Hope During Prenatal Depression

You’re probably familiar with the idea of postpartum depression. It’s something a lot of moms experience, and that healthcare providers regularly screen for.

In the past couple of decades, postpartum depression has become widely recognized as a risk for new moms. Healthcare providers have increased screenings for depression after childbirth. It’s more intense than the so-called “baby blues” that many women experience after giving birth.

If you’ve experienced postpartum depression, then you know that it can cloud your experience of new motherhood, shrouding those newborn days with anxiety, sadness, or numbness in the midst of fatigue and transitions. But, did you know that about half of postpartum depression cases actually begin during pregnancy?

Depression during pregnancy doesn’t tend to be talked about as often as postpartum depression. Maybe that’s because some of its symptoms—such as changes in sleep and appetite, or worrying about the baby—are often attributed to pregnancy itself.

Prenatal depression is sometimes called antenatal or perinatal depression. It is a very real and common condition, and it can take a toll on both mother and child during (and often after) pregnancy.

Defining Prenatal Depression

Depression is defined as “a mood disorder that causes a persistent feeling of sadness and loss of interest.” When this disorder occurs during pregnancy or after the baby is born, it is called prenatal depression.

(It’s worth noting that “prenatal depression” is a broad term that many experts use to refer to depression both during and after pregnancy. Some of the research referred to in this article applies to both prenatal and postpartum depression, but for the purposes of this article we will be using the term “prenatal depression” to refer to depression during pregnancy unless otherwise indicated.)

The Mayo Clinic reminds us that depression “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.” It’s easy to see, then, why pregnant women are an at-risk population for this disorder.

Depression During Pregnancy

Whether a pregnancy is planned, hoped for, prayed for, or a surprise, it is usually expected to be a joyful time in a woman’s life. Milestones are celebrated, and there are usually family and cultural traditions surrounding the new life.

Each woman is different in how she feels about pregnancy, but having depression while pregnant always has negative impacts. A woman whose pregnancy wasn’t planned may be at a higher risk for prenatal depression, but even planned, longed-for pregnancies carry a risk for developing a mood disorder.

A lack of awareness about the reality of prenatal depression (especially how common it is) can lead to feelings of guilt and shame, which makes depression worse, creating a self-fulfilling prophecy.

The other component that can make prenatal depression more complex is that treatment options affect both the mother and the child. Many women are reluctant to resort to commonly prescribed medication for depression because, understandably, they don’t want to risk detrimental effects to their unborn child.

But, there are treatments available for prenatal depression, including but not limited to relatively safe medication options. If you think you or someone you know may have prenatal depression, keep reading to find out more about the condition and what the treatment options are.

Symptoms of Depression During Pregnancy

Here are some of the most common symptoms of depression during pregnancy. Some of these symptoms apply to anyone with depression, and some are specific to depression during pregnancy:

• Changes in appetite, possibly leading to inadequate weight gain
• Not following a recommended prenatal care schedule
• Not enjoying activities that are usually enjoyable
• Excessive worrying about the unborn child
• Generalized anxiety
• Sadness
• Suicidal thoughts
• Use of illicit substances
• Low self-esteem and feelings of inadequacy
• Changes in sleep patterns

As you read through this list, you may recognize that some of these symptoms, such as appetite and sleep changes, are common to pregnancy, even in the absence of depression. This is why prenatal depression can be difficult to recognize or diagnose.

Prenatal depression is linked to postpartum depression, difficulty bonding with the baby postpartum, cognitive and emotional delays for the child, and challenges for the family as a whole. Some research has noted that prenatal depression can be more severe than postpartum depression, despite a heavier societal emphasis on the postpartum stage.

Contributing Factors

Researchers estimate that 14-23% of pregnant mothers have depression while pregnant. The onset of prenatal depression is linked to depression prior to pregnancy, especially if it was already being treated with medication.

The earlier prenatal depression is identified and treated, the better the outcome will be for both mother and child, possibly even preventing or minimizing postpartum depression.

What leads to the development of depression during pregnancy? Experts have identified numerous risk factors that may contribute, including:

• A history of depression and anxiety
• Unintended pregnancy
• Socioeconomic standing
• General life stress
• Interpersonal or relationship conflict
• Intimate partner violence

For pregnant women who are known to be at a higher risk for prenatal depression, early screening and treatment options may help reduce the risk of adverse outcomes.

Preventing Depression During Pregnancy

Treating depression during pregnancy is the second best place to start. The best place to start is before the onset of depression. In the ideal situation, a woman will be in a healthy place physically, mentally, and emotionally before becoming pregnant.

But this is real life, and pregnancy doesn’t always occur under ideal circumstances. If a woman knows that she has depression already, this doesn’t mean she shouldn’t have a child; it does, however, mean she has the opportunity to go into pregnancy equipped and informed about her condition, and aware of the treatment options available to her.

What about a woman who doesn’t have depression prior to pregnancy? If women are aware that they are at heightened risk for developing depression during pregnancy, they may be able to identify the signs and seek support sooner than they otherwise would.

The American College of Obstetricians and Gynecologists recommends at least one screening for depression during pregnancy. Although the effectiveness of this screening has not been proven, it’s at least a good step to take. One study proved therapy, including Cognitive Behavioral Therapy and interpersonal therapy, to be effective at preventing depression in high-risk pregnant patients.

Treating Depression During Pregnancy

Non-Medical Options

What are the options other than medication to treat depression during pregnancy?

• Counseling or various forms of therapy. Christian counseling for depression during pregnancy can be a good place to start. In a compassionate and life-affirming environment, you can be open about the struggles you’re facing and explore the coping mechanisms available to you.
• Social support. This factor is imperative in mental and emotional health for moms both during and after pregnancy. Counseling can play a role in providing social support, but a network of family and friends makes a big difference as well.
• Self-care. One study found that integrative yoga reduced depressive symptoms. Other coping mechanisms include exercise, being outside, and general stress reduction.

Medical Options

Non-medical options sometimes fall short, yet pregnant mothers and healthcare providers are often reluctant to use medication for treating depression due to the inherent risks involved. A 2011 meta-analysis found that psychological intervention can have a significantly helpful effect, especially since many women are reluctant to use medication while pregnant or breastfeeding.

Yet medication is recommended as the first resort during medium to severe cases of prenatal depression. There are risks of birth defects and newborn withdrawal symptoms, yet the risks are comparatively low, and prenatal depression carries its own risks.

Each individual mother and healthcare provider must weigh the risks and benefits of medication together. SSRIs are generally considered safe for use during pregnancy.

Hope for Pregnancy Depression

Prenatal depression is a unique mood disorder since the risks to the unborn child must be weighed, both in the effect the disorder will have on the child as well as treatment options. But, while medication always carries risks, moms should be encouraged that there are treatment options that have been proven to be effective.

There are options and you do not have to suffer in silence. The earlier you can recognize and get support for your depression during pregnancy, the more you will increase the chance of a healthy outcome for both you and your child.