What causes mood swings and depression during pregnancy?
There is enough research to show that a lot of hormonal changes occur in the mother during pregnancy. Along with pregnancy, daily life itself brings in a lot of stress. It could be work-related stress, which we call physical stress like getting up very early in the morning, doing work in the house and then rushing to work. And, if there is marital discord at this point of time, it makes the woman very insecure. On the one hand, there is a growing baby inside you and, on the other there is the question of ‘what’s going to happen to my future’. So, would-be mothers during this period are very vulnerable and anxious. In addition, if there is an older child who is going through a problem, the coping pattern of the mother comes under pressure. It depends upon the personality of the mother. If she is a panicky or anxious person or depressive, it can accentuate the mental illness in a person.
What are the first symptoms?
The first indication is increased sleep or not being able to sleep and lack of appetite. First, the biological system gets disturbed. Then, there are crying spells – crying without any reason or getting anxious for no reason. In some cases, they could be seeing or hearing things, which, of course, is a much more serious issue. In case, there is a psychotic breakdown and the patient is keen to go ahead with the pregnancy, the psychiatrist would try to wean away the medications so that the baby is not impacted. It is quite possible that there could be a relapse in the patient, but it will have to be managed.
How do you deal with it? Is family help enough or do you need to consult a psychologist?
There are several ways of dealing with it. For instance, if a person is already ill or has been under treatment for psychosis which has been suspended because pregnancy is coming its way, then she definitely needs to go back to the doctor who had been treating her. He or she might give medicines which is not dangerous for pregnancy. But, otherwise, a lot of such issues can be dealt with through relaxation, therapy (by talking to the person), enhancing the kind of support systems to cope with the situation. Sometimes, as we have seen in working professionals, giving them short breaks from work particularly if they are involved in some very stringent project work, certainly helps the person.
Do mood swings and depression during pregnancy happen in a normal person or only in those who have the history of psychosis?
We have seen it happening in even normal and healthy persons, especially in the stressed world of today. As it is there is so much stress and added to that if there are physical problems, we see very many people falling into the stressed and anxious phase. For this, yoga helps. In fact, it helps a long way in relieving stress-related problems during pregnancy.
What is postpartum depression? How is it different from postpartum psychosis?
Postpartum depression has a range. The milder ones are defined within the first 6 to 8 months after the delivery of the child. If a person suffers a breakdown they fall under the rubric of postpartum psychosis. In this, you could have a mild depression that is quite normal because, suddenly, the lactating mother is deprived of sleep having to look after the baby because there is no support from the husband as well. This leads to irritability and angry outbursts, all of which can be treated with therapy or counseling. But, only if there is a psychotic breakdown, is medication required. Psychotic breakdown can present itself either by severe weeping or suicidal ideas. They can have hallucinatory ideas. It can be as extreme as homicide like wanting to kill the baby. So the range of treatment can vary from medication of patient to admission for therapy.
When does a mother need professional help while combating postpartum depression and psychosis?
What we would advocate is that the minute the mother starts feeling a little low, not being able to sleep, feeling that she can’t cope, has anxiety, worries, she should immediately go for counselling and start psychotherapy.
Do mood swings and depression affect the baby or the growth of the baby in any way?
It depends on the social support system. Very often if there is a grandmother, or any other older member, who takes care of the infant while the mother rests, there are no serious issues. But when a mother has a psychotic breakdown and you have to wean away the child from breast milk, those are more complicated issues. But in 90 percent of the cases, the child does not get affected because of the mother’s mental illness.
How does stress affect a pregnant working woman? How does she overcome it?
Like I mentioned, being associated with several corporates, we do see, especially in working women of today, that they are no such issues if they are in a slightly understanding environment. The problem arises if the manager does not understand the physical condition especially in the latter part of the pregnancy. Of course, companies now-a-days have become more lenient with leave and have made it a little easier for the woman to cope with pregnancy. But, when the stress load increases, some women may not be able to cope with it. People are also not able to prioritise. It depends upon the personality patterns as we discussed earlier. There are also women who are very perfection oriented. They want to be excellent at home as well as at work and they want to be pregnant as well. Now, everything cannot be done at the same time. That’s when stress begins to build up.
Does it also lead to psychosis in normal people?
Psychosis may not have a one-to-one correlation; we don’t see that so much in clinical practice. We do see stress, mild to moderate, people feel overwhelmed, they feel they cannot cope, they feel they have lost on technology because change is taking place so fast that they feel they have not caught up with recent technology. ‘What’s going to happen post-maternal break and what’s going to happen in future’, this kind of fears start coming up in their mind.
So what is the solution for this?
Very often they settle with counselling, generally when the ‘what if’ questions are answered. And of course with the support of the husband they do settle down a lot.
What happens to the single mothers?
That is another problem that we are seeing of late. A single mother maybe has twice the number of stressors that we see. For one, finance also becomes very important. So finances and her growth up the ladder become all the more important and the stress becomes all the more profound. And it becomes important for her to maintain the equanimity because she realises that she is the only one for the child as well. So that becomes a little more of a complex problem. But they do extremely well with support systems and we often encourage them to get more support. As psychologists, we also give them constant support and if they don’t have family support, we offer them support from friends. They may not need medication, except for a very few.