Coping With Depression During Pregnancy

Christine Doherty Ashley, currently six months pregnant, realizes that her first trimester was fraught with depression. Now, with the perspective of an improved mood, Ashley recalls being particularly judgmental of her doldrums, questioning, "Am I allowed to say I'm sad or that I hate how I feel?" Nausea kept her on the couch and logistics kept her isolated: She was a high school teacher on summer break, had just moved to a new town, and she and her husband were not yet sharing the news because, at 41, she was at higher risk of early miscarriage. "It was a perfect storm," she explains.

Video: Learning About Depression

Depression in pregnancy not only causes mom to suffer; it can also pose health risks to the baby. Research published today in the journal Human Reproduction found that women with symptoms of depression were more likely to experience a preterm birth. The greater the severity of depression symptoms, the greater the likelihood of early delivery. This research adds "strong evidence that depression during pregnancy is bad for the fetus," says lead study author De-Kun Li, reproductive and perinatal epidemiologist at Kaiser Permanente's Division of Research in Oakland, Calif., "This should not be dismissed anymore." Preterm birth, write the study authors, is the leading cause of infant mortality and medical expenditures for newborns.

Contrary to the belief that all expectant moms are buoyed by their own joyous anticipation, the reality is that pregnancy offers no protection against depression. A woman's overall risk of depression peaks during childbearing years, and "roughly 12 to 14 percent of mothers will experience depression during pregnancy," says Cindy-Lee Dennis, researcher at the University of Toronto and associate professor of nursing with an appointment in the psychiatry department. The biggest risk factor for symptoms while pregnant, Dennis explains, is a previous history of depression.

Such depression may also be linked to a baby being born at a lower birth weight with elevated levels of cortisol (a stress hormone) and changes in attention or alterations in electroencephalography (an infant brain test), says Diana Dell, assistant professor of psychiatry and obstetrics-gynecology at Duke University Medical Center. These issues can affect health even into adulthood. "Being anxious or depressed is not [going to have] a neutral impact on a developing fetus," says Dell.

But silence often accompanies such melancholy. Fear of being judged a less-than-capable mother or labeled mentally ill can lead to quiet suffering, says Dennis. It wasn't until Ashley's depression lifted that she broached the topic with her husband. To ward off postpartum depression, she's enlisted his help, telling him, "You need to ask me [because] sometimes I can't say it; I judge myself." In fact, depression during pregnancy is the top risk factor for developing postpartum depression.

But treatment options exist. To alleviate prenatal depression, lifestyle elements are quite significant, experts agree, including stress reduction, eating well, drinking enough of water, consistently getting good sleep, and exercising. Depending on the depression's severity and cause, physicians may recruit cognitive behavioral therapy, couples therapy, bright light therapy, or antidepressant medications. While some research suggests certain antidepressants may pose risks to the baby, some have been shown to be safer than others. Dell weighs such risks against the dangers of a fetus developing inside a mother who cannot function because she's depressed and not caring for herself well. An untreated depressed or anxious pregnant woman, says Dell, "generates some pretty noxious chemicals" that are not good for a fetus.

For those who feel motivated enough to get some exercise, a known mood enhancer, doing so is plenty safe. "Anything equivalent to brisk walking is fine," James Pivarnik, kinesiology professor at Michigan State University and coauthor of the section on activity in pregnancy and after delivery in the 2008 Physical Activity Guidelines released this month by the Department of Health and Human Services. The new recommendation for pregnant women and those who recently delivered is at least 150 minutes of moderate activity per week. Keeping this schedule may also reduce the risk of preeclampsia and gestational diabetes. Pivarnik notes that women should be careful not to overheat—like using a fan during indoor workouts—which can be problematic for the fetus.

But a woman's mood may be too low for physical activity. This is when the support of friends and family can have a significant impact, says Dennis. It is critical, she explains, that the mother, partner, and family are all aware of the risks and symptoms of depression in pregnancy, including feelings of emptiness, sadness, hopelessness, irritability, crying excessively; trouble sleeping, or sleeping all the time. Many women assume this is all part of being pregnant, but persistent symptoms are not. Both Dennis and Dell say the Edinburgh Postnatal Depression Scale, though designed for the postpartum period, can be a helpful tool for expectant mothers, too, and is widely available online and is also available here. Dennis also recommends the Motherisk program website, affiliated with the University of Toronto and intended to provide information on drug, chemical, and disease risks in pregnant women.

Mothers need not feel guilt about depression in pregnancy or about the chosen treatment—pharmacological or otherwise, experts emphasize. "This is a brain disease, it's not a character flaw, not a pull-yourself-up-by-the-bootstraps kind of thing," says Dell, "You don't have to tough it out."