Women and Depression

pregnancy | postpartum | menstrual | menopause

Depression in Pregnancy

Why am I depressed?
Depression can be confusing for women when it occurs during pregnancy. They can't figure out why they feel bad during a time when they should feel good. However, up to 10% of women will experience depression during pregnancy. The most likely women to have depression during pregnancy have a personal or family history of depression. While it was once thought that the high levels of estrogen and progesterone during pregnancy "protected" women from depression, more recent studies suggest that this is not the case. Pregnancy does not cause depressive symptoms to be more severe.

What are the symptoms of depression during pregnancy?
The symptoms of depression during pregnancy are: two or more weeks of depressed mood, decreased interest or pleasure in activities, change in appetite, change in sleep patterns, fatigue or loss of energy, difficulty concentrating, excessive feeling of guilt or worthlessness, thoughts of suicide, extreme restlessness and irritability. Symptoms may be ignored or misdiagnosed because they are confused with symptoms of pregnancy. The more common ones include changes in appetite, sleep or energy. Many women suffer needlessly because they do not ask for help. When depression is severe, women may not eat properly, get adequate rest, or receive prenatal care. These factors may contribute to premature and low birth-weight infants.

What can I do about depression during pregnancy?
You have already taken one of the most important steps in helping your depression - you have come for help. Fortunately, depression is treatable. Believing one's condition is "incurable" is part of the hopelessness that accompanies depression. This way of thinking is a symptom of depression and will improve with treatment.

Treating depression is just as important as treating any other health concern during pregnancy. Without treatment, the depression can get worse or be harmful to the baby or mother. Studies also show that postpartum depression is more likely to occur if depression during pregnancy goes untreated. Therefore, it is important to get help while you are pregnant. There are many treatment options available to help depression.

Medication -
Research indicates that many effective, well-tolerated antidepressant medications are safe for use during pregnancy. Discuss taking antidepressant medication during pregnancy with your health care provider, including the risks to you and the baby if your depression goes untreated. If you decide not to take medication during pregnancy, ask about starting medication after the birth of your baby to prevent postpartum depression. Many medications are safe for use during breast-feeding.

Therapy -
Therapy involves talking with a trained professional (psychologist, psychiatrist, clinical nurse or social worker) on a short term (12-20 weeks) or a long-term basis and can take many forms. Two types of therapy are particularly effective for depression. Cognitive Behavioral Therapy (CBT) targets negative thoughts and behaviors that tend to worsen depressed mood and teaches better ways of thinking and behaving. Interpersonal Therapy (IPT) helps a person deal with changing roles and other stressors by learning how to communicate more effectively with others.

Alternative medicine, herbal remedies and dietary supplements -
There has been rising interest in the use of herbs and dietary supplements for the treatment of depression. St John's Wort (hypericum perforatum) has been the most common of these. However, scientific studies of these alternative forms of treatment have so far been short-term and not well controlled. There is no uniformity of dose or amounts and types of ingredients because the Food and Drug Administration does not regulate them. Be sure to tell your health care provider if you are taking an herbal or dietary supplement. Some of them may negatively interact with antidepressant medication or other medications you are taking.

Is there anything else that I can do?
Along with professional treatment, there are several other things that you can do to help yourself feel better.

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 also 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. The first step is to identify the main sources of stress in your life and find the most effective way to cope with those (such as avoiding them or using relaxation techniques). Identify stressors that you are putting on yourself (trying to be "perfect", doing too much). Set priorities and let unnecessary tasks wait.

Avoid Stress -
Address any additional stressors that may be present in your life. Risk factors for depression during pregnancy can be single marital status, poor health, drinking during pregnancy, marital conflict, limited social support, and a greater number of other children are. If one or more of these conditions are present in your life, be sure to address them with your health care provider.

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.

Give yourself a break -
The initial demands on a new mother are exciting and tremendous. Feeling better takes time. You will feel like yourself again and better able to handle the everyday pressures as well as the demands of pregnancy and motherhood. Be realistic about the demands and expectations you make on yourself.