Published in Panorama
Keeping the mind healthy during pregnancy
Alia 30, and pregnant for the first time, has a sister who is being treated for schizophrenic illness for the past few years. Alia is afraid that she might develop a severe problem such as her sister s during pregnancy or following delivery. Her apprehensions may not be baseless!
If pregnancy is a time of growth, hope and happiness, it may also be a period of anxiety, fear, confusion and vulnerability for a woman, who, perhaps, for the first time in her adult life, feels incredibly fragile, despondent and dependent. For many women, the first and last trimester of pregnancy may well be particularly trying. 66% of pregnant women are depressed during these periods of pregnancy and at least 10% of them are severely depressed. But these things are many times overlooked because it is all simply considered a part and parcel of the pregnancy as the lady is anyway going through a lot of changes and consequent stress. Though others may offer some sympathy, it is only the woman herself who feels what she's actually going through and therefore, her problems need to be addressed with care," reveals Dr.Sanjay Khanna, Psychiatrist, Zulekha Hospital, Sharjah.
Pregnancy is in itself a stressful period since it is associated with physical, physiological, emotional and hormonal changes in the woman. While many women are able to cope with pregnancy through support from family, friends, prenatal classes, and routine medical care, emotional disturbances, mood swings, fatigue, lethargy, irritability, frustration, feeling lonely and trapped, disturbed sleep and appetite, decreased energy and sexual interest, tearfulness, lack of motivation, anxiety bouts, may be frequently seen in pregnant women, says Dr.Khanna.
"However, you may observe these features even in a non-depressed woman, because pregnancy in itself is a very stressful period. But if the patient is severely depressed and has feelings of guilt all the time, feels a sense of hopelessness and worthlessness about her and has suicidal ideations, it is cause for alarm and requires prompt attention and action."
Lack of emotional support from spouse and family, relational problems with partner, in-laws and others, unplanned, unwanted or ill-timed pregnancies, stressful socio-economic conditions of the family, previous depressive or psychiatric disorders, especially during previous pregnancies, genetic inheritance with a family history of depression during pregnancy, hormonal changes during pregnancy, stress factors in the environment, are some of the risk factors that make women susceptible to distress and depression during pregnancy, explains Dr.Khanna.
Working women may not relish being on maternity leave, doing nothing; alternatively, some women may be too watchful of their cosmetic looks, body shape, weight and changes that pregnancy brings on and may fear rejection by the partner. These are all again stress-inducing factors which a pregnant woman may well do without!
In fact, in some women you may even see psychotic features, which may not be related directly to the pregnancy; the woman may have been suffering from some psychotic problem prior to pregnancy, which may now be precipitated during the pregnancy. These women exhibit abnormal talk, behaviour, mood disorders and schizophrenic symptoms. For instance, Alia's risk of a psychotic episode during pregnancy is possibly higher than in the general population since her sister suffers from a schizophrenic illness, says Dr.Khanna.
What are the typical symptoms of depression in a pregnant woman predisposed to the problem? The symptoms of clinical depression can be both physical and emotional, explains Dr.Khanna. "While individual women may manifest them in different ways, most prominent symptoms include feelings of anger, despair, melancholy, sadness, weeping for no reason, suicidal thoughts, irrational thoughts especially about the baby, excessive worry about her own health and that of the baby, undesirable thoughts about the future, constant fatigue, guilty ramblings, obsessive behaviour particularly with respect to eating, feeling of numbness, panic attacks with shortness of breath and palpitation and dryness of mouth."
Why is it important to treat depression during pregnancy? While untreated depression would not allow a woman to enjoy the joys of pregnancy, it may also hamper early bonding with the baby which may have long term relational consequences for the mother and child, says Dr.Khanna.
Besides, depression may lead to neglect of the self during pregnancy, indifference to healthy eating, sleeping, exercise and resorting to undesirable habits as indulging in alcohol, et al, all of which would harm the growing fetus. And suicidal tendencies is a cause for concern in itself, concludes Dr.Khanna.
What is the course of action once a pregnant woman is diagnosed as depressed? Dr.Khanna explains, "Most of the times we would prefer a short-term psycho therapy, especially to treat depression and deal with the patient's grief, inter-personal disputes, deficits and the like. Psychiatric counseling is almost always the first choice of action. But if the symptoms are severe enough and are not being controlled by the counseling, we will then have to go for medication."
But how safe is medication during pregnancy? Dr.Khanna elucidates, "Most of the drugs are relatively contra-indicated during pregnancy. However, as per FDA classification of drugs which are categories as A, B, C, D and X, category A are the safest drugs and X are the contra-indicated ones. But most of the anti-psychotic and anti-depressant drugs fall under category C. This category implies that human studies are lacking, but for which the risks cannot be ruled out. So, we have to consider the severity of the psychiatric problem in the pregnant woman, her past psychiatric history, her current symptoms, her attitude towards the psychiatric medication and what will happen if we will discontinue or do not give her the drug, the extent of risk of the fetal exposure. For instance, we will measure the risks versus the benefits to the fetus of giving the drug to the mother: if we give the drug, how much of the drug will the fetus be exposed to and what will happen to it as a consequence of this exposure. On the other hand, how will the fetus be affected if we leave the mother's psychiatric problem untreated. This is a tricky situation and as I said earlier, the ideal situation would be to catch the problem early and treat it with counseling."
Does nutrition have any role to play in this framework of things? "Most certainly," opines Dr.Khanna. "Nutrition has a great role because vitamins and minerals like calcium, magnesium, iron etc, have to be given in adequate quantities so as not to cause anaemia and associated problems in the pregnant women. In fact, many times, being anaemic alone may be a major cause of depression, lethargy and irritable behaviour in the women. Therefore, healthy and nutritious diet may prevent the problems from setting in, in the first instance in several cases."
In addition to psycho-therapy, good nutrition and possibly medication where absolutely necessary, creating a supportive environment for the mother-to-be is imperative in the treatment, in fact in the prevention of the problem itself, emphasizes Dr.Khanna.