Back to Blog List

Pregnancy-Related Depression

     

It is a common belief that pregnancy is an event that women have planned and looked forward to for months, if not years. In fact, half of all pregnancies are unplanned. Pregnancy can, therefore, be a challenging and tumultuous time for a woman just when our society expects her to be exuding excitement and joy. For many pregnant women, feeling depressed is embarrassing and even shameful, and they are afraid that other people will judge them negatively. As a result, too many women suffer in silence.

Pregnancy is a time of monumental physical and emotional change. So you may have trouble recognizing whether you’re experiencing the normal effects of pregnancy or seeing signs of depression. For example, all women feel more fatigued at various points during their pregnancy, and about two-thirds experience some nausea and loss of appetite. Hormonal changes may leave you feeling fleeting symptoms such as mood changes or increased worrying.

If you are experiencing depression or an anxiety disorder, however, you will have some of the following symptoms:

  • feeling sad and perhaps crying most days;
  • losing interest in the things you usually enjoy;
  • eating either too much or too little;
  • not being able to feel a connection with the developing baby;
  • either staying in bed and sleeping too much or feeling so much extra energy that you think you don’t need to sleep;
  • feeling that you’re failing to do a good job with the pregnancy;
  • feeling so bad that you drink alcohol or use drugs that could harm your baby’s development; or
  • having bad thoughts about hurting yourself or the developing baby.

pregnancy.jpgIf you’re experiencing an anxiety disorder, you will have some of the following symptoms:

  • worrying all the time that something is terribly wrong with your pregnancy or the developing baby despite normal test results;
  • having a physical anxiety attack that you feel in your body;
  • being afraid to leave the house; worrying all the time about catching germs; or
  • repeating the same actions over and over again.

If your disorder is severe, you may feel that your mind is getting stuck on scary or disturbing thoughts, or you may be hearing voices.

Many pregnant women will have fleeting anxiety or mood swings, but these symptoms must be present for at least two weeks and result in a decrease in your normal functioning to qualify as a disorder. If you have any of these signs, it’s important to let your caregivers know. Often the hardest thing to do is admit that you’re struggling—but it’s also the most important thing you can do for yourself and your developing baby.

You are at higher risk of developing these disorders if you have a personal or family history of either illness, if you’re experiencing significant stress or financial pressures while you’re pregnant, if you don’t have a good social support system, or if you experience complications during your pregnancy.

Many depressed pregnant women go undiagnosed and either untreated or undertreated. At your prenatal checkups, your obstetrician or midwife should screen for these symptoms either in person or by questionnaire. Both the APA and the American College of Obstetricians and Gynecologists (ACOG) have established guidelines recommending that all women be screened during pregnancy for depression and anxiety disorders, but studies have shown that under half of obstetricians screen their patients. And screening alone is not enough: it must lead to appropriate follow-up and treatment

Recent studies have shown that untreated depression during pregnancy has significant consequences. Women with untreated depression or anxiety disorders during pregnancy have higher rates of preterm births and low birthweight infants. Moreover, babies born to these mothers may have higher rates of developmental and behavioral problems throughout childhood and adolescence.

If you are one of the women who develops depression or an anxiety disorder during your pregnancy, there is good news for you: there are effective treatments for these problems. Studies show that therapy and social support significantly help most women; individual psychotherapy, cognitive behavioral therapy (CBT), pregnancy support groups, telepsychiatry or Healthy Start home visits, and social supports to correct financial or social constraints can all be useful.

Some pregnant women with depression may need medication to restore their health and functioning. Historically, studies have drawn different conclusions about whether antidepressants like SSRIs harm fetal development. In the past three years, promising new data shows that the risk posed by some medications becomes almost negligible when researchers control for other risk factors and confounding variables in their studies.

Ultimately, the decision about whether to use psychiatric medication during pregnancy—and if so, what type—should be an individual determination that you and your physicians make based on your own unique history and the most up-to-date drug safety information. Do not abruptly stop taking a psychiatric medication without first talking to your psychiatrist.

If you are experiencing signs of depression or anxiety, the most important thing you can do for yourself and your developing baby is to tell your doctors about your symptoms to find out if you need treatment. You are no less of a mother for having these difficulties. These are medical illnesses that are not your fault—and with help and support, you will get better.

References

  • Gaynes BN, Gavin NI, Meltzer-Brody S, et al. Perinatal depression: prevalence, screening accuracy, and screening outcomes. Evid Rep Technol Assess (Summ). 2005;(119): 1-8. full text
  • Gavin NI, Gaynes BN, Lohr KN, Meltzer-Brody S, Gartlehner G, Swinson T. Perinatal depression: a systematic review of prevalence and incidence. Obstet Gynecol 2005;106(5, pt 1):1071-1083. abstract
  • Pearson RM, Carnegie RE, Cree C, et al. Prevalence of prenatal depression symptoms among 2 generations of pregnant mothers. The Avon Longitudinal Study of Parents and Children.JAMA Netw Open. 2018;1(3):e180725. full text
  • abstract
  • Unintended pregnancy. Centers for Disease Control and Prevention website. Updated September 15, 2017. website
  • La Rocca-Cockburn A, Melville J, Bell M, Katon W. Depression screening attitudes and practices among obstetrician-gynecologists. Obstet Gynecol. 2003;101(5, pt 1):892-898. abstract
  • Hadley EE, Le V, Swen T, et al. Screening and treatment practices of OB/GYN providers for postpartum depression and anxiety [4L]. Obstet Gynecol.2018;131(suppl 1):p130s. abstract
  • Huybrechts KF, Bateman BT, Palmsten K, et al. Antidepressant use late in pregnancy and risk of persistent pulmonary hypertension of the newborn. JAMA 2015;313(21):2142-2151. full text
  • Payne JL, Meltzer-Brody S. Antidepressant use during pregnancy: current controversies and treatment strategies. Clin Obstet Gynecol. 2009;52(3):469-482. full text
  • Grigoriadis S, Graves L, Peer M, et al. Maternal anxiety during pregnancy and the association with adverse perinatal outcomes: systematic review and meta-analysis. J Clin Psychiatry.2018;79(5):pii:17r12011. full text
  • Jarde A, Marias M, Kingston D, et al. Neonatal outcomes in women with untreated antenatal depression compared with women without depression: a systematic review and meta-analysis. JAMA Psychiatry2016;73(8):826-837. full text

     

AnxietyDepressionPatients and Families

 

Comments (0) Add a Comment

 

Add a comment

Enter the text shown in this image:*(Input is case sensitive)
* - Only comments approved by post author will be displayed here.