The Low Down - Antenatal Depression.

Nikki C is wearing the 'Casual Tank' in lavender and the 'Classic Maternity Leggings - Full Length' in black.

Postnatal depression (PND) is something most of us have heard about, if not experienced for ourselves. I suffered from both PND and postnatal anxiety (PNA) after the birth of my first son and battled for about 10 weeks before coming right. 

PND/PNA was absolute hell and I wouldn’t wish either on my worst enemy.

Despite having experienced these conditions, it recently dawned on me that I knew very little about antenatal depression (depression whilst pregnant). In fact not a lot of us do know much about it. As a society we’re only now starting to give PND the spotlight it needs, but we still have a way to go in regards to antenatal depression.

I came to learn about the mental illness when my friend emailed saying she’d been diagnosed. I immediately wanted to know more, because even though it’s something I hadn’t experienced personally, I could definitely sympathise. I wanted to write about it on this Cadenshae platform to raise awareness, and to give hope to any pregnant woman who may be reading this, and not quite feeling herself…

Kristy Paterson lives in New South Wales with her lovely husband Mike and their two daughters, Audrey (4) and Georgia (nine months). Kristy and I had our first babies around five months apart, and subsequently, we both suffered from PND and PNA. I remember when I was at my lowest speaking with Kristy and being so grateful to her as she really understood my pain...she got it. She made me feel I wasn’t alone, and I wasn’t crazy. She gave me hope as she was coming out the other side...just as I was going in.

“My PND/PNA with Audrey was all the feelings...I felt stuck under a dark cloud. I was on autopilot, numb and so full of fear,” says Kristy.

“The more I struggled to connect and feel the 'overwhelming joy' I’d heard so much about, the more I panicked I was doing it wrong, or that I was broken.”

“It got to the point where I couldn't think straight when Audrey cried. I would cry, tremble and shake, or I’d get so frustrated and angry. I felt anxious all the time, and about everything...”

Kristy eventually went to a psychologist, and after some time, she finally found the joy in motherhood she had been so desperately craving. In fact, Kristy loved being a mum so much she and Mike decided to buckle up again just a few years later! The couple had another successful round of in vitro fertilization (IVF. Audrey was also conceived via IVF) - Kristy was pregnant again.

“My antenatal depression with Georgia started as a feeling of resentment that this 'parasite' (OBGYN's words not mine) was making me so dreadfully sick. It then turned into anxiety and panic when I started to get overwhelmed thinking of how I would manage to give Audrey all the love and attention I had always given her with a newborn here too.”

“I would then feel so desperately guilty that I had these thoughts, especially because we did IVF and so ‘how dare’ I feel anything but joy and pure happiness. I think that's how it started with Audrey too...I felt like because we had conceived through IVF I should love every second of being a mum...but I just didn't.”

Kristy with her two beautiful daughters, Georgia and Audrey.

It’s estimated between 10-20% of women develop some type of pregnancy related mood disorder, and according to recent studies, 1 in 20 women will experience major depressive disorder (MDD) during pregnancy. If a woman has suffered from any type of anxiety or depression previously, she is at a higher risk (as was the case with Kristy), and unfortunately to boot, a woman who experiences antenatal depression is more likely to suffer from PND or PNA if she hasn’t recovered before her baby is born.

Antenatal depression can be hard to diagnose as some of the symptoms occur naturally in pregnancy anyway, with many women thinking it’s just ‘part of the process.’ For example, pregnant women and those with antenatal depression will both be tired, experience some insomnia and gain weight...so it’s easy to see how just ‘being pregnant’ can mask some of the symptoms.

Registered Psychotherapist Susan Goldstiver from the Postnatal Distress Centre says women who’re experiencing antenatal depression will exhibit some, or all of the following symptoms:

• Sleep disturbance.
• Anxiety - worrying a lot, feeling a sense of panic.
• Low mood - tearful or feeling sad.
• Loss of interest in previously enjoyed activities, including sex.
• Appetite changes.
• Negative and/or obsessive thoughts.
• Irritability, grumpiness, rage.
• Sensitivity to noise.
• Memory problems and loss of concentration.
• Exhaustion, fatigue and no motivation.
• Inability to make decisions and feeling overwhelmed.
• Body aches, pains and headaches - e.g. feels like you have the flu.
• Excessive feelings of guilt and inadequacy and feelings of shame - wanting to isolate and withdraw.
• Loss of confidence and self-esteem, fear of being alone.
• Scary thoughts of harming her baby, or her older children.
• Suicidal thoughts.

“Just like with my PND/PNA, antenatal depression affected my moods, my sleep, my concentration and my relationships,” says Kristy.

“I questioned everything I’d say and do. I would constantly worry that I had said something to offend someone. I would cancel appointments, catch ups and call in sick to work.”

“Antenatal depression affected my parenting and my marriage, which made me spiral more. The feelings and thoughts were similar to my previous experiences, but they were just before the birth this time, not after.”

The treatment of antenatal depression is the same as any other type of low mood disorder, and fortunately the recovery rates are much higher than that of postnatal depression. 

Between 80-90% of pregnant women are helped by antidepressants, therapy, or a combination of both. Exercise, a diet full of omega-3s and sufficient exposure to sunlight (vitamin D) can also play a part in the recovery process.

“Depending on whether the symptoms of antenatal depression are mild, moderate or severe - psychotherapy on its own can treat it, or if it’s extreme, a combination of medication and therapy is recommended,” says Susan Goldstiver.

If a woman opts for medication, doctors will generally select serotonin reuptake inhibitors (SSRIs - i.e. Citalopram (Celexa), Escitalopram (Lexapro), Fluoxetine (Prozac), Paroxetine (Paxil, Pexeva) or Sertraline (Zoloft)) as studies conducted in both the UK and the US have found SSRIs are generally safe for pregnant women and nursing mothers. 

There’s currently no evidence that antidepressant drugs have long-term harmful effects on a child when taken during pregnancy. However, there is a chance of drug withdrawal reactions in newborns that may include jitteriness or irritability. In rare cases, there’s a risk of seizures.

Many women choose not to take the medications, despite evidence suggesting there’s little risk to their child. In those cases, women will speak to a professional if they’re able, while others swear by alternative therapies such as acupuncture and massage therapy.

Ms. Goldstiver says when assessing what treatment to choose, it should be noted that not treating the condition appropriately will cause more harm in the long run.

“I think when considering medications, it’s a case of cost benefit analysis - I believe that a mother's mental health is critical and needs to be prioritised.”

“Getting advice on medication from an expert doctor in maternal mental health can be reassuring. This may be a private psychiatrist, or accessing maternal mental health, or your GP.”

Goldstiver says just like PND, antenatal depression is something that doesn’t discriminate and happens TO a person, it’s not something they’ve brought upon themselves.

“Antenatal depression is not a character flaw. There may be no one real reason a woman experiences antenatal depression or PND.”

“No woman should ever feel embarrassed or ashamed to have antenatal depression. It's an unfortunate thing that happens to some and should be treated just like any other medical issue. There should be no taboo associated with the condition.”

“With the right support and treatment she will make it through,” says Goldstiver.

As for Kristy, unfortunately she hadn’t fully recovered from her antenatal depression when she gave birth to Georgia and her antenatal depression morphed into PND and PNA...again.

Kristy received the hat-trick...of the worst kind.

“My anxiety just flowed on once I’d had Georgia. How can I love both? What if Audrey stops being amazing because of the newborn?”

It’s not all bad news though, at around eight months postpartum Kristy IS starting to feel better. In order to combat the depression she’s speaking to a counsellor, exercising and meditating. 

“The anxiety is still there but it’s about different things. Not so much about parenting, and I am better...it will just take a little more time.”

When asked what Kristy would say to those women who are currently experiencing antenatal depression, she recommends talking.

“I tell all mums to talk! Talk about what they’re thinking and feeling. They don’t have to love being pregnant and they don’t have to love every moment of the newborn stage either!”

“We’re allowed to have multiple feelings about pregnancy and mothering.”

“We’re allowed to be worried and overwhelmed and feel like !@#$!”

“We’re allowed to love it one minute and hate it the next, it’s all normal.”

“Acknowledge your depression or anxiety...don’t ignore it...acknowledge it and then it has less power over you,” says Kristy.

If you’re pregnant and experiencing any of the symptoms mentioned, get in touch with your healthcare professional immediately for an assessment and advice. You can also self-refer to a therapist or counsellor if you suspect you have antenatal depression.

If you’re concerned about someone you know, discuss the possibility of antenatal depression with them and encourage them to seek help in your local area.

Thank you to Kristy Paterson for her vulnerability and insight.

Written by Ellen Chisholm in conjunction with Susan Goldstiver and Kristy Paterson.

If you're concerned about yourself, or someone close to you, please visit the PADA New Zealand website. Perinatal Anxiety and Depression Aotearoa can help you find the best support systems in your local area.