Depression During Pregnancy

By Connie Matthiessen

Pregnancy is a time of many changes not only for your body, but also for your mind. Your mood can swing from sunny to dark, and you'll probably start worrying more than usual. And no matter how much you're looking forward to your baby's arrival, you just might find yourself feeling depressed.

By some estimates, depression strikes one in five women during pregnancy. If you're feeling down during pregnancy, you may be tempted to overlook your feelings or beat yourself up for feeling sad at a time that ought to be one of the happiest occasions of your life. But you don't have to let depression take over your life. By taking depression seriously, you can rediscover the joys of pregnancy, worries and all.

Far too many women accept depression as a part of pregnancy. A survey of 1,837 pregnant women by University of Michigan researchers found that only 33 percent of those who were experiencing major depression received any treatment. This may be because of the general misconception that pregnancy is a purely blissful state and that if a woman isn't happy, she should be. But depression is not something to be ashamed of, and if you deny your feelings you may be less likely to take care of yourself -- and your unborn child. The consequences can be extreme: Some studies have shown that maternal depression may raise the risk of preterm birth, low birthweight, and low Apgar scores in newborns.

What are the symptoms of depression?

Mood swings are common during pregnancy, largely because of the dramatic increase in hormones coursing through a woman's system. But if you find that you are having trouble shaking the blues, or if you don't have the energy or will to perform routine tasks, you may be suffering from depression. Symptoms of depression can include irritability, ongoing sadness, appetite loss, compulsive eating, constant fatigue, disturbed sleep, inability to focus or think clearly, extreme mood swings, feelings of hopelessness or worthlessness, and guilt or anxiety. If any of these symptoms persist for more than two weeks, they could signal depression.

Leah Seidler, a San Francisco psychotherapist who specializes in pregnancy-related issues, says that a wide range of feelings are to be expected during pregnancy, not all of them positive. "It is a rich and multifaceted experience that includes fear and loneliness, as well as joy and excitement," she says. Seidler points out that pregnancy has been increasingly medicalized in recent years as Western medicine has become more sophisticated and pregnancy treatments and interventions more elaborate. This is a positive change in many ways, because it has made childbirth generally safer. On the other hand, says Seidler, "We now treat pregnancy like a disease, rather than a joyful, powerful transition in a woman's life."

Am I at risk for depression during pregnancy?

If you've experienced depression before, or if you have close family members who have wrestled with the problem, you are more vulnerable to depression after you become pregnant. Financial concerns or relationship problems also put you at risk.

Pregnancy can be especially nerve-racking if you've had infertility problems or miscarriages in the past. As months go by, that anxiety can easily shift to depression. Finally, if you have recently experienced a significant life change -- a move to a new city, a job loss, a recent breakup, or the death of a loved one -- you are more vulnerable to depression.

What can you do about depression during pregnancy?

The following steps can help you ward off long-term depression in pregnancy:

Create a community: As therapist Seidler points out, "Today we don't have a reliably available women's world to provide support. We don't sit around in quilting circles, trading information and celebrating the stages of a woman's life. Isolation may not cause depression, but it certainly exacerbates it -- and developing community can reduce it." Call your relatives for support, join a prenatal support group and childbirth education class, or contact your local parenting resource center.

This is especially important if you don't have family nearby or if you are single. Many pregnant women don't have partners to call on when they need help or just companionship. Finding support among people who are in the same situation may alleviate your isolation.

Take care of yourself: Make sure that you get plenty of rest and follow a healthy diet. You may be tempted to complete your entire "to do" list, put in long hours at work, or see all of your friends before the baby comes, but try to pace yourself. Soon you'll have a new baby to take care of and little time for yourself. Nap when you can, take a walk around your neighborhood or go to a prenatal exercise class.

Seidler encourages women to follow their instincts. "If you feel like going out and splurging on a steak, maybe you need to do that. Your body is doing very important work and it deserves to be nurtured." Staying healthy -- physically and mentally -- is your most important responsibility now, and that means taking good care of yourself.

If you have a partner, make your relationship a priority: A new baby is going to add stress to your relationship, so its important to clear the air and improve your communication now, before your child arrives. If your conflicts are serious, consider couples therapy. Talk openly about your fears and hopes and, in turn, listen to your partner's concerns. Take a vacation together if you can, or even a weekend getaway. Devote time and attention to this intimate bond; your partner's support, trust, and goodwill are going to be crucial during the exciting and challenging days ahead.

If your life is generally hectic and full of stress, consider your pregnancy as an opportunity to make some fundamental changes: Join a meditation or prenatal yoga class, or see a therapist. You may need to change your job or reduce your hours to ease some of the pressure at work. Concentrate on developing a balanced lifestyle -- with plenty of time for rest, recreation, and relationships. Your life will change dramatically after the baby arrives, but the steps you take now will give you a solid foundation to build on. If your depression symptoms persist for two weeks, consult your physician right away. She will likely refer you to a therapist, who will provide support and the opportunity to talk openly about your anxieties and fears.

Some antidepressant medications are safe to take during pregnancy, so keep an open mind about using them if you are diagnosed with major depression. One large recent study found that taking a class of antidepressant drugs known as SSRIs during pregnancy led to an increased risk of miscarriage, up to 51 percent in the case of Paxil (paroxetine) and Effexor (venlafaline); the lead researcher urged women to avoid those two drugs during the first trimester, although some experts felt that the risk was exaggerated. Talk it through with your physician and your psychotherapist. They can help you weigh the risks and benefits and come to a responsible decision.

A 2016 study of 850,000 women in Finland found more short-term complications among new babies, but also fewer premature births and C-sections. And a Canadian study of 145,000 women from the Quebec province found a small added risk of autism among their offspring when they took antidepressants during pregnancy, especially when the drugs were taken in the 2nd or 3rd trimester, although the study didn't prove cause and effect.

Be sure to ask your therapist and your practitioner for information on postpartum depression, including antidepressants: Women who experience depression during pregnancy are more likely to develop postpartum depression as well. Postpartum depression can catch any woman by surprise, even those who had no signs of depression during pregnancy.

Depending on how severe your depression is, a combination of therapy and antidepressant medication may be an effective path to recovery from postpartum depression.

Nobody can honestly expect pregnancy to be a time of nonstop bliss. You'll have your bad days, but don't forget: You're gearing up for the great day when your child arrives, and, with luck, you'll be at your best.

References

Boukhris, T., et al. Antidepressant Use During Pregnancy and the Risk of Autism Spectrum Disorder in Children, 2016 170(2):117-124. http://jamanetwork.com/journals/jamapediatrics/fullarticle/2476187

Esposito, L. Antidepressants During Pregnancy: Stay on Them or Stop? U.S. News and World Report, Jan, 13, 2016.

Bérard, Anick, et al. Antidepressant Use During Pregnancy and Miscarriage. Canadian Medical Association Journal.

Interview with Leah Seidler, a psychotherapist and licensed clinical social worker practicing in San Francisco.

Murkoff, H. et al. What to Expect When You're Expecting. 4th Ed. Workman Publishing.

Depression After Delivery. FAQs. http://www.charityadvantage.com/depressionafterdelivery/faq.asp

Depression After Delivery. Antepartum Disorders. http://www.charityadvantage.com/depressionafterdelivery/antepartumdisorders.asp

Mayo Clinic. Depression in pregnancy. http://www.mayoclinic.com/

American Pregnancy Association. Depression During Pregnancy. http://www.americanpregnancy.org/pregnancyhealth/depressionduringpregnancy.html

Marcus, Sheila M. MD et al. Depressive Symptoms among Pregnant Women Screened in Obstetrics Settings. Journal of Women's Health, Vol. 12, No. 4, Pages 373-380.

Harvard Health Publications. Depression During Pregnancy and After. http://www.health.harvard.edu/hhp/article/content.do?name=WN0504b

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