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When Depression Strikes During Pregnancy
You're no doubt familiar with postpartum depression, but it turns out the baby blues can strike during pregnancy as well.
By Elizabeth Shimer Bowers
Medically Reviewed by Lindsey Marcellin, MD, MPH
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At a time when she should have been elated, newly pregnant Elizabeth Dowling felt a period of stunned, semi-excited disbelief, quickly followed by an overwhelming sense of dread and fear. “That fear spiraled out of control to the point where I denied I was pregnant," she recalls. "I was constantly hoping for a spontaneous miscarriage, I couldn’t function normally, and I just felt like I couldn’t handle this in my life.” An assistant director of public affairs in New York City, Dowling was forced to take time off from work because of her constant state of depression, and she eventually went on medication.
Though there's no lack of attention to postpartum depression, which develops in the weeks and months after a woman gives birth, less recognized, but no less real or serious, is antepartum depression, or depression during pregnancy. According to the American Congress of Obstetricians and Gynecologists, 14 to 23 percent of pregnant women experience some form of depression.
Depression during pregnancy has several causes. “Pregnancy is a joyful time, but it can also be a time of great psychological disturbance,” says Stephan Quentzel, MD, a psychiatrist at Beth Israel Hospital in New York City who specializes in women’s psychiatry. “It stirs the pot in a woman’s own psychology as she goes from being a child to a parent,” he says. “The hormonal changes that occur and a prior history of depression can also contribute to depression during pregnancy.” Disruptions in sleep and eating habits and bodily changes that take place can be factors, too.
You're at a greater risk for depression during pregnancy if you’ve experienced depression in the past; such was the case with Dowling, who's had a history of episodic depression and anxiety since she was 18. “Pregnant women who experience domestic violence or physical abuse, those who use drugs or alcohol, and those with significant financial, work, or home stressors are also at an increased risk of antepartum depression," says Farzaneh Sabi, MD, an obstetrician/gynecologist at the Kaiser Permanente Gaithersburg Medical Center in Maryland.
Recognizing Depression During Pregnancy
“The symptoms of depression during pregnancy can be subtle, and they are often hard to differentiate from other pregnancy-related symptoms,” Dr. Sabi says. “They include lack of energy and concentration, low mood, decreased libido, insomnia or fatigue, change in appetite, feelings of helplessness and hopelessness, anger or irritability, loss of interest in daily activities, reckless behavior — such as drinking alcohol or using drugs during pregnancy — and suicidal or homicidal thoughts.”
If you (or your family members) suspect depression, see a health care professional as soon as possible. “You don’t want to delay addressing depression because you think it is a cost of being pregnant,” Dr. Quentzel says. “Like most other diseases, the sooner you treat depression, the better the outcome — so announcing depression during pregnancy to your obstetrician, primary care physician, or mental health professional is an important first step.”
Treating Depression During Pregnancy: Weighing the Benefits and Costs
There are some concerns about treating antepartum depression with medication — top among them the risk of birth defects, Quentzel says. Some antidepressants have been shown to increase the chances of withdrawal symptoms in the baby at birth, and have been linked to a condition called pulmonary hypertension, or high blood pressure in the arteries of the baby’s lungs.
“But what is often underappreciated is the cost ofnottreating depression during pregnancy, and only with a careful analysis can we determine if treatment with drugs is the best answer,” he says.
Among the serious potential consequences of not treating depression during pregnancy are:
- Poor prenatal care.“A woman with depression during pregnancy is more likely to use substances like tobacco and alcohol and less likely to stick to a healthy regimen that makes for a healthy pregnancy, like proper nutrition, hydration, and exercise,” Quentzel says.
- Risk of blood clots.“Pregnancy increases risk of blood clots, and depression also increases this risk, so you have a double-whammy,” he explains.
- Low birth weight.“Stress hormones of depression can cause the placenta to age faster, just like a president who comes out of the office four years later looking much older,” Quentzel says. This aging causes reduced flow of blood and nutrients to the baby, leading to a lower birth weight.
- Postpartum depression.“The number one risk factor for postpartum depression is depression during pregnancy,” Quentzel says.
Choosing the Safest Treatment for Antepartum Depression
If your health care team decides that treatment is in order, you have choices. First to consider are non-drug treatments such as psychotherapy, meditation, yoga, eating a balanced diet, and getting regular exercise. Many hospitals and medical centers offer health education classes dedicated specifically to expecting parents, as well as individual and group therapy sessions for women with depression during pregnancy.
“In some women, these non-drug treatments work as well as antidepressants,” Quentzel says. “However, herbal medications to treat depression during pregnancy are frowned upon because they haven’t been well-studied.”
If you need medication to get your condition under control or if you were taking medication for depression before you got pregnant, there are still options. “As a general rule, the selective serotonin reuptake inhibitor (SSRI) class of antidepressants has a good track record in not creating problems in the infant,” Quentzel says. The SSRI that appears to be safest is sertraline (Zoloft), and the one with the biggest risk is paroxetine (Paxil), he says.
If possible, try to go into a pregnancy as emotionally healthy as possible, so you can potentially avoid taking medication for depression during the first trimester, the time of biggest risk to the baby, Quentzel adds.
The Best Possible Health for Mother and Baby
Depression during pregnancy is treatable, and a big factor in treatment success is recognizing depression symptoms. “A mom’s recognition of her depression and motivation to get better are vital for the treatment process to work,” Quentzel says.
This was certainly true for Dowling — her acknowledgement of her depression symptoms early on in her pregnancy was instrumental in her eventual recovery. After she realized the seriousness of her depression, she spoke up. She went on a low dose of Zoloft in her second trimester, stopping it shortly before her baby girl was born. She did not develop postpartum depression, as so many women with depression during pregnancy do.
“Some doctors recommend tapering the antidepressant during the third trimester to reduce risk of pulmonary hypertension and withdrawal, but this can raise the risk of postpartum depression,” Quentzel notes. “Again, you have to weigh the costs and benefits for your individual situation.”
Dowling, though, is living proof that women with depression during pregnancy can become emotionally stable, wonderful parents. “It’s hard to believe I felt the way I did when I was pregnant because I am so filled with love, gratitude, and excitement about the life we’ve created, and for my daughter’s future,” Dowling says.
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