important role in your recovery.
Interpersonal Psychotherapy (IPT)
As depression may be associated with past losses and/or changes, this type of therapy can assist you to resolve these losses, changes or manage conflicts which may be contributing to your experience of depression.
If your depression is more severe, however, and you are finding it difficult to get through the day and even small things seem too hard, it might be time to consider medical treatment for your depression.
Antidepressant medications are most commonly used for the treatment of depression. There are antidepressants that are safe to use during pregnancy, as they are not associated with any birth defects. Unlike the earlier antidepressants, the medications that are available now are not only safe, but also effective and not addictive.
Antidepressants can ultimately help you to manage the symptoms so that you can put what energy and resources you have into recovery and getting back to yourself.
The fog in your head clears (with medication) and you can think straight, and so you can then make decisions.
Taking antidepressants can also help protect against potential negative impacts of depression on your developing baby. It is vital that you discuss the role of medication in your treatment for depression with your health professional, so that together you can assess the best course of action for you.
The National Perinatal Mental Health Guideline identifies two types of antidepressant medication that can be used in pregnancy, namely selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs). If you are prescribed one of these medications, be aware that it can take up to three weeks to have an effect and you may experience some side-effects.
Sometimes you may need to try more than one antidepressant to find one that is right for you with the least amount of side-effects. Once settled on a medication, it is likely that you will need to keep taking them for at least six months and up to 24 months. This length of time may increase if you have had several other bouts of depression in the past.
Once on an antidepressant, it is important that you do not stop taking them suddenly, even if you are feeling better. Coming off medication should be a carefully planned process and discussed with your GP or psychiatrist.
Whilst you may initially have concerns about taking antidepressant medication, it’s important to consider the risks and benefits of medication for you personally, including the impact that depression is currently having on your ability to function from day to day.
With advice from many and varied medical professionals, I chose to stay on my medication throughout my second pregnancy with my daughter, and remained on them up until a year over her birth. This decision was based on the simple equation of benefits outweighing risks. I resisted any kinds of social pressures to go off them until I knew, in my heart of hearts, I was well and truly ready.
Medication can help get you to a place that you can then develop strategies to get on top of depression, through the described psychological treatments. Trying to engage in these therapies with severe depression is likely to be too difficult, as severe depression can be so debilitating. Thus, medication is recommended as the first step, followed by psychological treatments, to the road to recovery.
Electroconvulsive therapy (ECT)
This type of treatment is only used in pregnancy for the treatment of severe depression when other treatments are not having any effect and the risk of not treating symptoms (such as suicidal thoughts) outweighs the risk of the treatment itself.
As this is a very specialist treatment, it can only be prescribed by a perinatal psychiatrist who generally performs the treatment alongside your obstetrician and a specialist obstetric anaesthetist. Together, the specialist team will work to ensure the close monitoring of you and your unborn baby. The risks to the woman and baby from the treatment are low and, in many cases, is a life-saving treatment for women with severe depression in pregnancy.