Recognizing and Treating
Antepartum Depression

How do you know if you are among those women or simply experiencing the usual ups and downs of pregnancy?

You're pregnant. You page through books and browse the Web for articles about "what to expect" in the joyful months ahead. Everyone you meet pats your belly and gushes about the excitement you must be feeling. But what if excitement and joy are far from what you are experiencing? What if you can barely bring yourself to get off the couch or find yourself crying day after day?

Certainly, fatigue and moodiness are normal symptoms of pregnancy; many a pregnant woman have burst into tears over a Kleenex commercial or have been too tired to do much but pick up the remote control. But according to Marcia Starkman, a nurse psychotherapist specializing in prenatal and postpartum depression, 10 percent of pregnant women suffer from something far more serious than the normal symptoms of pregnancy: antepartum depression, or depression that occurs before the baby is born. Unlike its cousin, postpartum depression, or depression that occurs after the baby is born, antepartum depression is rarely discussed or described. Since many of its symptoms are similar to "normal" pregnancy woes, antepartum depression is a difficult condition to recognize. "During the course of pregnancy, many physicians only focus on the woman's and baby's physical well-being, without inquiring about the mom's emotional health," Starkman says.

Women seek Starkman's help when they realize they are not meeting society's expectation that pregnancy should be one of the happiest times of their lives. "They may feel very stressed. They may also exhibit signs of typical clinical depression. In extreme cases, they may even consider suicide."

How do you know if you are among those women or simply experiencing the usual ups and downs of pregnancy? Examine your behavior. Depression is often marked by one or more of the following:

• Lack of motivation or interest
• A change in appetite
• Changes in sleep patterns
• Helplessness or hopelessness
• Significant weight loss or gain
• Excessive fatigue
• Lack of concentration or focus
• Extended periods of sadness
• Suicidal thoughts

If you exhibit any of these symptoms for more than two weeks at a time, you probably can't blame your feelings on the normal mood fluctuations of pregnancy and should seek help, suggests the National Mental Health Association.

Peggy, a working mother from Austin, Texas, was miserable throughout the final weeks of her first pregnancy. She blamed her misery on everything from her job to the death of her mother. She finally started feeling better six months postpartum and put the experience out of her mind. But a few months after, she became pregnant with her second child. "I was a basket case and swore I'd see someone about it as soon as the baby came," she says. She suffered through the pregnancy and went on to suffer from postpartum depression as well. It was months before she finally sought help. "[My doctor] asked me the standard screening questions for depression, which, of course, fit me like a glove. Shortly after, I was seeing a therapist and trying Prozac. That was four years ago, and it changed my life."

Antepartum depression can be treated with medication, therapy or a combination of both. In the New England Journal of Medicine, Dr. Elisabeth Robert says drugs of any type should not be taken in pregnancy unless the risks to the mother and baby without the drug outweigh the risks of taking the drug. But if you consider that women suffering from antepartum depression are more likely to ignore the advice of their health care provider, eat poorly and abuse substances, sometimes medication to treat depression does make the most sense. Starkman says, "I may decide, in my professional opinion, that a woman needs a support group and/or may benefit from antidepressant or anti-anxiety medication. In [my] case, as a nurse who cannot prescribe medication, I either refer her to a psychiatrist or family doctor."

While antepartum depression is a real condition that can affect your health and the health of your unborn child, many women never seek treatment at all. A pregnant woman named Jan realizes she is experiencing depression, but hesitates to talk to her doctor.

"I rarely feel motivation to do the things I used to love. I feel ashamed most of the time and have not even admitted this to my doctor."

According to Trudy, who started feeling depressed when she was about 5 months pregnant, "My doctor said [antepartum depression] was really very common, but that most women don't tell their doctors. She suggested that we treat it with antidepressants and even researched what drug was best to take without harm to the baby."

Lisa, a 17-year-old who is expecting her first child in a few weeks, is another woman who sought help when feelings of depression started affecting her daily routine. She spoke to her midwife, who "took my feelings seriously. Now, at the end [of my pregnancy], I'm starting to feel a little better and look forward to motherhood."

Treating antepartum depression now may also prevent postpartum depression later. Starkman indicates that women with antepartum depression are two and a half times more likely to experience postpartum depression within six weeks of giving birth.

If you notice that signs of antepartum depression are affecting the enjoyment of your pregnancy, find support immediately from family, friends and care providers. Your doctor may not notice symptoms of depression unless you bring them to her attention, and your emotional health is just as important as your physical health to the baby inside you.

Want to see more?

• Pregnant and Depressed? Find the Support You Need
• Postpartum Depression: Preventing Tragedy
• Postpartum Depression: When Having a Baby Gives You More Than the Blues
• Talk about it!