✓ Depression in pregnancy: how to recognize it, how to intervene

Fonte: Science Photo Library

For a long time, experts - and women too - have been concerned exclusively with postpartum depression in its various forms, from mild baby blues to very severe psychosis. Still, there are women who report feeling sad and depressed even during the nine months of waiting

. Recognizing that there is something wrong, and addressing the problem correctly is very important, both to help the woman - and her baby - to live her pregnancy peacefully, and to avoid the risk of any depressive forms dragging on even after childbirth.

When feeling down is normal

Let's start immediately with a reassurance: having some bad days is normal for everyone, don't think you are depressed just by feeling a little down. "During the nine months of gestation, significant changes of a physical, mental and practical nature occur that can upset the future mother, especially if it is the first experience and you do not know what to expect" says Roberta Anniverno, psychiatrist in charge of the Psyche Center. Woman at the Macedonio Melloni Hospital (Fatebenefratelli Hospital) in our city.

In fact, in just 40 weeks many things change: the body changes in various ways, one passes from the identity of a daughter to that of a mother, the couple's relationship changes, but also social relationships and working life are inevitably influenced. "Here then is that the woman may feel overwhelmed by mixed feelings, joy and happiness, but also fear, anxiety, inadequacy and uncertainty about what will happen "underlines the expert. Above all in the first weeks, moreover, there may be a psychological difficulty in becoming familiar with the new condition, especially if it is an unplanned or, a fortiori, unwanted pregnancy.

However, these moments of anxiety and worry, of a reflective or somewhat somber mood, are generally temporary and occasional conditions, very different from actual depression, to arrive at which the participation of other factors is required. "For example, a kind of individual predisposition, since Especially women who have suffered from similar problems before are most vulnerable to depression in pregnancy"says Anniverno.

The signs of depression in pregnancy

"It is often thought that a woman who is expecting must be happy and positive by definition. In fact, even in this particular moment of life, depression can occur, which is a real disease and is estimated to affect, at various levels of severity, the 10-20% of pregnant women "says Mauro Mauri, director of the UO of University Psychiatry 2 of the Pisa University Hospital and head of a research group dedicated to perinatal depression.

But what are the specific symptoms of this condition? We see:

depressed mood constant and protracted over time, which causes pessimistic, negative, worried thoughts, relating both to one's current state of health and to the planning of future life with the baby. For example, it is very common to think that the child may have malformations;
sleep disorders (sleep little or badly, or sleep too much);
appetite disturbances, from lack of appetite to excessive appetite;
sense of apathy and struggles to carry on daily activities;
negative thoughts about the ability to carry on with the pregnancy.

In reality, it is not always easy to understand that you are experiencing a depressive state, because some symptoms have vanished and can be confused with physiological manifestations of pregnancy. Lack of appetite, for example, could be attributed to the nausea typical of gestation and insomnia to the bulky belly or the need to go to the bathroom during the night.

"In any case, if these manifestations are associated with negative moods that persist for days or weeks, the first thing to do is talk about it with someone who feels close, typically one's partner (who has a fundamental support role for the woman!), and then contact a trusted doctor, who can be the family doctor, the gynecologist or simply the obstetrician of the preparatory course "suggests Anniverno. They are easy to find reference figures, who can help to understand what is happening to us and, if they deem it appropriate, advise a specialized center to contact.

How to cure depression in pregnancy

If we are dealing with depression, we cannot resort to some mild palliative: we are talking about a real disease, which as such must be treated, even in pregnancy.

"For the milder forms, a few targeted psychological interviews may also suffice"says Mauri." Not a real psychotherapy, but a kind of psychoeducation, which helps to make it clear to the woman - but also to her family, who may not be fully aware of the problem - as things actually are, and to help her organize accordingly. Often, the simple fact of talking about it, of understanding that it is a condition common to many women and for which there are no faults, is of great help ".

"For example, mothers-to-be are often afraid that their child may have malformations and tend to exaggerate this thought, but if they understand that it is a typical thought in pregnancy, they reassure themselves that they are not too anxious."

For slightly more important shapes, there are two fundamental strategies: psychotherapy, generally of a cognitive-behavioral type, and drug therapy. Depending on the case and the seriousness of the situation, they can be used individually or together.

Of course, the question arises spontaneously: but is it possible to take psychiatric drugs during pregnancy? Are there any risks for the baby? "In fact, even today there are doctors who are afraid of prescribing these specific drugs to pregnant women, but they are wrong" says Cesario Bellantuono, psychiatrist and perinatal psychopharmacologist, author of a recent volume dedicated to psychiatric drugs in pregnancy.

"Research conducted over the past decade clearly shows that some specific categories of drugs do not involve particular risks for the newborn. For example, in the first trimester of pregnancy, antidepressants such as fluoxetine, sertraline, citalopram and velafaxine they are not associated with an increased risk of fetal malformations. Intake in the second and third trimesters can sometimes be associated with the presence, in the newborn, of symptoms such as excessive crying, difficulty in sucking, tremors, sleep disturbances. In most cases, however, these symptoms are not particularly serious and tend to regress spontaneously in a few days ". So, if there is a need, there are depression medications that can actually be used in pregnancy as well.

What Happens If Pregnancy Depression Is Not Treated?

If a depressive state is diagnosed during pregnancy, it should not be neglected. Meanwhile, for live the nine months of gestation peacefully, and also the period following the birth of the child. “Our studies show that we detect and treat depression in pregnancy significantly reduces the risk of postpartum depression, with all that this condition can entail "explains psychiatrist Mauro Mauri.

But the positive effects of the treatment are more specific and also affect the progress of pregnancy and the well-being of the fetus and baby. "A depressed woman who is not treated or is treated inadequately often takes 'incorrect' behaviors, at risk for the gestation and the baby"says Bellantuono." For example, he can eat 'badly', abuse substances such as alcohol, smoke or drugs, neglect medical checks. All of this can result in an increased risk of miscarriage and preterm delivery and medical complications for the newborn. "

Not only that: recent studies suggest that children born to mothers who suffered from severe (untreated) depression during pregnancy have the more you risk experiencing depression or behavioral disturbances themselves during childhood and adolescence.