The question was submitted
10/02/2008
Subject: Pregnancy, depression, GAD and PND
If you have depression, anxiety, a GAD, phobias, self harm, what is the likelihood if you have a baby that you will suffer from PND? What medications need to be reviewed if you are pregnant and what do you have to do if you get PND?
Thanks
Answer from DepNet
Thank you for your very important questions. There are a number of things to consider if you have had depression, anxiety, GAD, phobias and self harm, and are planning to become pregnant.
Likelihood of getting PND
The risk of developing depression after the baby is born (post-natal means ‘after giving birth’) is affected by many, many factors and there are probably a number of forms or types of PND. So it is not possible to predict completely accurately who will, and who won’t, develop PND.
There are a number of factors known to increase or to decrease the risk. The degree of evidence for these varies and some are stronger risk factors than others. Remember that these are only ‘risks’ – every woman will be different as every set of circumstances is unique.
Factors that increase the risk:
o Depression or anxiety during the pregnancy
o Past depression or anxiety
o Past emotional or sexual abuse
o Stressful life events other than having a baby, eg difficulties with money, accommodation, work, relationships
o Limited social and personal supports
o Difficulties in the relationship with your partner
o A tendency to want to do things perfectly and to be in control
o Complications with the pregnancy, delivery, breast feeding or baby (eg unwell or very unsettled).
The more of these you have, the more likely you are to develop PND, but there is no numerical ‘formula’ and everyone will be different.
Factors that decrease the risk:
o Effective treatment for depression or anxiety before or during the pregnancy
o Already in a solid treating relationship with a trusted clinician (local doctor, psychologist, psychiatrist, therapist) with whom you can openly discuss your feelings
o Support (emotional and practical) from family and friends
o Support from professional agencies, such as support groups, mothers group, childcare, community nursing etc.
If you are concerned you may be at risk of developing PND, it is important that you get professional help as soon as possible, preferably before becoming pregnant, to DECREASE the factors that make you vulnerable, and to INCREASE the factors that can provide some protection.
Medications and pregnancy
Many medications can affect pregnancy or breast-feeding. This changes through the pregnancy too, as some drugs that should not be taken early in pregnancy are safe later on, and vise versa. It is not possible to give you a comprehensive list here, but if you are taking any medications and planning to become pregnant (or have just found out you are pregnant), you should see your doctor immediately and get everything you are taking checked.
Unless you know for sure something you are taking is very dangerous, don’t stop any prescribed medications suddenly without discussing it with your doctor, as this can have its own risks, to you and/or to the baby.
Note that any medication review should include prescribed medications, over the counter medications, herbal or alternative preparations, traditional treatments, tonics and mega vitamin preparations, legal substances (eg cigarettes, alcohol, caffeine) and illegal ones (eg social drugs or performance enhancing substances).
MotherSafe in NSW (see http://www.sesiahs.health.nsw.gov.au/rhw/default.asp?page=103.1&template=6&leftnav=57 ) provides specialist information and advice on this matter for anyone in NSW. Other States will likely have similar services.
Getting help
In answer to your final question, if you suspect you might have PND you should get help fast. Even better than that, though, especially if you have a number of significant risk factors, is to ensure you get help BEFORE getting depressed: either before you get pregnant or during the pregnancy. That way you may be able to prevent the PND, or at least catch it very early.
Some places to go to get help are below. The important things here are to do it quickly and to persist. If you feel you are not heard the first time, try again and again and if necessary elsewhere, until you are heard).
o Your local doctor
o Your psychologist/psychiatrist if you are already in treatment
o Your obstetrician, post-natal clinic or community midwife
o Your community mental health centre
o Your community mother and baby nurse
o PaNDA (in Victoria, see http://www.panda.org.au/ )
o The BeyondBlue website has a comprehensive list of service providers (see: http://www.beyondblue.org.au/index.aspx?link_id=94.625 )
We wish you all the best, and remember: once you are planning to become pregnant, all your health and treatment decisions become extra important, as they will soon affect more than a single life. Good luck.
The answer was published on DepNet
12/02/2008