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General Practice 2023

Depress&activity in Pregnancy: how to identify symptoms and treatment

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Depress&activity in Pregnancy: how to identify symptoms and treatment
Depress&activity in Pregnancy: how to identify symptoms and treatment
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Depression in pregnancy is characterized by mood swings, anxiety and sadness, which can result in a lack of interest in pregnancy and have consequences for the baby. This situation can happen due to the common hormonal variations that occur during pregnancy or be the result of the fear of being a mother for the first time, for example. Teenagers are more likely to suffer from depression during pregnancy, especially if you have had an anxiety or depression crisis before.

The diagnosis of depression in pregnancy is made by the doctor from the observation of the signs and symptoms presented by the woman. From the moment the diagnosis is made, it is possible to start the treatment that is often done through psychotherapy.

Can depression affect the baby?

Depression in pregnancy, when not identified and treated, can have consequences for the baby. This is because depressed mothers have greater hormonal changes, less care with food and he alth, in addition to interacting little with the baby in formation, which impairs fetal development and increases the chances of premature birth and low birth weight babies.

In addition, women with depression in the last trimester of pregnancy have a greater need for epidurals, delivery with forceps, and newborns have a greater need for hospitalization in neonatology.

It was also verified, in a study carried out by the Institute of Psychiatry and Neuroscience of a University in London, that the babies of women who had depression during pregnancy had higher levels of circulating cortisol, which is the hormone related to stress, and who were more hyperactive and reactive to sound, light and cold than the babies of women who did not experience any psychological changes during pregnancy.

Symptoms of depression in pregnancy

Mood swings during pregnancy are normal, as they result from changes in hormone levels that a woman undergoes at this stage. However, if these variations persist for weeks or months, the woman should talk to her obstetrician to assess the situation and see if she may be depressed.

To characterize depression, it is necessary to present at least 5 of the following symptoms:

  • Sadness most days;
  • Anxiety;
  • Crying crises;
  • Loss of interest in daily activities;
  • Irritability;
  • Agitation or sluggishness almost every day;
  • Fatigue or loss of energy every day or most of the time;
  • Sleep disorders such as insomnia or excessive sleepiness, practically every day;
  • Excessive or lack of appetite;
  • Lack of concentration and indecision practically every day;
  • Feelings of guilt or worthlessness most of the time;
  • Thoughts of death or suicide, with or without a suicide attempt.

Often, depression in pregnancy leads to absence from work, as the woman is unable to perform daily activities and gets tired easily. Symptoms usually appear in the first or last trimester of pregnancy and the first month after the baby is born.

How is the treatment

Treatment for depression during pregnancy varies according to the number of symptoms presented and the presence or absence of signs of severity. Thus, when the woman presents between 5 and 6 symptoms, the recommended treatment is psychotherapy, which improves the quality of life and increases the women's self-confidence. Alternative therapies, such as acupuncture, are also indicated to treat depression.Physical activity, he althy eating and family support are other indispensable ways to treat depression in pregnancy.

In case a woman has between 7 and 9 symptoms, the use of medication is recommended, however there is no antidepressant medication that is indicated for pregnant women and that is totally safe. Therefore, before starting the medication, the doctor needs to evaluate the risk and benefit that can be provided by the medication. In addition, it is not advisable to take natural remedies because they can harm the baby, including St. John's wort, normally used against depression, is contraindicated at this stage.

Although the obstetrician monitors every pregnancy, the psychiatrist is not expendable, being the most suitable doctor to accompany the woman during pregnancy as well.

When to use antidepressants

The use of antidepressants is only recommended by the doctor after the first 12 weeks of pregnancy and when the woman has 7 to 9 symptoms of depression, however the use of this medication should only be done if it is verified that there are no risks for the baby.That's because some antidepressants can result in malformation of the fetus, increase the risk of premature birth and hinder the normal growth of the baby.

Thus, to reduce the risk of changes caused by the use of antidepressants, it is usually recommended that women who have never used this type of medication, make use of selective serotonin reuptake inhibitor antidepressants, such as sertraline, fluoxetine or citalopram, as they are considered safer during this period.

Although they are considered safe, some studies indicate that the use of these antidepressants in the last trimester of pregnancy can result in some neonatal changes such as agitation, irritability, changes in eating and sleep, hypoglycemia and respiratory distress, for example, however, these changes are reported to last a few weeks and have no impact on the baby's long-term development.

What can cause

Situations such as lack of emotional support, comfort, affection, and assistance can trigger depression in women during pregnancy. Other factors that also contribute to the development of depression at this stage of life are:

  • The woman has had depression before becoming pregnant or any other psychiatric disorder such as anxiety attacks, for example;
  • Previous complicated pregnancy, previous miscarriage or loss of a child;
  • Not being married, not having financial security, being separated or not having planned the pregnancy.

Stressful issues such as fights with a partner, history of separation or divorce, serious he alth problems, kidnapping, history of fire or catastrophe, death of a close person, assault, sexual abuse, physical aggression are factors that can also trigger depression, but it can also develop in people who have not been exposed to these situations.

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