When Depression Strikes During PregnancyTracy B. McGinnis
“Congratulations!” That’s what so many of us hear when we announce we’re expecting a baby. Suddenly we’re surrounded by smiling faces eager and excited to help us plan projects like our nursery to offering us advice on everything from getting baby to sleep to rekindling our sex lives. But one piece of advice that many pregnant women may be looking for isn’t there—how to deal with prenatal depression.
During pregnancy women experience many emotions—excitement, nervousness, and anxiety about what to expect throughout pregnancy and after Baby arrives. Throughout recent years, women have become more comfortable sharing the not-so-happy times and admitting their weight gain, describing aches and pains, and swapping stories about how their waters broke to how they handled painful hemorrhoids. But depression both during pregnancy and postpartum is still whispered about behind closed doors, although recent studies and outspoken celebrities are bringing the subject to the forefront.
“More and more the stigma is decreasing,” says Dr. Shoshana S. Bennett, a licensed psychologist, and co-author of Beyond the Blues: A Guide to Understanding and Treating Prenatal and Postpartum Depression. “Women are more apt to come forward and get help themselves. Celebrities have helped to de-stigmatize ‘mental illness’ as has having health providers that women can trust.”
You’re Not Alone: Prenatal Depression Statistics
Because it is difficult to pinpoint whether a woman is experiencing normal pregnancy-related mood changes or something more serious, the symptoms of prenatal depression have often been overlooked. Recent news reports indicating the negative effects prenatal depression has on pregnant women and their unborn babies, including low birth weight and preterm labor, are bringing the matter to the forefront where it can be examined and discussed.
“Pregnancy is not always a happy, glowing experience. Anywhere from 10 to 20 percent of women get depressed during their pregnancy, and one out of five are more serious cases,” says Dr. Bennett. After her second bout with undiagnosed postpartum depression in 1987, Dr. Bennet founded Postpartum Assistance for Mothers, has counseled thousands of women around the country, and has been featured on programs such as 20/20. She stresses the need for women to understand the risks and symptoms of prenatal depression and share them with someone they trust so they can receive an individualized assistance plan.
Women at Risk: Triggers of Prenatal Depression
“Depression can occur at any time—before, during, or after pregnancy,” says Dr. Catherine Roca, chief of Women’s Programs with the National Institute of Mental Health. “We do not know the exact cause; there are likely environmental as well as biological factors.”
Women in general face a greater risk of depression during their lives than men. The American Association of Pregnancy reports that as many as one out of four women will experience depression at some point during their lifetime. Ten to 20 percent suffer some sort of depression during pregnancies and one-quarter to one-half of those will have major depression. Dr. Roca adds that recent studies show depression in pregnancy is more common than once thought. “We’re not exactly sure why this occurs. We do know that big shifts in hormones do play a role.” She adds that prenatal depression is a risk factor for developing postpartum depression, as about half of women with postpartum depression had signs of depression during pregnancy.
Who’s vulnerable to depression? Women who struggle with the following are at a heightened risk:
- Prior history of depression
- Low income
- Physical or chemical changes (such as having low levels of serotonin, the brain chemical that controls mood)
- A history of abuse
- Complicated pregnancies and/or miscarriages
- Poor partner support
- Troubles handling stress, either personal or professional
Signs of Prenatal Depression
How do you know if what you’re feeling is part of the normal emotions of pregnancy or if it’s something more serious? “The signs and symptoms of depression during pregnancy and postpartum are essentially the same,” says Dr. Roca.
Signs of depression can include but are not limited to:
- An inability to enjoy life
- Crying spells or tearfulness
- Disrupted sleep (or sleeping too much)
- Increased or decreased appetite
- Decreased energy
- Thoughts of harming others, including the baby
- Impaired concentration
- Thoughts of suicide or not wanting to live
- Low self-esteem
- Loss of interest in things you once enjoyed
- Feelings or guilt or worthlessness
Symptoms of depression can often be the same or similar to emotions that occur during pregnancy or in caring for a newborn, making depression more difficult to identify. “For example—sleep is often normally disrupted when taking care of a newborn and appetite changes can be a normal part of pregnancy. Also, a number of women suffer from anxiety in the prenatal period (excessive worrying about the baby, panic attacks, and so on), and these symptoms can occur along with depression,” explains Dr. Roca.
If women experience symptoms it is important that they seek help. “The right questions need to be asked to see if it’s normal or needs more attention,” says Dr. Bennett. “Specifics about the mother like, is she taking good care of herself or doing the bare minimum to get by? Self medicating can also be a sign of something more serious.”
There are things you can do to minimize your chances of experiencing postnatal depression:
- Let your family know how you are feeling
- Join a support group
- Exercise regularly
- Get enough sleep
- Eat well
Some women may not be able to avoid prenatal depression. Sometimes no matter what you do, people get depressed. It’s important to understand that it’s not your fault if you do find yourself battling with depression.
“Since stress and a lack of social support can contribute to depression in general it would make sense that increasing social support and reducing stress could potentially be beneficial,” says Dr. Roca. Dr. Bennett concurs, adding that having a plan in place and making sure that Mom is receiving the proper amount of nutrients, like protein and omegas which help keep serotonin levels even, is helpful. “Scheduling things for themselves, getting together with friends and family is important,” says Dr. Bennett. “Scheduling this time so you know you’ll be having a respite is important.”
There is no universal screening for prenatal depression by physicians. “There has been some effort to raise awareness of primary care physicians about prenatal depression and some clinics use screening tools, such as the EPDS (Edinburgh Postnatal Depression Scale),” says Dr. Roca.
The American Pregnancy Association (APA) says support groups, private psychotherapy, medication, and light therapy are all treatments for depression during pregnancy. “The particular circumstances need to be discussed with the woman’s physician,” says Dr. Roca. “It is not a simple matter of ‘what is safe’ because it depends in large part on the severity of depression, what kind of treatment someone has responded to in the past, etc.”
The FDA warns that babies exposed to certain medications used to treat depression may be at greater risk of developing birth defects. In a December 2005 alert, the FDA reports that, “Early results of new studies show that paroxetine (Paxil) increases the risk of birth defects, particularly heart defects, when women take it during the first three months of pregnancy.” The report says that paroxetine should usually not be taken during pregnancy, but for some women who have already taken the drug the benefits of continuing with it may outweigh the potential risk to the baby.
While the FDA provides no definite answers to long-term effects of other medications that treat depression such as Zoloft, they are continuing with drug evaluations, research and labeling of certain medicines. You should discuss all risks with your physician and determine what is right for you.
“I’m never in favor of just giving medicine,” says Dr. Bennett. “Even though medicine can be helpful, the doctor should make sure [the patient] is talking with someone. She needs to process what is happening to her and take a look at her wellness plan.” Dr. Bennett says the use of medicine ultimately depends on the severity of symptoms.
Medication can be required in some cases to help people engage in therapy. Research has found that interpersonal therapies, focusing on relationships, and cognitive therapies—ones that focus on how people affect their moods, are successful means of treatment for depression.
“Interpersonal therapy focuses role transitions which occur in pregnancy,” says Dr. Roca. General counseling can also be helpful; with the most important thing being getting access to treatment. Meetings with women’s healthcare providers that highlight prenatal depression could result in an increase of screenings and treatments options. “Small business grants have been given to companies working on modules for professionals,” says Dr. Roca. “Continuing education is being offered for lactation specialists, nurses, and other healthcare professionals to determine how to screen and what to do if someone screens positive.”