Depression, desire to be a mother, and pregnancy

Perinatal depression is a mental health problem that requires prompt and specialized care. Many women may experience symptoms of depression or be on antidepressant medication and still have a desire to become mothers or be pregnant. Having adequate support is essential for their well-being and that of their future baby.

Next, we will try to answer some common questions regarding depression and motherhood, focusing on the pre-pregnancy stage and pregnancy.

Symptoms of depression

Women with depression may experience some of the following symptoms for a period of at least two weeks:

• Persistent sadness.
• Sleeping very little or, on the contrary, sleeping many hours.
• Decreased or lost ability to enjoy.
• Anxiety.
• Thoughts of death, suicide, or hopelessness.
• Decreased self-care.
• Loss of interest in leisure activities.
• Changes in eating habits.
• Difficulty concentrating.

Depression can be categorized as mild, moderate, or severe.

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Factors that influence perinatal depression

Perinatal depression is a complex disorder influenced by multiple factors. Generally speaking, it can be determined by environmental, biological, and psychological aspects. Some factors that may contribute to the onset or worsening of depression include:

• Genetic predisposition.
• Hormonal changes.
• Chemical imbalances at the brain level.
• Deteriorated physical health.
• Chronic stress.
• Limited support network.
• Economic difficulties.
• Difficulties in reconciling work and family life.
• Gender-based violence, which can intensify during pregnancy.
• In vitro fertilization processes, which can generate anxiety and frustrated expectations.
• Pregnancy losses.
• Previous bad birth experiences, which can generate fear and anxiety.
• History of childhood sexual abuse.
• Low self-esteem.
• Self-demanding and perfectionist personality profiles or those with negative thinking styles.
• Certain parenting styles in childhood.

Perinatal depression can have a hereditary component, although this is not the only factor that influences its development. Women with a family history of major depressive disorder, bipolar disorder, or postpartum psychosis may have a higher risk of developing depressive symptoms during pregnancy or postpartum.

If you are pregnant and have symptoms of depression or are being treated with antidepressants, we recommend that you contact your midwife or your doctor as soon as possible.

However, in addition to genetic predisposition, environmental and psychological factors also play a role. For example, growing up in a family environment where mental health wasn't openly addressed can make it difficult to manage the emotional aspects of motherhood. Exploring family history and understanding the perinatal experiences of one's own mothers, grandmothers, or sisters can be a therapeutic process.

Consequences of depression in the perinatal stage

Untreated depression can lead to complications for the baby , such as malnutrition or comorbidity with smoking and alcohol use, among other factors. Elevated cortisol levels associated with maternal stress and anxiety have been linked to emotional, cognitive, and behavioral problems in the baby. Furthermore, it is important, as far as possible, to be as stable as possible during the postpartum period, since antenatal depression is correlated with postnatal depression . The consequences of untreated depression can affect the mother-child bond , and in extreme cases, even lead to maternal suicide or infanticide (rare). Untreated or poorly treated depression can also become chronic.

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Depression and desire to be a mother

If a woman is depressed or undergoing treatment and wants to become a mother , it is best to consult a professional for guidance. Prioritizing the mother's well-being is the most appropriate course of action. It is a common misconception that having a child will improve one's mood. However, it is recommended to prioritize the woman's clinical stability first.

If the woman is already pregnant and has symptoms of depression or is being treated with antidepressants, it is recommended to contact the midwife or her doctor as soon as possible to start the appropriate treatment or referrals.

Treatment of depression in the pre-pregnancy stage and during pregnancy

Psychological treatment , support groups for women in similar situations, or emotional support are usually the first therapeutic options. However, antidepressant medication may be necessary, especially in cases of moderate or severe depression or when other treatment options have failed.

The use of psychotropic medications during the pre-pregnancy or gestational period should always be under the supervision of a healthcare professional, preferably a perinatal psychiatrist. Withdrawal or continuation of a psychotropic medication should be carefully evaluated, taking into account, among other factors, the following aspects:

• Previous depressive episodes.
• Previous relapses after withdrawal of the drug.
• Environmental stressors to which women are subjected.
• Support network available to you.

Therefore, it is not advisable to stop taking medication if the woman was previously taking an antidepressant without first consulting an expert.

Is it safe to take medication during pregnancy?

In general, antidepressants called SSRIs (selective serotonin reuptake inhibitors), such as sertraline, fluoxetine, citalopram, or escitalopram, are most commonly used to treat depression in the perinatal period, as they have a relatively acceptable safety profile compared to the risks of not treating depression. They can take between four and six weeks to become effective.

Treating depression with psychotropic drugs when necessary is considered more beneficial than not doing so, although there are potential risks, as untreated depression can affect both the mother and the baby.

Although generally considered safe options, some research has analyzed potential effects on the baby . Among the aspects studied are:

• Fetal development . Research has explored whether certain SSRIs might influence the formation of the baby's heart, although the risks are low. In some cases, a fetal echocardiogram may be recommended.
• Newborn adjustment . In some cases, babies may experience a brief adjustment period after birth, with mild symptoms such as irritability or feeding difficulties. These cases are evaluated by a pediatrician.
• Respiration and circulation. An increase in certain respiratory conditions such as persistent pulmonary hypertension of the newborn has been observed with SSRIs, although the absolute risk remains low.
• Child development. Although some research has analyzed the impact on the baby's emotional and cognitive growth, the data are not conclusive.

Although there are potential risks, it is generally considered that treating depression with psychotropic drugs when necessary (especially moderate and severe depressions) is more beneficial than not doing so, since untreated depression can affect both the mother and the baby .

Other antidepressants, such as venlafaxine, can be used in cases of more severe depression, and it is generally accepted that this medication is safer than not treating depression at all. It is important to seek expert advice from a qualified professional.

Every woman is unique.

Every woman is unique and has her own story. That's why it's so important to personalize each case and establish a joint decision-making process between the woman and the expert professional.

Some women experience moderate or severe depression, or have complex previous childbirth experiences, a family history of mental illness, are undergoing fertility treatments, have a history of childhood or adolescent sexual abuse, experience difficulties in family relationships, have suffered violence, or have had previous pregnancy losses. These are just some examples of factors that must be considered when evaluating a treatment option. Therefore, when recommending discontinuing an antidepressant in a woman who expresses a desire to conceive, her history of previous depressive episodes, relapses after previous medication withdrawals, and current stressors, among other factors, must be taken into account .

Where to go and what the procedure will be

If you think you have depression or are on antidepressant treatment and you want to become a mother or are pregnant, seek professional help through your doctor or midwife. They can order additional tests, such as blood work, assess your overall health, and provide preventative care to reduce factors that can negatively impact a pregnancy, such as smoking, unhealthy eating habits, or lack of exercise, among others. They can also consider referring you to a perinatal mental health specialist.

There are specific programs and services for perinatal mental health care. These programs provide evidence-based information, subspecialized expert advice and assessment, to facilitate collaborative decision-making, and to implement a multidisciplinary approach that may include professionals such as psychologists, psychiatrists, obstetricians, social workers, mental health nurses, midwives, pediatricians, and primary care physicians, among others.

In summary, planning the pregnancy and prioritizing the woman's emotional well-being before deciding to become a mother are very sound recommendations, but, in any other case, the most important thing is to seek help to obtain individualized advice and address the mental health problem as soon as possible.