Depression During Pregnancy

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Are you pregnant? Are you wondering why this is not the greatest time of your life?

Pregnancy has traditionally been considered a time of emotional well being, but recent studies suggest that between 10% and 20% of women suffer from mood or anxiety disorders during this time. Contrary to popular belief, pregnancy hormones do not protect a woman from becoming depressed. For years, pregnant women were told that high levels estrogen and progesterone protected them against depression, and that they would only be more vulnerable after the birth of their baby. It is now believed that the rapid increase in hormone levels at the start of pregnancy can disrupt brain chemistry and lead to depression.

More importantly, recent research demonstrates that untreated maternal depression during pregnancy can have substantial prenatal risks. It can lead to poor nutrition, drinking, smoking, and suicidal behavior, which can then cause premature birth, low birth weight, preeclempsia, and developmental problems. A woman who is depressed often does not have the strength or desire to adequately care for herself or her developing baby, which is why problems arise.

Why is depression often overlooked in pregnancy?

There are many reasons why depression during pregnancy is often overlooked and not diagnosed properly.  First, many people attribute symptoms of depression during pregnancy as just another type of hormonal imbalance. Also, symptoms of depression can be difficult to recognize or treat because some of the normal pregnancy changes cause similar symptoms. Such symptoms include tiredness, problems sleeping, stronger emotional reactions, and changes in body weight. It is also good to know that anemia and hypothyroidism (which can happen during pregnancy) can both cause a lack of energy and symptoms similar to depression.

But what is depression anyway?

Depression can be described as feeling sad, blue, unhappy, miserable, or down. Most of us feel this way at one time or another for short periods. But true clinical depression is a mood disorder in which feelings of sadness, loss, anger, or frustration interfere with everyday life for an extended time. Depression can be mild, moderate, or severe. The degree of depression influences how you are treated.

Symptoms of depression

The symptoms of depression during pregnancy include:

  • Two or more weeks of depressed mood (feeling blue, sad, or “empty”) for most of the day, every day
  • Decreased interest or pleasure in activities
  • Change in appetite (eating too much or loss of appetite)
  • Change in sleep patterns, (trouble sleeping or sleeping too much)
  • Fatigue or loss of energy, difficulty concentrating
  • Excessive feeling of guilt or worthlessness
  • Thoughts of suicide
  • Extreme restlessness, irritability or excessive crying

 

When you are investigating whether or not you are depressed, make sure to have your doctor rule out potential physical causes. For example, anemia and hypothyroidism can both cause a lack of energy and symptoms similar to depression.

If you feel unable to handle your daily responsibilities or are having thoughts of harming yourself, call your doctor immediately.

Special Consideration

Mood swings with cycles of depression alternating with periods of an abnormally high spirits – including increased activity, little need to sleep or eat, racing thoughts, inappropriate social behavior, or poor judgment — are signs of a serious condition called bipolar disorder, which requires immediate attention. Call your caregiver if you have those symptoms.
Sometimes, the symptoms experienced can be described as anxiety more than depression. Talk to your provider if you feel overwhelmed and nervous every day or are having:

  • Panic attacks. These can come on with no warning signs and can include symptoms like, racing heart, lightheadedness or faintness, sweaty palms, breathlessness, and feeling like you’re having a heart attack or are about to pass out.
  • Frequent, recurrent concerns about your or your baby’s health or a frequent feeling that something terrible is about to happen.

 

RISK FACTORS

There are several factors which may put you at risk for depression during pregnancy. It is a good idea to be aware of one’s risk to be able to take proper steps to reduce them.

During pregnancy, these factors may increase a woman’s chance of depression:

risk

  • Personal history of depression or anxiety
  • Family history of mental illness
  • Relationship (marital) difficulties
  • Little support from family and friends
  • Anxiety about the fetus
  • Problems with pregnancy
  • Previous pregnancy loss
  • Fertility treatments
  • Difficulties with previous birth
  • Stressful life events
  • Financial problems
  • History of abuse
  • Being young or single
  • History of substance abuse
  • Unplanned pregnancy

 

TREATMENT

Why seek treatment?

Depression that goes untreated can have potential dangerous risks to the mother and her baby. A woman who is depressed often does not have the strength or desire to adequately care for herself or her developing baby, which is why problems arise. If a woman is feeling depressed and as a result is not eating, not sleeping, feeling stressed or anxious — these could have an adverse impact on a developing fetus. Untreated depression can interfere with a woman’s ability to care for herself, impair nutrition, increase the use of tobacco, alcohol, and drugs, lead to premature labor and low birth-weight babies, and interfere with bonding feelings with her unborn child. This means that getting treatment is important for both the mother and the baby.

What can I do about depression during pregnancy?

The good news is that depression can be treated. Medications and psychotherapy are the most widely used treatment modalities.

The general consensus is that psychotherapy or group therapy can be an effective type of treatment for mild to moderate depression. In fact, a recent survey (APA, 2007) found that 65% of American practitioners would choose psychotherapy as a first-line treatment for a pregnant woman with new, major depression. However, for severe cases, a psychopharmacotherapy consultation is recommended. Many women are concerned that taking antidepressants may harm their baby but given the risks of untreated depression, the risks of taking medicine have to be weighed against the severity and the risks of depression. It is a decision that women need to discuss carefully with their doctors.

Important: If you are taking an antidepressant and find that you are pregnant, do not stop taking your medication without first talking to your health provider. Call him or her as soon as you discover that you are expecting. It may be unhealthy to stop taking an antidepressant suddenly.

A note about herbal remedies:
There has been rising interest in the use of herbs and dietary supplements for the treatment of depression with St John’s Wort being the most common of these.  As a society, we are often drawn to “natural remedies” over pharmaceutical drugs. It is very important to understand that we still know very little about the effect of St. John’s Wort or other herbs on the fetus. It is highly recommended to not take this herb or other herbal remedies without first speaking to your health provider. Some of them may negatively interact with antidepressant medication or other medications you are taking.

For more information on the effects of medications in pregnancy,  The Organization of Teratology Information Services (OTIS), (866) 626-6847 provides fact sheets on pregnancy and specific antidepressants.

Talk Therapy

Therapy involves talking with a trained professional (psychologist, psychiatrist, clinical nurse or social worker). Recent evidence suggests that two types of psychotherapy, cognitive behavioral and interpersonal therapy, may be effective for alleviating depression during pregnancy.

Cognitive Behavioral Therapy
This type of psychotherapy targets negative thoughts and behaviors that tend to worsen depressed mood and teaches better ways of thinking and behaving. Therapy helps to learn new ways to react to situations and challenge one’s preconceptions.

Interpersonal therapy
Interpersonal therapy focuses on how your relationships with other people play a role in your depression. It focuses on practical issues. It helps one learn how to recognize unhealthy behaviors and change them.

Things you can do now!

Both depression and anxiety are biochemical conditions, so you may not be able to avoid them altogether, especially if you are prone to them. Taking care of yourself emotionally can help ease your symptoms and keep your spirits up.

Support
It is not uncommon during pregnancy to feel fatigued, whether or not one is depressed. It is very important that you get support for yourself and communicate your needs to others. Ask for help with housekeeping, preparing meals and other daily tasks. Don’t feel you have to do it all yourself.

Exercise
The benefits of exercise in depression are well documented. Be sure to discuss any changes you make in your exercise routine with your health care provider. Exercise helps treat depression by releasing the body’s mood-elevating compounds, reducing the depression hormone cortisol, providing perspective on life, providing a feeling of accomplishment, enhancing self-esteem, and increasing levels of serotonin (a neurotransmitter found to be key in the development of depression). It doesn’t matter what you do as long as you do something physical for 20 to 30 minutes three times a week or more. Even exercising as little as 10 minutes a day has been found to have beneficial effects. Walking is perhaps the most accessible form of exercise because it costs nothing and you can start it immediately.

Stress Management
Depression can be made worse by stress. Pregnancy and the anticipated changes that come with the new baby add new stresses to a woman’s life. Learning to deal more effectively with stress may reduce depression.

  • Identify the main sources of stress in your life
  • Find the most effective way to cope with those (such as avoiding them or using relaxation techniques).
  • Identify other stressors that you are putting on yourself (trying to be “perfect”, doing too much).
  • Set priorities and let unnecessary tasks wait.

Don’t make any major life changes during pregnancy. Major changes can cause unneeded stress. Sometimes big changes cannot be avoided. When that happens, try to arrange support and help in your new situation ahead of time.
Consider taking a pregnancy yoga class or practicing meditation.

Promote sleep
Adequate sleep is important to promote a healthy pregnancy and prevent worsening of depression. Sleep is sometimes disrupted during pregnancy due to changing hormone levels and physical discomfort, especially as the baby grows bigger. Try different sleeping positions and bedtime “props” such as body pillows or extra pillows. Take care to keep your sleep cycle regular by going to bed and waking around the same time. Develop relaxing bedtime rituals such as reading or a warm bath. Take time to rest during bedtime hours, even if you aren’t asleep.

Dietary changes
Eating a well balanced diet and regularly scheduled meals is important. Be sure to follow the recommendations of your obstetrician or nurse midwife regarding additional caloric intake and dietary supplements such as vitamins, even if you don’t feel hungry. Decreasing refined sugar, caffeine, and chocolate may help symptoms. Use of calcium, and B vitamins (B6) may also benefit symptoms. Of course, avoidance of alcohol during pregnancy is essential.

Spend time with others
Depressed women often withdraw from others because they mistakenly feel they would not be good company. Being with others is another way to gain perspective, which helps with the symptoms of depression. Consider joining a support group for pregnant mothers or even a support group for others experiencing problems with depression.

Make time to do what you enjoy
Depressed women sometimes temporarily lose the ability to enjoy themselves. Avoiding enjoyable activities only makes this worse. Continue doing pleasurable activities even if you don’t feel like it. You will soon find that you have come to enjoy yourself again, at least for short periods.

Take it easy –
Resist the urge to pack in as many chores as you can before the baby comes. You may think you need to set up the nursery, clean the house, or work as much as you can before you go on maternity leave, but you don’t. Pencil yourself in at the top of your to-do list. You won’t have as much time for yourself once the baby’s around. Read a book, have breakfast in bed, or go for a nice long walk around the neighborhood. Choose something that makes you feel good. Taking care of yourself is an essential part of taking care of your baby.

Preparing for the “Fourth” Trimester

About half of women who suffer from depression during pregnancy go on to develop postpartum depression but getting treated during pregnancy can reduce your chances dramatically.

Here are a few other things you can do:

 

  • Get in the habit of taking care of yourself now so it becomes part of your routine. Plan ways to take breaks and get time off to rest once the baby comes.
  • Talk with your partner about how you’re going to divide the household responsibilities and care for each other as well as for your baby.
  • Build a support network now (made up of friends, family members, your partner, healthcare practitioner, or therapist) so that your helpers will already be in place when the baby arrives.
  • Start lining up help with cooking, cleaning, or baby care so you’ll be able to grab some much-needed time to shower, nap, or take a walk after the baby arrives.

DONA International (Doula Of North America) developed a Postpartum Plan to help expectant parents to prepare for the changes that the lack of sleep, recovery from the birth experience, and having an additional family member can have upon their lives and home. The Plan helps couple identify and set up their support network in advance.

All children deserve the chance to have a healthy mom. All moms deserve the chance to enjoy their life and their children. Don’t suffer alone…

Online Resources

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You can find out more about depression during pregnancy by contacting the National Women’s Health Information Center (NWHIC) at 1-800-994-9662 or the following organizations.

National Institute of Mental Health, NIH, HHS
Phone: (301) 496-9576
Internet Address: http://www.nimh.nih.gov
National Mental Health Information Center, SAMHSA, HHS
Phone: (800) 789-2647
Internet Address: http://www.mentalhealth.org
American Psychological Association
Phone: (800) 374-2721
Internet Address: http://www.apa.org
National Mental Health Association
Phone: (800) 969-NMHA
Internet Address: http://www.nmha.org
Postpartum Education for Parents
Phone: (805) 564-3888
Internet Address: http://www.sbpep.org
Postpartum Support International
Phone: (805) 967-7636
Internet Address: http://www.postpartum.net