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The Trials and Tribulations of Antenatal Depression

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In an ideal world, being pregnant is the happiest of times. The knowledge that a mini-person is growing inside you evokes sheer wonder and delight, and this is enhanced by pleasant kicking sensations and precious ultrasound photographs. Partners are brought closer together in their mutual love for the bundle of cells they created, and maternity leave provides the perfect excuse to relax and take up enjoyable hobbies that one never had time for before.

So what happens if your pregnancy is characterised by feelings of worthlessness, hopelessness and a lack of interest in the baby? Or suicidal thoughts, sleep problems and an inability to think concisely? Unfortunately, this is the case for growing numbers of women who suffer from antenatal depression. The shame that surrounds such symptoms prevents women from confiding in others, provoking the Royal College of Midwives to comment that more attention needs to be paid to the disorder.

The seriousness of antenatal depression cannot be overemphasised, as a wealth of research suggests extremely negative consequences for the growing fetus. For example, studies have found that women who suffer from depression and anxiety during pregnancy are more likely to have low birth weight babies, premature births, and infants with colic and sleeping problems. This is thought to occur due to antenatal stress elevating the release of maternal glucocorticoid hormones, which cross the placenta and permanently affect the fetus' neuroendocrine system. The fetus' resulting hormonal imbalance manifests itself as poor emotional regulation and an irritable temperament.

Knowledge of these effects puts women suffering from antenatal depression under great pressure to pick themselves up and feel 'normal' again, and this may exacerbate their symptoms. A further challenge is faced as use of anti-depressant medication is strongly discouraged in pregnancy, due to its associated risks with miscarriage, preterm birth, and behavioural problems. It is a difficult dilemma: are unborn babies better off being exposed to antidepressants than the elevated stress hormones and other physiological effects of a mother's untreated depression? Or will taking antidepressants exacerbate the mother's feelings of guilt and anxiety over the potential health of her foetus?

This is problematic for those who prior to the pregnancy relied on medication to manage depression. As psychotherapy costs around £80 per session, many women see medication as their only option. So what should be done about this? One potential solution lies in the NHS, which provides free 'talking therapy' in the form of counseling or cognitive behavioural therapy (CBT). Individuals can either refer themselves or have their GP refer them for a consultation with a psychological well-being practitioner, who will offer computerised CBT, guided self-help and psychological education.

CBT works by asking patients to identify their irrational, dysfunctional thoughts and challenge them with realistic, positive ones. By changing one's thought pattern, behavioural change is expected to follow and patients are encouraged to try out new things and put an end to 'safety' behaviours, such as avoidance of situation associated with anxiety. In the case of depressed patients, self-deprecating thoughts such as 'I'm never going to be good enough' are challenged, and enjoyable activities such as exercise or socialising are encouraged.

CBT is associated with considerable success and statistics suggest that two fifths of patients suffering from depression and anxiety can recover if treated with the therapy. However, NHS expenditure on mental illness is only a mere 13% of their budget, and as a result CBT is only available free in specific areas with access to a mental health clinic. Furthermore, in such areas there is often a long waiting list for treatment. The finding by the London School of Economics which suggests that only 25% of people suffering from mental health problems are receiving treatment is hardly surprising.

Statistics show that 12% of people experience depression every year, and science suggests that antenatal depression may have disastrous consequences on the growing foetus. As anti-depressant medication is effectively a 'no-go' for pregnant women, their only option is psychological therapy. However, due to the lack of NHS investment in treating such mental health problems, those lucky enough to gain access to treatment are in the rare minority. The pressure on the NHS to put more money into psychotherapy has been mounting: with influential figures like Ed Miliband suggesting that the NHS constitution should be rewritten, with greater emphasis on mental-health problems; and several campaigns by charities like MIND. The impetus for change is there, but unfortunately action is yet to be taken.