Depression in pregnancy or antepartum depression is an often under diagnosed condition. The perception is that pregnancy is always a time of joy and exuberant anticipation. While that is true for many, about 10 percent of pregnant women experience profound sadness, anxiety, fatigue, and hopelessness often associated with clinical depression. Understanding the nature of depression before, during, and after pregnancy can help women make healthy decisions that will help them and their developing fetus have a positive pregnancy outcome.
Foremost, it is important to recognize the symptoms of depression during pregnancy so you can share this information with your healthcare provider. Many women chalk up symptoms to change in hormones or anxiety about their pregnancy and don’t understand that their symptoms may actually be attributed to depression. Common symptoms include anxiety, difficulty with concentration, and persistent sadness lasting more than two weeks. Other symptoms are loss or increase in appetite and sleeping too little or too much, as well as losing interest in activities you would normally enjoy. Severe depression may involve thoughts of suicide.
Often antepartum depression is simply a continuation of a pre-existing diagnosis of depression, and sometimes depression can begin during pregnancy. Some circumstances can contribute to depression in pregnancy and these can include: complications in pregnancy, relationship issues, previous pregnancy loss, stressful events while pregnant, infertility problems, and family or personal history of depression. If a woman is diagnosed and/or is being treated for depression prior to becoming pregnant, she should discuss this with her healthcare provider. Together they can discuss the best options for planning treatment during pregnancy.
Treatment for antenatal depression is not very different than treatment while not pregnant. Depending on the symptoms and severity of depression, your healthcare provider may recommend psychotherapy or talk therapy, support groups, or medication. Sometimes a combination of treatments may show the best results. Treatment for depression is extremely important during pregnancy because the health of both mother and baby can be impacted. Depression can lead to the inability for a woman to adequately care for herself and her developing fetus. Untreated depression can lead to making poor health decisions. For instance, untreated antepartum depression has been linked with poor nutrition, increased tobacco and alcohol, and illicit drug use during pregnancy. Depression in pregnant women has been associated with increased premature birth, low birth weight, and infant developmental growth. Studies of antepartum depression are scant, but it is possible that the stress hormones that accompany depression could cause these negative birth outcomes. Additionally, we know that postpartum depression and the more serious postpartum psychosis are much more common in women with antepartum depression.
For these reasons, it’s extremely important to come up with treatments that will mitigate the condition. Psychotherapy involves cognitive behavior therapy where you meet with a trained professional, such as a physician or licensed therapist, to identify negative thinking and work on strategies to overcome these thoughts or beliefs. In instances where psychotherapy is not helping, your provider may recommend the addition of antidepressants or continuation of their use if you are already taking them.
Historically, pregnant women were not treated with antidepressants because of concerns about birth defects to the fetus. However, more recent studies show they are generally safe when prescribed and taken at proper dosing. If a woman is taking antidepressants before becoming pregnant, she should share that information with her healthcare providers. Common antidepressants such as fluoxetine (Prozac or Sarafem), sertraline (Zoloft), and bupropion (Wellbutrin), escitalopram (Lexapro) are considered safe to take during pregnancy.
It is extremely important to always discuss all medications you are taking with your healthcare provider because serotonin reuptake inhibitors (SSRI’s) can pose particular risks if you stop taking them abruptly. If you and your healthcare provider decide it is best to stop these medications, it should be done gradually by weaning off the medication. These same protocols apply to breastfeeding mothers. Unfortunately, the studies about the effects of antidepressants in pregnancy are not numerous, but physicians will discuss the pros and cons of taking any medications during pregnancy and breastfeeding to optimize the health of the mother while minimizing the risks to the fetus.
All pregnant women should try to take steps to optimize their health, but it can be particularly important for women who have depression. A healthy diet with plenty of fruits, vegetables, and lean proteins can help to sustain both a growing baby but can also help with your mental health.
Prenatal vitamins are essential during pregnancy, and your healthcare provider is a great resource for recommending the proper supplements you should take through your pregnancy. Likewise, regular exercise can help to reduce stress. Walking and yoga are excellent ways to improve your cardio and get those endorphins up. Getting adequate sleep is important to help minimize depression. Meditation and mindfulness training can be used as excellent ways to help combat depression.
However, the most important tool is open dialogue with your healthcare provider. Unlike blood pressure or other physical symptoms that are easily measured in your provider’s office, your mental and emotional well being must be conveyed to them. Open and frank discussion about your emotions, fears, and stresses can be difficult. However, knowing that depression in pregnancy can be effectively treated should encourage women to speak up and seek the help they need.