Her acute depression intensified throughout her first pregnancy at 35, and again during her second at 38, which lingered for months postpartum.

“I was just so overcome with emotions (during my pregnancies). If I felt angry, I would be really angry, and it was quite debilitating when I was sad because I just could not do much throughout the day.

“If I’m in one of my emotional episodes, I attach very strongly to a feeling and I cannot detach from it. It’s a whole loop of overthinking that I cannot escape,” she said.

Chan, a preschool guide, said she felt stigmatised during obstetrics and gynaecology visits when her personal feelings and depression differed from friends who were also expecting.

She said there was a lack of awareness and openness towards perinatal mental health conditions, which often led to these problems being downplayed as hormonal mood swings during pregnancy.

“As a new mother, so many things are uncertain and you often feel judged. It is really hard to admit that you’re going through something deeper and need help,” she said.

Consultant obstetrician and gynaecologist Dr Prasanna Raj Supramaniam said it was important to recognise mental health issues during pregnancy and postpartum.

“Women do experience a varied sense of hormonal changes and stress response throughout the perinatal period, but those responses are shortlived.

“However, the difference with a perinatal mental health issue is that it persists,” he said.

The World Health Organization reported that almost one-in-five women will experience mental health problems during the perinatal period, which is the time during pregnancy through to a year after giving birth.

Prasanna said one of the biggest stigmas associated with mental health is that it is often viewed as an individual problem rather than a societal issue, with women who are experiencing perinatal mental health problems labelled as unfit mothers.

The associate professor at TMC Fertility also said there was a notable lack of awareness of women’s health and called for campaigns held during specific celebrations, such as Women’s Day or Mother’s Day.

“The fundamental place to start would be to improve awareness for women to recognise the symptoms.

“We need to empower them to be able to have a conversation with a dedicated person about mental health issues or perinatal mental health concerns early on,” he said, adding that implementing support systems like telemedicine would make it more accessible for mothers.

Early signs and risk factors

Prasanna said it was crucial to recognise perinatal mental health conditions because untreated cases can lead to worsened maternal mental health and child developmental issues.

He said one of the most common perinatal mental health conditions is depression, with bipolar or mood-affective disorders and postpartum psychosis as the lesser known but also prevalent issues, among mothers.

A 2018 systematic review of five local studies published between 2006 and 2016 found that postnatal depression rates in Malaysia ranged anywhere from 6.8% to 27.3%, with varied findings due to the difference in instruments and methods used.

A Malaysian cohort study published in the same year reported that 12.2% of women displayed antepartum depressive symptoms, while 28% displayed symptoms of antepartum anxiety.

Prasanna said perinatal mental health conditions can be recognised through persistent low moods, anxiety, feelings of hopelessness and guilt, as well as a loss of interest in activities.

“One of the risk factors that predisposes women to perinatal mental health conditions is having mental health issues prior to conception, then being subjected to the stresses of pregnancy,” he said.

He called for mothers who recognised these symptoms to first contact their nearest healthcare provider.

Counselling psychologist Snigdha Gupta said depression, anxiety and irritability were among the most common perinatal mental health conditions. She said there was a risk of self-harm or intrusive thoughts of harming the baby if left untreated.

“Mothers also tend to start resenting their husbands for being unable to return to a ‘normal’ life, causing conflicts in relationships,” she said.

Snigdha said sudden appetite loss, overeating, abnormal decrease in energy, and isolation were some symptoms of perinatal mental health conditions.

She said support groups would be helpful in spreading awareness and addressing perinatal mental health conditions.

She also recommended incorporating yoga and meditation into routines, as well as seeking professional help from psychologists or psychiatrists if needed.

“Having social groups or informal gatherings by mothers makes it seem less scary because they are seeing other mothers go through the same issues.

“There’s no need for much intervention with this because there will be a bond between the mothers,” she said.