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."