Pregnant with Depression and Anxiety: Symptoms, Causes + 3 Coping Tools
If you're pregnant, chances are you've heard about postpartum depression. But did you know that many women also experience depression during pregnancy
Here's what you need to know about pregnancy and depression.
How common is depression during pregnancy ?
Pregnancy can be a time of joy — and stress. Research suggests that about 7% of pregnant women experience depression during pregnancy. Rates might be higher in low and middle income countries.
Depression, a mood disorder that causes a persistent feeling of sadness and loss of interest, is the most common mood disorder in the general population. The condition occurs twice as often in women as in men, and the initial onset of depression peaks during a woman's reproductive years.
Why does depression during pregnancy often go unrecognized ?
Some symptoms of depression, including changes in sleep, energy level, appetite and libido, are similar to symptoms of pregnancy. As a result, you or your health care provider might attribute these symptoms to your pregnancy, rather than depression.
Women might also be reluctant to talk to their health care providers about changes in moods during pregnancy, due to the stigma associated with depression. There's also a tendency to focus more on women's physical health during pregnancy, rather than mental health.
What are the risk factors for depression during pregnancy ?
Some risk factors for depression during pregnancy include:
Anxiety
Life stress
History of depression
Poor social support
Unintended pregnancy
Intimate partner violence
What are the signs and symptoms of depression during pregnancy ?
The signs and symptoms of depression during pregnancy are the same as those that occur with depression in the general population. However, additional clues that might indicate depression during pregnancy include:
Excessive anxiety about your baby
Low self-esteem, such as feelings of inadequacy about parenthood
The inability to experience pleasure from activities usually found enjoyable
Poor response to reassurance
Poor adherence to prenatal care
Smoking, drinking alcohol or using illicit drugs
Poor weight gain due to a decreased or inadequate diet
Thoughts of suicide
Some research suggests that depressive episodes occur more frequently during the first and third trimesters.
Why is treatment for depression during pregnancy important ?
If you have untreated depression, you might not seek optimal prenatal care, eat the healthy foods your baby needs or have the energy to care for yourself. You are also at increased risk of postpartum depression and having difficulty bonding with your baby.
Depending on the severity of your depression, treatment options might include psychotherapy or antidepressants in addition to psychotherapy.
What are the recommendations for screening for depression during pregnancy ?
The American College of Obstetricians and Gynecologists recommends that health care providers screen for depression and anxiety using a standardized tool at least once during pregnancy. During screening, your health care provider will likely ask questions from a standardized screening questionnaire, which consists of questions about mood and anxiety. Your answers are scored and your total score can be used to identify whether you have depression. Alternatively, your health care provider might ask you if, in the past month, you have been bothered by feeling down, depressed or hopeless or by having little interest in doing things.
There is limited evidence that screening to identify and treat depression during pregnancy improves outcomes. This might be due to variations in access to resources and appropriate treatment once depression has been diagnosed. However, screening for depression during pregnancy might provide some self-awareness of your risk of depression and anxiety.
If you think you might have depression during pregnancy, don't wait for a screening. Talk to your health care provider about how you're feeling and work with him or her to determine the next steps.
Non-Medicinal Approaches
The following treatments have been shown to help pregnant women with mild to moderate depression.
Psychotherapy, such as cognitive behavioral therapy (CBT), in which a skilled therapist teaches new approaches to managing thoughts and emotions
Omega-3 essential fatty acids, which are found in foods such as oily fish and walnuts, can act as a natural mood-booster
Light therapy, in which patients are exposed to artificial sunlight at specific times of the day to help relieve depression symptoms
Acupuncture, a Chinese practice that (in this case) involves placing tiny needles into areas of the body thought to influence mood
Antidepressants and Anti-Anxiety Medication
Medication is usually the most effective method for treating anxiety and depression. "But many doctors and mothers-to-be are afraid of the medications," says Gideon Koren, M.D,. director of the Motherisk program at the Hospital for Sick Children in Toronto. Their concerns? The majority of drugs have never been tested on pregnant women, so doctors are unsure of their effects on unborn babies.
The most commonly prescribed options include Wellbutrin and selective
serotonin reuptake inhibitors (SSRIs) such as Zoloft, Prozac, Lexapro, and Celexa. Some studies show a potential link to preterm birth, autism spectrum disorder, and short-term effects like fussiness and poor feedings. You and your doctor need to weigh the benefits of antidepressants against the risks.
Pregnancy and Antidepressants: A Guide for Moms-To-Be
If you're currently taking medication for depression or anxiety, consult your psychiatrist before you stop. A 2006 study published in the Journal of the American Medical Association showed that "women who discontinued an antidepressant around conception had a 68 percent chance of recurrence of depression during pregnancy, compared to 26 percent for those women who continued their medication," says Stephanie Ho, M.D., a reproductive psychiatrist in private practice in New York City. Of those that relapsed, the majority had to restart their medication during pregnancy.
What’s more, a February 2019 study reported that the prenatal vitamin EnBrace HR may effectively prevent depression during pregnancy. The results, published in Annals of Clinical Psychiatry, found that pregnant women taking EnBrace HR had a 40% lower rate of depression than those who completely discounted their antidepressant. “In this study, EnBrace HR was investigated for depressive relapse prevention and for acute treatment of Major Depressive Disorder (MDD) in women planning pregnancy or during pregnancy,” according to the report. “The efficacy observed in this study confirms that Rx EnBrace HR, an all-natural, nutritional pre- and post-natal vitamin with methylfolate is an effective, safe option for treating and preventing depression in pregnancy and was well tolerated by patients.” EnBrace HR has no side effects, and it also provides protection against conditions like spina bifida, congenital disorders, neural tube defects, and miscarriage.
Finding Support and Specialists
If you're pregnant and you're having depression or anxiety symptoms, talk to your OB-GYN or midwife. She should be able to treat you directly, or connect you with the appropriate mental health care provider. These organizations can also offer confidential help:
Postpartum Support International will connect you directly to a local coordinator who can help you find local resources, offer support, and give you tips on managing mood and anxiety disorders during and after pregnancy (www.postpartum.net).
The MGH Center for Women's Mental Health offers credible information on the risks of untreated depression during pregnancy, as well as evaluation and treatment options (www.womensmentalhealth.org).
