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Assessing low mood during pregnancy

BMJ 2019; 366 doi: https://doi.org/10.1136/bmj.l4584 (Published 29 July 2019) Cite this as: BMJ 2019;366:l4584

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Perinatal depression is not uncommon

Depression is two to three times more frequent in women than men. The highest prevalence figures are reached during the years of fertile life, so that women may be depressed before conception or depressed during pregnancy.

Some countries report depressive illness during pregnancy represents a public health problem. It is estimated that in 2020 depression will be the second leading cause of disability worldwide.

In recent years there has been notable progress in the field of perinatal psychiatry, a discipline that deals with psychopathological aspects related to pregnancy and postpartum. In light of this fact, it is essential that gyneco-obstetrics and pediatrics professionals become familiar with these advances, since the close contact they have with pregnant or puerperal women provides a unique opportunity to diagnose and treat depression early. maternal pre and postpartum. This can make it possible to avoid or minimize numerous negative consequences that perinatal depression can cause to the mother, the family environment and in particular, to the offspring, at the stage of the fetus or infant and at later times of life.

The clinical picture of pregnancy depression is similar to that presented in depressive episodes at other times of life. In addition to the cardinal symptoms of depression - such as discouragement, disinterest in activities that were previously attractive, deterioration in self-esteem, emotional lability - symptoms such as distress, irritability and deconcentration usually occur.

There may be rejection or ambivalence in relation to pregnancy, especially if it is not planned. Likewise, the woman may experience anguish over the responsibility of assuming the role of mother or feeling guilty for believing that she is not contributing to the well-being of her baby.

It is essential to diagnose episodes of major depression. In this sense, the persistence of discouragement as a diagnostic requirement is particularly important. To diagnose a major depression it is required, among other clinical characteristics, that the discouragement be prolonged for at least two weeks.

Depressed pregnant women have a higher risk of neglecting their pregnancy, of abandoning prenatal check-ups, or of not following or erroneously following medical indications, compared to non-depressed pregnant women. In addition, they are more likely to abuse tobacco, alcohol and drugs; all of which can affect the obstetric outcome. In turn, some symptoms of depression such as anorexia, can alter some aspects of pregnancy - such as weight gain - and thus contribute to adverse outcomes.

Some discomforts typical of gravity, such as fatigue, emotional lability and sleep and appetite disorders, are usually found during depression. It is also pertinent to remember that pregnant women may suffer from certain medical conditions such as anemia, gestational diabetes and thyroid dysfunction, which are often associated with depressive symptoms. For this reason to minimize the risk of false positives, it is recommended to systematically explore the psychic symptoms of major depression, feelings of guilt, hopelessness and suicidal ideation.

Acute major depressive disorders of pregnancy are often not treated or treated insufficiently. Moreover, it is known that even having made the diagnosis of a psychiatric disorder during pregnancy, it is often not treated.

The purpose of a treatment for depression in a pregnant woman is to improve her mood, minimizing the risks to the developing fetus. You should start with general strategies such as recommending to stop the consumption of caffeine, nicotine and alcohol, or try to maximize the chances of rest. It may be beneficial to resort to relaxation techniques and also to environmental management measures.

In general, its use is considered in pregnant women with moderate to severe depression, pregnant women who have not responded to other treatments or when there is a high probability of recurrence. Due to obvious ethical reasons, there are no studies on the efficacy of antidepressants in the treatment of depression in pregnant women. However, there is no reason to think that the therapeutic response of gravid women should be different from that observed in non-pregnant women. Moreover, there are guidelines for the treatment of depression during pregnancy.

References
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Competing interests: No competing interests

29 July 2019
Moises A. Santos-Peña
Medical Doctor and Professor. Internal Medicine and Intensive Carte. Advisor to the Board of Directors
Rocha-Hernandez Juan F., Rodriguez-Roque María O., Garcia-Sanchez Dumeivy, Mesa-Perez Dayalierky, Rodriguez-Duarte Luis A.
Gustavo Aldereguia University General Hospital
Ave 5 de Septiembre and 51-A street. Cienfuegos, Cuba 55100