When Pregnancy and Depression Collide

Being pregnant and knowing your little bundle of joy is on the way is supposed to be one of the happiest times of your life. Unfortunately for some women, pregnancy brings a wide range of emotions on the other end of the spectrum including fear, stress, hopelessness, confusion and depression.

The National Institute of Mental Health reports that one in eight women will experience some form of clinical depression during her lifetime.

“It is estimated that about 14 to 23 percent of pregnant women experience depression during pregnancy, or antepartum depression, and five to 25 percent experience depression postpartum,” says Courtney A. Seacat, M.D., an OB/GYN physician at INTEGRIS Health Edmond.

What is antepartum depression?

Depression is a mental health or mood disorder that can affect how you feel and think. It can even affect how you’re able to go about daily activities like sleeping, eating and working. Unlike postpartum depression, which affects women after they have given birth, antepartum depression affects women while they are pregnant.

When women are pregnant, they experience many natural hormonal imbalances that can affect their mood and cause feelings of anxiety and depression. While these mood fluctuations are a normal side effect of pregnancy, feelings of unhappiness or hopelessness that persist and last for more than two weeks can signal a larger problem.

Unfortunately, both antepartum depression and postpartum depression frequently go undiagnosed by women who attribute their symptoms to pregnancy-related hormonal changes and don’t seek proper treatment. “Many women do not talk about these feelings of depression,” Dr. Seacat says. “They feel guilty or ashamed of these feelings since they are ‘supposed’ to be happy because they just had a baby.”

While depression itself does not have a direct impact on a developing baby, a depressed mother is less likely to have the desire to properly care for herself or her baby. This can lead to both pregnancy complications and birth defects.

Signs and symptoms of depression during pregnancy

Several of the symptoms of depression, such as having trouble sleeping or being fatigued, are normal and are to be expected for pregnant women. However, when these are paired with other symptoms such as persistent sadness, a loss of interest in activities you once found enjoyable or having persistent feelings of guilt and worthlessness, it may be a sign of clinical or antepartum depression.

“Depression may go unnoticed because changes in sleep, appetite and libido are usually attributed to normal pregnancy and postpartum change,” Dr. Seacat says. “This is why screening during and after the pregnancy is so important. I always ask my patients how they are doing and about any anxiety or depression symptoms.”

The following are common signs and symptoms of depression during pregnancy. If you have experienced a combination of the following symptoms persistently for at least two weeks, talk to your prenatal care provider or mental health professional. Only they can truly diagnose depression.

• Persistent sadness
• Changes in eating habits, such as wanting to eat all of the time or not wanting to eat at all
• Having difficulty concentrating on everyday tasks
• Sleeping too much or too little
• Recurring thoughts of suicide or hopelessness
• Anxiety
• Feelings of guilt or worthlessness
• Being sad or feeling empty for most of the day
• Having little to no energy and feeling fatigued throughout the day
• Frequent unexplained or uncontrollable crying
• Losing interest in activities you once enjoyed

Causes of depression during pregnancy

Depression affects many people for many different reasons. However, some of the possible triggers or causes of antepartum depression are detailed below.

“Sometimes there is no exact cause,” Dr. Seacat says. “Women who are at increased risk for depression or postpartum depression are women with baseline anxiety and/or depression, life stressors, lack of social support, unintended pregnancy, Medicaid insurance, domestic violence, lower income and education and smoking.”

• Family or personal history of depression
• Stressful life events
• History of abuse or trauma
• Infertility treatments
• Relationship problems
• Previous pregnancy loss
• Pregnancy complications
• Lack of support
• Young pregnancy (under the age of 20)

Coping with depression

Without treatment, clinical depression is unlikely to go away on its own. However, for those that seek help and recognize the signs, there are many effective options for treating and coping with depression.

“Early intervention and treatment are key,” Dr. Seacat says. “It often involves a team including the OB/GYN, pediatrician, mental health clinician and primary care provider. Counseling is one of the first things to do. Being able to identify and acknowledge your feelings of depression, and know that a lot of your thoughts and feelings are the depression talking, is very helpful.”

Dr. Seacat shares that medications, such as antidepressants, are also an important part of treatment and that a single medication is favored over multiple. Mixing multiple antidepressant medications during pregnancy may intensify any side effects and put you and your baby at a higher risk for complications.

The following are other non-medicinal treatments that have shown to be effective in helping pregnant women with depression.

• Support groups made up of women going through the same situation can be helpful for those wish to discuss their feelings in a safe and welcoming environment.
• Foods rich in omega-3 fatty acids, such as eggs, dark green leafy veggies, olive oil or walnuts, are proven to help treat depression and are natural mood boosters.
• Light therapy, in which depression patients are exposed to artificial lights that are meant to mimic natural sunlight, has shown to relieve depression symptoms.
• Acupuncture, the method of stimulating specific points on the body with thin needles, is often used to treat depression by placing the needles in spots thought to influence mood and emotions.
• Exercise can naturally increase your serotonin levels and decrease cortisol levels, both of which have been linked to lessening depression symptoms.

Is it safe to take antidepressants while pregnant?

There is much debate surrounding whether or not antidepressants are safe for women to take while pregnant, as well as the long-term effects they may have on newborn infants. However, some antidepressants, such as selective serotonin reuptake inhibitors (SSRIs), are proven to be low-risk to your baby. Examples of SSRIs include Prozac (fluoxetine), Zoloft (sertraline) and Celexa (citalopram).

“Overall, there is limited evidence of dangerous effects on the fetus and effects during breast feeding,” Dr. Seacat says. “There is some limited information out there that there may be an increased risk of heart defects associated with some SSRI exposure in the first trimester (during the organ formation). Exposure to these medications in late pregnancy may be associated with short-term complications to the baby such as jitteriness, mild respiratory distress, weak cry and possible NICU admission.”

Women with mild to moderate depression may be able to manage their symptoms through other methods. However, for pregnant women suffering from severe depression, both their mental health provider and prenatal care provider can discuss using antidepressants as a treatment method.

“All in all, using medication is an individual decision and should be made between the patient and doctor after weighing risks and benefits,” Dr. Seacat says. “Although medications have potential side effects, worsening depression or anxiety during pregnancy can be even more detrimental to the pregnancy, fetus and baby.” 

If you’re experiencing symptoms of depression during your pregnancy, don’t be afraid to seek help and contact your health care provider about what you are experiencing. INTEGRIS Mental Health offers a confidential and anonymous online mental health screening tool if you are unsure whether or not a consultation with a mental health professional would be helpful.