Pregnant and Depressed?

Find the Support You Need By Heather Johnson Durocher

Like most expectant moms who experience highs and lows throughout their pregnancy, Rachel* chalked up her bad moods to her physical state and looming life changes. Already the mother of a 6-month-old, during her second pregnancy, she found herself feeling increasingly overwhelmed and unhappy about becoming a mother again. Still, Rachel didn't believe her negative outlook would last long. "I never considered that I was depressed," she says. "I contributed it to hormones."

But Rachel's sadness didn't ease as she had hoped. Instead, it grew more serious and family members urged her to seek help. Like many women – more than the number of those who suffer from postpartum depression, according to a recent study – Rachel was experiencing depression during pregnancy.

While depression following the birth of a baby often makes headlines, depression during pregnancy isn't as well known. But according to a 2001 study of more than 9,000 mothers during and after pregnancy, symptoms were more common during pregnancy than after. Some evidence suggests that mood during pregnancy may affect the unborn child, according to the study published in the British Medical Journal. As a result, the studies' authors called for more emphasis to be put on understanding, detecting and treating depression during pregnancy.

Parenting and pregnancy expert Ann Douglas says dealing with life changes and a lot of physical discomforts at the same time contribute to depression during pregnancy.

"It's just not the picnic you thought it would be," explains Douglas, a mother of four who is the author of 15 books including The Mother of All Pregnancy Books (January 2002). "Even if you were really gung ho about becoming a parent, there is still a lot of adjustment."

Feeling guilty about any negative thoughts during pregnancy doesn't help the situation, Douglas adds. "Everybody always expects you to be totally euphoric throughout your total nine months of pregnancy. (But) when you're suffering extraordinary depression – you could feel unfit for motherhood."

The solution, as tough as it may be, is to seek help. "Definitely you need to talk your feelings through with people who understand. It has nothing to do with your fitness as a mom – you need to get lots of support."

The sooner you receive help, whether in the form of counseling, medication or a combination of both, the better off you and your baby will be, agrees Margaret Howard, Ph.D., clinical director of Women & Infants Hospital's Day Program in Providence, R.I. The program provides services for postpartum or pregnant women with depression, obsessive-compulsive disorder, anxiety, or mild psychosis.

Expectant moms who are depressed are less likely to take their prenatal pills and make their prenatal doctor visits. They may turn to cigarettes, alcohol or drugs. "Depressed women tend to not take good care of themselves and that's not good for the fetus," Dr. Howard says. And left untreated, the depression could continue after the baby is born.

Rachel acknowledged that she wished she'd sought help sooner. But as an obstetric nurse, she felt ashamed of her depression.

"Most people view this as some sort of weakness or just do not believe it at all," says Rachel. "But I am a much better nurse because of this, because I really pay attention to patients who have histories of depression or signs of it in the hospital."

Experts suggest watching for the following symptoms of depression:

• Insomnia or excessive sleep;
• Changes in energy (low energy levels, feeling unmotivated);
• Feelings of inadequacy, guilt, hopelessness;
• Inability to take pleasure in things that are normally pleasurable;
• Suicidal thoughts;
• Difficulty making decisions;
• Fear of being left alone;
• Desire to run away;
• Panic attacks;
• Feeling that life is out of control;
• Eating disturbances (other than typical morning sickness).

"When these persist consistently, for two weeks or longer, that's when we begin to consider a diagnosis of mood disorder or major depression," Dr. Howard notes.

Women of childbearing age are at a high risk of suffering from depression, according to Dr. Howard. While it's not clear why this is, Dr. Howard says women at this time in their life are more likely to experience their first episode of depression. In general, women are twice as likely to become depressed at any time in their life compared to men, she notes.

"At least for a sub-group of women, there seems to be a connection between hormonal fluctuations and mood states," Dr. Howard explains.

The risk increases, Dr. Howard adds, if they've experienced depression prior to getting pregnant or they have a family history of depression. In addition, "there's some suggestion that women with an unwanted pregnancy or women with very poor social support are at higher risk for developing depression."

Other factors – such as financial worries or marital or job problems – can contribute to the depression.

Medication during pregnancy is tricky, experts say. Certainly the idea is to help the mom as much as possible while at the same time limiting possible negative effects on the fetus. Some medications have been linked to birth defects, which rules those out, while others have little or no data available on potential effects, explains Douglas. Physicians typically will err on the conservative side, she says.

"Luckily, we live in a day and age that a depression can be treated and managed well," she explains. "If the doctor recommends a drug, they really should take it. No doctor is going to put a pregnant woman on a drug she shouldn't be on."

And if you aren't pregnant yet but are concerned about depression when you do conceive? "What I always tell people is if you have a history of depression, you want to have a discussion with your doctor ahead of time," Douglas says. "Ideally, you should get on emotionally stable ground before pregnancy."

If medication isn't the answer for you, other options are available. A physician could recommend local resources, such as counseling services or support groups. Listings for this type of assistance may also be found in the phone book or online. An expectant mom's spouse or partner also may need support of this kind as they are struggling with their loved one's depression.

"Don't wait before seeking treatment; it can only improve your life," adds Rachel. "There is that shame, but you have to get over it to care for your children."

*Name has been changed

Want to see more?

• Recognizing and Treating Antepartum Depression
• How to be Pregnant and Proud
• The Unenthusiastic Partner: Coping with Lack of Support in Pregnancy
• Talk About It!

About the Author: Heather Johnson Durocher is a contributing writer from northern Michigan, where she lives with her husband, Joe, and their daughter, Emma.