Prenatal Depression
A woman can suffer from depression during and after her pregnancy. Depression does occur during pregnancy; this is known as prenatal depression. A pregnant woman may be depressed and not know it.

Dr Helen Chen, Head and Senior Consultant from the Department of Psychological Medicine at KK Women's and Children's Hospital, gives detailed answers to your questions.

Question by emmechow

I've just had a miscarriage, can you suffer from depression from that? I have two fibroid, one on my left side which was going along w/my fetus, the fibroid grew until 9 cm, fetus was 8 1/2. Anyway, had a dnc, and now the fibroid is 7cm. Not sure if I should get a operation to remove fibroid?

I did suffer from postpartum depression, when I had my lst daughter. I'm hyper and do cry easily. I don't know why I cry for no reason, it's been 2 months since my dnc. Have been doing yoga, treadmill and swimming. But not every day, maybe twice a week.

I don't want to take any medication, if possible. I would like to cope naturally.

Answered by Dr Helen Chen, Head & Senior Consultant Psychiatrist, Department of Mental Wellness Service KK Women's and Children's Hospital

I am sorry for your loss – yes, indeed the grief can be pronounced after a miscarriage, and if the symptoms are severe and prolonged, it can signal a depression due to the pregnancy loss.

Having had a previous episode of depression – as you did after your first delivery – can also be a risk factor for a subsequent episode of depression. If your find yourself feeling overwhelmed with low mood, easy tearfulness, and having difficulty with sleep and appetite, or negative thoughts, such that you have difficulty functioning, it would be good to consider getting an assessment.

You certainly seem to be trying to keep your spirits up, with the exercise – do carry on as this can help your mood. Don’t worry about medication being a must if you seek help – talk therapy can benefit much too.

Question by pearlynwan

Dear Dr.

Since I have my 1st baby 3 years ago, I have been having problem focusing, feeling moody and do not have energy. I cannot work at all. Last year, I have taken medication to stop the depression. I thought I am Ok since the symptoms have subsided.

I am now pregnant with my 2nd child, and the same symptoms have come back. I seek consultation again but the doctor is asking me to withhold from taking any medication as he feared that it might hurt the baby.

What can I do? I cannot focus at work and have to stay at home. I am so moody, angry at times and crying at another time. Will my condition worsen with time? Will this emotional swing upset my baby?

Answered by Dr Helen Chen, Head & Senior Consultant Psychiatrist, Department of Mental Wellness Service KK Women's and Children's Hospital

It does sound like your symptoms are recurring, and I do strongly recommend you seek advice from a doctor who is trained in managing depression in pregnancy – there are alternative treatment strategies that are relatively safe in pregnancy. Especially if you are past your first trimester (the first 3 months) when the baby’s organs are forming, certain medications can be used with little worry.

As you are experiencing difficulty functioning, I would advise you seek appropriate help. It is hard to predict the course of your depression as many issues need to be considered – your past recovery, your current stressors, and other risk issues.

Science has not completely unraveled how the in-utero environment can influence the growing fetus – but there are clues that mother’s distress can affect the fetus through various biochemical pathways. We also understand that mothers who are depressed sometimes eat poorly or sleep poorly, so that can affect fetal development. But with appropriate treatment, a lot can be improved upon, so do talk to your doctor and get an appropriate referral.

Question by Jtlman

I am not sure whether this is the place to ask. I have abortion last week, and now I feel terribly bad. I can’t sleep, don’t have appetite for food and just want to be away from everyone I know. I don’t feel like crying but I just feel numb. Some night, I feel like going through another pregnancy again to get back my baby. What is happening to me? Should I seek treatment or this feeling will fade away?

Answered by Dr Helen Chen, Head & Senior Consultant Psychiatrist, Department of Mental Wellness Service KK Women's and Children's Hospital

I am deeply sorry for your experience. It’s not uncommon to have such a strong reaction following abortion – it must have been a difficult process for you, and I can only imagine your immense struggle coping with this trauma.

The psychological consequences of abortion include the sense of guilt, self-reproach, withdrawal, numbness, seeking resolution, regret – much like what you are experiencing, and all understandable given the traumatic nature of having to abort baby.

For some women, the feelings are easily repressed, or rationalized – for others it can persist and remain raw and painful. It will be good for you to seek counseling support, or talk to a trusted friend. If the symptoms persist past one month, and don’t start to improve, then it would be advisable for you to seek professional help.

Take care…and be gentle with yourself, even as you deal with the reality of your loss.

Question by lindi2000

I am going to deliver in another 6 months. However, due to this is an unexpected pregnancy, I actually hate the baby. I feared that my baby will take away my freedom, my career and my hubby can’t help much since he is based in Vietnam. The more I think of all the hard work involved and sacrifices, the more I worried and ended up sleepless at night.

This is the first baby in my family for the last 20 years, and everyone is excited but me. I can’t tell anyone about how I feel. If my situation continues, is it possible that I might end up in depression? Can you please advice what can I do to avoid feeling helpless and worried? Can I take sleeping pill during pregnancy?

Answered by Dr Helen Chen, Head & Senior Consultant Psychiatrist, Department of Mental Wellness Service KK Women's and Children's Hospital

First, I must encourage you – you are brave to be able to acknowledge your feelings, because it must be very, very difficult for you. The ambivalent feelings you have towards your baby is not uncommon, and lest you think you are going to be a bad mother – I think the fact that you are so distressed, and that you are seeking answers even in this state tells me that you can come around and learn to accept and love this baby.

It is frightening when you think of how your life will change with the baby – every first time mother probably has shades of these fears. And it’s good you are facing up to this, as yes indeed, you can be depressed if you don’t deal with the issue. I would suggest you speak to your husband, or someone trusted, or seek counseling support.

If you find yourself overwhelmingly depressed, worried, with problems sleeping or eating, and persistent negative thoughts, you should seek professional help. There are some medications that are safe in pregnancy for sleep – but it would be more advisable for you to get a proper assessment to see if you are clinically depressed. This is because just taking sleeping pills may help to “numb” you to sleep, but not address the fears and your emotional distress.

Ref: V10​