Depression during pregnancy

Highlights

• Is it common to suffer from depression or anxiety during pregnancy?
• How can tell if I'm at particular risk for depression or anxiety during pregnancy?
• What are the symptoms of depression?
• What are the symptoms of anxiety?
• How are depression and anxiety treated during pregnancy?
• How can I help prevent depression and anxiety during pregnancy?
• What can I do to ward off postpartum depression?

Is it common to suffer from depression or anxiety during pregnancy?

Although pregnancy is often portrayed as a time of great joy, that's not the reality for all women. At least one in ten pregnant women suffers from bouts of depression.

For years, experts mistakenly believed that pregnancy hormones protected against depression, leaving women more vulnerable to the illness only after the baby was born and their hormone levels plunged. They now believe that the rapid increase in hormone levels at the start of pregnancy can disrupt brain chemistry and lead to depression.

Hormonal changes can also make you feel more anxious than usual. Anxiety is another condition that can and should be treated during pregnancy.

Depression and anxiety may go undiagnosed because women often dismiss their feelings, chalking them up to the temporary moodiness that often accompanies pregnancy. So don't be shy about letting your doctor or midwife know if you feel low. Your emotional health is every bit as important as your physical health. And in fact, it can affect your physical health.

Research has shown, for instance, that depression and anxiety can increase your risk for preterm labor. Untreated, these conditions can hamper your ability to care for yourself and your developing baby.

How can tell if I'm at particular risk for depression or anxiety during pregnancy?

Some common risk factors are:

• Personal or family history of depression or anxiety. If you've struggled in the past with depression or extreme anxiety (or, to a lesser extent, if depression runs in your family), you're more likely to become depressed now that you're expecting. Even if you've never experienced a full-blown bout of depression or anxiety but have a tendency to get down or anxious during stressful or uncertain times, you may be more susceptible to depression now.
• Relationship difficulties. If you're in a troubled relationship and talking things out as a couple isn't working, get counseling. Don't make the mistake of assuming that your baby's arrival will make everything rosy. A newborn will only add to the strain on your relationship — so don't put off seeking professional advice on repairing your relationship now, particularly if you're the victim of abuse.
• Fertility treatments. If you had trouble getting pregnant, chances are you've been under a lot of stress. And if you've gone through multiple fertility procedures, you may still be dealing with the emotional side effects of months or even years of treatments and anxiety-laden waiting. On top of that, now that you're pregnant, it's not uncommon to be terrified of losing the baby you worked so hard to conceive. All of these make you more prone to depression.
• Previous pregnancy loss. If you've miscarried or lost a baby in the past, it's no wonder you're worrying about the safety of this pregnancy. And if the loss was recent or if you've miscarried several times in the last year, you may not have had time to fully recover emotionally or physically. And as with fertility treatments, if you're dealing with health restrictions you're more vulnerable to depression and anxiety.
• Problems with your pregnancy. A complicated or high-risk pregnancy can take an emotional toll, particularly if you're enduring weeks of bedrest or numerous genetic tests. (Women who are pregnant with twins or more often fall into this category.) The strain of having to endure difficult procedures combined with fear about your baby's well-being is often difficult to shoulder. Likewise, not being able to work or do other things you're used to doing makes it tougher to maintain your emotional balance. Talk to your caregiver about caring for your emotional well-being. Taking proper steps now will also reduce your risk for problems after giving birth — and help you to better enjoy the baby you've worked so hard to bring into the world.
• Stressful life events. Financial worries? Relocating? Contemplating switching jobs? Planning to stay home after years of working? Any major concerns or life changes such as these — as well as a breakup, the death of a close friend or family member, or a job loss — can send you into a serious funk.
• Past history of abuse. Women who've survived emotional, sexual, physical, or verbal abuse may have low self-esteem, a sense of helplessness, or feelings of isolation — all of which contribute to a higher risk for depression. Pregnancy can trigger painful memories of your past abuse as you prepare for parenthood, and the loss of control over your changing body may mirror the helplessness you experienced when you were abused.
• Other risk factors. If you are young, are single, or have an unplanned pregnancy, your risk of depression is also higher.

What are the symptoms of depression?

Some of the symptoms below, such as fatigue or trouble sleeping, are common among healthy women during pregnancy. But when they're combined with a sense of sadness or hopelessness or they interfere with your ability to function, depression is probably at least partly to blame.

If you feel unable to handle your daily responsibilities or are having thoughts of harming yourself, call your doctor or midwife immediately for a referral to a counselor. Seeing a therapist or psychiatrist isn't an indication of weakness. On the contrary, it shows that you're willing to take the steps necessary to keep your baby and yourself safe and healthy.

If you've experienced three or more of the following symptoms for more than two weeks, talk to your healthcare provider about whether you should see a therapist:

• A sense that nothing feels enjoyable or fun anymore
• Feeling blue, sad, or "empty" for most of the day, every day
• It's harder to concentrate
• Extreme irritability or agitation or excessive crying
• Trouble sleeping or sleeping all the time
• Extreme or never-ending fatigue
• A desire to eat all the time or not wanting to eat at all
• Inappropriate guilt or feelings of worthlessness or hopelessness

Finally, 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.

What are the symptoms of anxiety?

Call your doctor or midwife for a referral to a therapist if you feel overwhelmed and nervous every day or are having:

• Panic attacks. These can come on with no warning and include a 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.

How are depression and anxiety treated during pregnancy?

Both psychotherapy and antidepressant medication can be used to treat these conditions during pregnancy. Ask your doctor or midwife for a referral to a psychologist or psychiatrist, or check with your insurance company for a list of mental health providers. Don't try to treat yourself by taking St. John's wort or other remedies. The safety of these remedies during pregnancy is unknown, and they're not an effective substitute for professional help.

How can I help prevent depression and anxiety during pregnancy?

Depression and anxiety are biochemical conditions, so you may not be able to avoid them altogether if you're prone to them. But taking care of yourself emotionally can help ease your symptoms and keep your spirits up.

• 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.
• Bond with your partner. Make sure you're spending plenty of time with your partner and nurturing your relationship. Take a vacation now if you can. Do what you can to strengthen your connection so that once the baby comes, you'll have that bond to rely on.
• Talk it out. Air out your fears and worries about the future with your partner, friends, and family.
• Manage your stress. Don't let frustration build up in your life. Find ways to take care of yourself emotionally. Take breaks, get plenty of sleep, get some exercise, and eat well. If you find anxiety creeping in, try taking a pregnancy yoga class or practicing meditation.

What can I do to ward off postpartum depression?

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.