1. Depression in Pregnancy A Mothers’ Mental Health Toolkit Project Learning Video with Dr. Joanne MacDonald Reproductive Mental Health Service IWK Health Centre Halifax, NS

2. Depression in Pregnancy Pregnancy is a time of change. Physical change. Emotional change. Role change. Relationship change. Depression can be an unexpected experience for the pregnant woman and her family.

3. What is the Rate of Depression in Pregnancy? a. 3.5 % b. 10 % c. 25 % d. 48 %

4. Fast Facts Answer: 10% of pregnant women can have depressive symptoms of moderate to severe intensity – what is called Major Depression Take Home Point: Pregnancy doesn’t prevent or protect mothers from a depressive illness. Rates of Depression in pregnancy are similar to non- pregnant women of the same age

5. Depression in Pregnancy Typical symptoms of Major Depression include: Changes in sleep patterns Appetite Energy Mood Capacity to cope with stresses Speed of thinking Daily thoughts more negative, fearful or guilty Sense of connection to people or roles

6. Depression in Pregnancy How do we recognize depression from the usual changes in pregnancy?

7. Depression in Pregnancy Fatigue, speed of thinking or response & increased intensity or expression of emotion can come with the hormonal & physical changes of pregnancy. But, they should improve with rest & support, not last long and not interfere with function.

8. Depression is more likely if: the symptoms persist and are getting worse the emotions and thinking are increasingly negative the experience is not typical for this woman the feelings don’t fit with her situation Depression in Pregnancy

10. Risk factors? Depressive episodes in past Sensitivity to mood change with hormonal change, for example pre-menstrually High levels of current stress Loss of supports Physical pain and complications in the pregnancy Depression in Pregnancy

12. Protective Factors: Stresses have been recent, not ongoing Good coping in difficulty in the past Strong support systems Capacity to increase self-care strategies Psychological insight and skills for resilience High desire and motivation to parent Depression in Pregnancy

13. Approaches to Intervention: Interpersonal and cognitive-behavioral psychotherapies can be very effective for mild to moderate symptoms Untreated severe depression is associated with poor outcomes for mothers and infants Medications can be used for severe symptoms with relative safety and monitoring Family and friends are important supports Depression in Pregnancy

14. What is the outcome for the pregnant woman with a depressed mood? Not all women go on to have Postpartum Depression. Some cases improve around delivery Successful and safe treatments in pregnancy can limit the depressive illness Treatment enhances function in labour and attachment postpartum Depression in Pregnancy

16. Considerations in Treatment & Intervention: 1. Reduce stressors when possible. 2. Increase rest, moderate exercise & nutrition. 3. Bring in practical & emotional supports. 4. Seek out mental health assessment. 5. Consider psychotherapy where possible. 6. Discuss benefits & risks of any medication recommended. Key Resource: www.motherisk.org (Sick Kids Hospital-Toronto)www.motherisk.org Depression in Pregnancy

17. Pregnancy doesn’t protect from depression Self-care and psychological strategies are key Medications can be used in severe cases with safety and monitoring Successful treatment of depression in pregnancy is critical to the new mother’s function when the infant comes Points to Remember

18. A learning module in a series developed from the Mothers’ Mental Health Toolkit Project To promote knowledge and advocacy in mothers’ mental health through front line support & service providers A project of the Reproductive Mental Health Service, IWK Health Centre & Dalhousie University, Halifax NS Depression in Pregnancy

19. Thank You!