Safe treatment options

If you develop depression in pregnancy you may think that there are few treatment options available to you. This misconception is not difficult to understand since many general practitioners will tell you to stop all medication but then not tell you what you can do instead to deal with feelings of sadness and depressed mood.

1. Alternative treatments 2. Counselling 3. Exercise for mood 4. Nutrition for mood 5. Medical treatment

Why is it important to offer real treatment options for depression experienced during pregnancy? It's only 9 months, a little over a year with breastfeeding. Why not just ride it out? I think this is what many doctors, midwives and partners do think. But it is not all that simple since a mother's depression experienced in pregnancy also has an effect on her unborn baby. Many people also forget that depression can be a fatal illness. A person who is depressed might often think about ending their life but, unless they say so out loud, people around them who are not depressed will not realise that things could go this far. The report on the Confidential Enquiries into Maternal Deaths in the United Kingdom 2000-2002, "Why Mothers Die", found that maternal suicide, associated with psychiatric illness in pregnancy or postnatally, was the leading cause of mothers' deaths around the time of having a baby. They say, "Until recently it had been thought that pregnancy and the postpartum period exerted ‘a protective effect’ on suicide and that the maternal suicide rate was lower than would be expected. [However] the last Report found that overall maternal suicide was more common than previously thought and was in fact the leading cause of maternal death." As a result recommendations were issued as to how to train health care professionals to look out for depression in pregnancy and the post natal period. Click here to read their recommendations on treatment options that should be available for every woman who is pregnant. So pregnancy depression IS known to be a big deal, although not WIDELY known.

Even though medical service provision is changing, I do feel that only a small minority of women will get access to specialist care if they actually develop depression in pregnancy, because these specialist teams are often very understaffed and underfunded. From what I see in my practice in this area, it seems that what help we do provide often turns out to be too little too late. And that is why I have created this website: to put the information about treatment options 'out there' for you to find.

So, moving on to the treatment options themselves..... Obviously, prevention is better than cure. Depression-prevention measures are dealt with on another page. However, many of the following treatment options can also be used as techniques to prevent a depression taking root in the first place.

'Alternative' treatments

There are a number of non-medical treatment options that have been shown to be effective in treating depression and which are safe in pregnancy.

ACUPUNCTURE has been demonstrated in some clinical trials to be at least as effective as antidepressants or psychotherapy in treating mild and moderate depression in women. The question is whether or not acupuncture is safe and effective in pregnancy. There is very little literature on the subject and it is not specifically related to depression in pregnancy. Acupuncture has been found to be safe and effective in pregnancy for the treatment of such things as lower back pain, insomnia and nausea. The most obvious risk is that of infection. The National Centre for Complementary and Alternative Medicine reports that "complications have resulted from inadequate sterilization of needles and from improper delivery of treatments. Practitioners should use a new set of disposable needles taken from a sealed package for each patient and should swab treatment sites with alcohol or another disinfectant before inserting needles." In short, go to a recognised practitioner!

MASSAGE therapy is also known to be effective in treating depression and is safe in pregnancy. AROMATHERAPY is safe and effective but make sure you go to a registered practitioner who knows her oils (i.e. which are safe to use in pregnancy and which are not) and preferably one who specialises in pregnancy therapy.

BREATHING EXERCISES are a safe and inexpensive way of augmenting other depression treatment options, especially when you suffer from a lot of anxiety. When you are worried you either don't breathe as deeply as you could or you 'hyperventilate' out of panic. In pregnancy you become breathless as the baby pushes your abdominal contents into your chest cavity and this can actually sometimes cause you to feel anxious. Taking the time on a daily basis to practise a few simple breathing techniques can help a great deal to alleviate these problems. Focusing on the breath also has the added benefit of focussing your thoughts (as in meditation) on something other than your worries or your low mood, which in turn helps to lift mood. If you have not got the motivation or the money to do anything else about your depression you can at least do this for a few minutes a day. You can do it anywhere and it doubles up as preparation for being in labour.

SIMPLE RELAXATION TECHNIQUES practised regularly are also helpful in treating mental discomfort. Part of depression and anxiety is the belief that we really DO need to worry and ruminate about all the things that could go wrong or are going wrong in our lives. The ruminating and worrying feeds the depression state that generated them, so it's a vicious circle. Relaxation exercises help to break that cycle and give you time out from your damaging thoughts. Don't underestimate the power of tiny things done often to beat depression. And five minutes of relaxation every day is not expensive either.

MINDFULNESS MEDITATION is another non-medicinal technique that recent research has shown to be effective in depression. It is important to say, though, that it has not been found to be helpful in moderate to severe depression as a technique on its own. This is because mindfulness meditation takes some personal motivation and a bit of commitment and, if you have been depressed or are depressed you will know that personal 'oomph' is something that one lacks in depression; it's one of the symptoms. So mindfulness meditation has been shown to be effective in accelerating recovery and in preventing relapse. I would personally highly recommend it as a technique to use in pregnancy, though, because of the high likelihood of depression relapse in pregnancy if you have had depression before.

This is by no means meant to be an exhaustive list of alternative treatment options, just a handful that the author has found evidence to support their usefulness and safety in depression as well as in pregnancy.

Counselling treatments

Both traditional INTERPERSONAL and COGNITIVE BEHAVIOURAL THERAPY have been shown in scientific studies to be effective in the treatment of depression. Severe depression is most effectively treated with antidepressant medication and, usually, only as the patient begins to get better is talking therapy suggested. But for mild to moderate depression talking therapy is accepted to be a useful adjunct to medication as well as being effective on its own as a treatment. A few studies have been done looking at the usefulness of talking therapy in pregnancy depression and it has been shown to be helpful. A limitation of counselling, when compared to antidepressant medication, seems to be that it takes longer to work i.e. longer before you would start to feel better. That is an issue to consider in pregnancy where you would want to get adequately treated as quickly as possible because of possible risks to baby. For answers to questions you may have about the safety of antidepressants as a treatment option, click here.

MINDFULNESS BASED COGNITIVE THERAPY is a relatively 'new' form of therapy which is primarily offered as group therapy. It combines the techniques of mindfulness meditation with simple cognitive behavioural therapy techniques. I mention it because it has been shown to help prevent relapse into depression in people who have had two or more depressive episodes in the past. Since having had previous episodes of depression puts you at risk of developing a depression in the course of pregancy, it might be worth investigating whether this kind of group runs in your area. Having personally participated in such a group, and having found it helpful in managing my depression and staving off a relapse, I would recommend it as a treatment option that has far-reaching benefits that extend way beyond pregnancy.

Exercise to help other treatment options

YOGA, PILATES and GENTLE AEROBIC EXERCISES such as walking, swimming and water aerobics are recommended in pregnancy and are also widely recommended to augment other treatment options in depression. This will probably not be the first place that you have read that regular exercise will benefit your mood so I am not going to labour the point but rather offer suggestions on how to make exercise easier to do.

When you are depressed you don't feel like doing anything, you don't believe that anything will help, it takes extra effort to get started doing something and you can't decide what to do. Exercise can help but it is a difficult treatment option to begin. The best way is to take away the self-motivation factor and get someone else to motivate you. Ask your partner to drive you to a class; ask a friend to arrange safe exercise that you can do together; don't weigh up the pros and cons of joining a class, just join and then get someone to help you to show up. Your depressive thoughts are the enemy of your getting better. Your mind will tell you it's not worth it so just believe ME when I tell you that a little bit of exercise will help you to feel better and more able to cope. Your mind will tell you that nobody wants to be bothered to have to help you but you couldn't be more wrong.

If you have small children already, and finding the time to do some exercise is difficult, then just do what you can. Your depressed mind will tell you that it's no use if you can't do it properly. I promise you that you will feel better after five minutes of simple stretching or a yoga video than after nothing at all. Walking your toddler in the buggy for ten minutes qualifies as exercise and is something that you could do a few times a week, rather than going everywhere in the car. If you are anything like me your mind will tell you that you can't ask other people to take your kids off your hands so that you can have time to yourself, but really you CAN and there is usually SOMEone who will help.

Nutritional supplements

EATING PROPERLY is important, both in pregnancy and in depression, although doctors will often forget to mention this as one of the useful treatment options. If you have depression in pregnancy the likelihood is that you aren't eating enough or are eating food that doesn't have great nutritional value. Once again, don't feel guilty; it's just part of the depression. You don't have the motivation to feed yourself properly and you lose your appetite, or want to eat comforting sugary food. If you can afford it see a NUTRITIONIST who can offer suggestions on how to choose the right food for pregnancy as well as eat in a way that helps you fight your depression - nutritional therapy is a treatment option too. It's all about taking the burden of the decision-making and self-motivation off your own shoulders. If your partner or a good friend can help you to prepare food, accept their help. Try to eat regular meals, even if you don't feel hungry, rather than waiting until you feel hungry before you eat. Don't diet in pregnancy; your body doesn't need that kind of stress and neither does your mind.

VITAMIN SUPPLEMENTS are important, especially if you are having difficulty eating well. If you don't feel motivated enough to research which vitamins you need or to go out and buy them then get your partner or a friend to do that for you. OMEGA 3 FISH OILS have been shown to be helpful in mental illness including pregnancy depression and they are safe in pregnancy. VITAMIN B6 is known to be effective in improving mood in depression as an adjunct to other treatment options. A good pregnancy MULTIVITAMIN with folic acid is the very least that you should take. Get your partner to buy it and give it to you if you can't manage to do that for yourself.

Medical treatment options

As mentioned in the depression prevention page, if you develop depression in pregnancy one of the things you can do is make sure you get access to the best services. Most large hospitals, these days, will have a SPECIALIST MOTHER AND INFANT MENTAL HEALTH SERVICE as a treatment option. Ask your obstetrician or general practitioner for a referral if you are feeling low in mood in your pregnancy, have had depression in the past or are on antidepressant medication at the time of falling pregnant. There are many midwifery practices that specialise in looking after women who are depressed or otherwise mentally unwell in pregnancy and they offer excellent sensitive support. It helps to be with a small midwife practice or a single midwife who will look after your care all the way through your pregnancy. This means that you can see the same person on every visit, develop a trusting relationship and thus be better supported. Find a midwife or doctor that you like and trust. Don't be shy to ask to be referred to someone else or to 'interview' until you find the right person for you. All these treatment options do a little bit to work together to help you beat pregnancy depression.

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