To her patients, Dr Julie Tan (not her real name) is the calm and collected doctor who dishes out sensible health advice. But even her wealth of medical knowledge and training couldn’t prevent her from spiralling into depression early during her fourth pregnancy last year.
“I often felt stressed and sad, and didn’t have the energy to do things that I usually do, like read with my kids and supervise their homework,” says the 38-year-old specialist in private practice, whose four kids are now aged one to seven. She has requested to remain anonymous to protect their identities.
Julie shares that she was also not in the mood for activities she usually enjoyed, like listening to music and watching movies. While watching the adrenaline-pumping action flick Spiderman, for example, she recounts how she felt an overwhelming sadness come over her and almost burst into tears.
The negative emotions caught her by surprise. “I’m usually very logical, so I couldn’t understand why I felt so down,” shares Julie, adding that her previous three pregnancies went well.
Thanks to her medical background, she knew that something wasn’t right. She eventually sought help from a friend, a psychiatrist, and found out that she was suffering from depression.
Is it my hormones?
Most people think that pregnant women must be thrilled and optimistic during the nine months. But that’s not always true. Some women, like Julie, struggle with depression at some point.
In Singapore, antenatal depression hits about one in 10 expectant women, says Dr Cornelia Chee, senior consultant and director of Women’s Emotional Health Services at National University Hospital (NUH).
According to experts, it can affect women from all walks of life.
The cause is more than just a hormonal glitch. Like most psychiatric disorders, many stressors can come into play, says Dr Choo Chih Huei, senior consultant and head of the Women’s Mental Wellness Service at KK Women’s and Children’s Hospital (KKH).
“When a pregnant woman is tearful or emotional, the common reaction is: ‘It’s her hormones!’” says Dr Choo.
“But while this may be partly true during the first trimester, when oestrogen levels are low and progesterone levels are relatively higher – and morning sickness adds to the misery – hormonal changes alone do not conclusively account for antenatal depression. Otherwise, every pregnant woman would be depressed!”
For women undergoing their first pregnancy, the massive psychological adjustment can be challenging. He adds that it becomes even more daunting if the baby was unwanted or unplanned, or if the mum-to-be has work-related issues.
Those who are underage or have unresolved emotional conflicts with their own mothers may also find the transition tough.
Other factors, like a previous history of depression, pregnancy complications or marital problems, may add to the risk.
Experts are heartened that women are more willing to come forward to seek help for antenatal depression. But not many are comfortable to discuss or admit to it openly.
“The stigma of mental illness often results in the mother keeping the suffering to herself, because everyone around her expects her to be happy and excited about her baby,” says Dr Choo of KKH.
In 2008, NUH launched a routine antenatal- and postnatal-depression screening programme for mums. The screening programme, which is voluntary, has helped NUH doctors identify and reach out to some 150 women with antenatal depression each year, notes Dr Chee.
“Emotional care is something women need, and will rarely voice on their own. Routine screening takes away the stigma, and allows us to be proactive in reaching out to mothers in need,” she says.
KKH’s Women’s Mental Wellness Service, for instance, sees about 40 to 70 cases each year.
Identifying at-risk women early is important because of its link to postnatal depression. About 40 to 50 per cent of mums who are depressed during pregnancy continue to feel miserable after they deliver their babies, says Ch’ng Ying Chia, senior case manager and deputy director of postnatal-depression intervention programme at KKH.
Seek help, for Baby’s sake
Antenatal depression doesn’t just start and end with the mum, either. It also affects the unborn baby in many ways, adds Dr Choo.
He explains: “A depressed expectant mother may not rest or eat properly, and may not attend to antenatal care as well as she should. Some may turn to smoking, drinking or taking various substances to cope with their emotions, which can, in turn, cause health problems.”
He shares that studies also show that those with antenatal depression are at a higher risk of premature labour.
A 2008 British study, which looked at records of over 11,000 women and their children, suggested that babies whose mums had depression during pregnancy developed more slowly than their peers.
Seek professional help, if you feel down and cannot go about your usual activities for more than two weeks, advises Dr Choo. Early treatment can help prevent the depressive symptoms from becoming more severe.
In milder cases, the negative emotions may go away without treatment. But there’re also some women with serious depression, who are unable to function normally for months or even years, warns Dr Choo.
“In the most severe cases, depression can lead to psychotic symptoms, such that the patient may start hearing voices or developing odd fears and beliefs that are not real,” he says.
Dr Chee from NUH knows of one mum who had such severe depression during her pregnancy that she couldn’t get out of bed to attend to her other kids.
“She wasn’t able to do any of her usual activities when she was previously very active and managed the household on her own. Her husband had to take over but, thankfully, she responded well to medication,” she says.
Not every sufferer requires medication; this is usually reserved for those with moderate to severe depression, says Dr Choo.
Psychological support and therapy, such as counselling, is usually the first line of treatment for depressed mums-to-be and mothers. But the experts add that mums shouldn’t shy away from medication if they really need it.
“Many women are often reluctant to get help because of the misconception that medications are dangerous to their babies,” he says. “Certainly, a number of them are not recommended, but there’re some that are compatible with pregnancy and breastfeeding.”
Dr Chee advises checking with a psychiatrist who is familiar with treating maternal depression.
Honey, I need you
Loving support from Hubby and family can also make or break a depressed mum’s recovery.
“My patients often tell me that their husbands don’t understand or believe them, and tell them to snap out of it,” says Dr Choo.
That was true for 34-year-old Kelly Tan (not her real name), a KKH patient. The lack of support from her family made her pregnancy journey unbearable.
While the first-time mother was thrilled to finally conceive after being married for six years and suffering a miscarriage, she developed depression during her third trimester after learning about her breech baby.
She lost her appetite and drive at work, and couldn’t control her mood swings. To make matters worse, her in-laws mistakenly blamed her for the complicated pregnancy.
Julie’s strong family support is a stark contrast to Kelly’s experience. Her husband and mother chipped in with the household duties during her pregnancy.
“My husband, who is also a doctor, offered tons of support. Whenever he noticed that I was becoming increasingly weepy, he would stop whatever he was doing and hold my hand. He constantly reminded me not to be too hard on myself for not being able to give my older kids as much attention,” says Julie.
“The kids were great, too. They understood that I wasn’t feeling well and didn’t whine about it. I’m really fortunate.” With family support and counselling, she got better during her last trimester. By the time she delivered her baby, the depression “simply disappeared”.
Having experienced the blues herself, Julie advises mums-to-be to seek help when they feel something is not right.
“A lot of expectant women go through antenatal depression without recognising it. It doesn’t matter if you’ve sailed through previous pregnancies. It can hit anyone,” she says.