In a time when she should have been elated, recently pregnant Elizabeth Dowling believed a period of astonished, semi-excited incredulity, swiftly followed by an overwhelming sense of apprehension and fear. “That fear spiraled out of control to the point where I denied I had been pregnant,” she recalls. “I was always expecting for a spontaneous miscarriage, I couldn’t work normally, and I only felt like I couldn’t handle this in my life.” An assistant director of public issues in Nyc, Dowling was made to take off time from work due to her constant state of depression, and she eventually went on drug.

Though there’s no dearth of focus to postpartum depression, which develops in the weeks and months following a woman gives birth, serious or less recognized, but no less real, is antepartum depression, or depression during pregnancy. According to the American Congress of Obstetricians and Gynecologists, 14 to 23 percent of pregnant women experience some kind of depression.

Depression during pregnancy has several causes. “Pregnancy is a joyous time, but it may also be a time of great psychological disturbance,” says Stephan Quentzel, MD, a psychiatrist at Beth Israel Hospital in New York City who specializes in women’s psychiatry. “It stirs the pot in a girl’s own psychology as she goes from truly being a kid into a parent,” he says. “The hormonal changes that happen and a previous history of depression can also contribute to depression during pregnancy.” Disruptions in sleep and eating habits and bodily changes that take place can be factors, too.

You’re at a larger risk for depression during pregnancy if you’ve experienced depression in the past; such was the case with Dowling, who’s had a history of episodic depression and anxiety since she was 18. “Pregnant women who experience domestic violence or physical abuse, those using drugs or alcohol, and those with substantial financial, work, or house stressors will also be at an increased threat of antepartum depression,” says Farzaneh Sabi, MD, an obstetrician/gynecologist in the Kaiser Permanente Gaithersburg Medical Center in Maryland.

Recognizing Depression During Pregnancy

“The apparent symptoms of depression during pregnancy might be subtle, and they’re frequently hard to differentiate from other pregnancy-associated symptoms,” Dr. Sabi says. “They include dearth of energy and concentration, low mood, reduced libido, insomnia or tiredness, change in appetite, feelings of helplessness and hopelessness, anger or irritability, loss of interest in daily tasks, dangerous conduct — such as drinking alcohol or using drugs during pregnancy — and suicidal or homicidal thoughts.”

If you (or your household members) suspect depression, see a health care professional when you can. “You do not desire to delay addressing depression because you believe it’s a price of being pregnant,” Dr. Quentzel says. “Like most other disorders, the sooner you treat depression, the better the result — thus declaring depression during pregnancy to your obstetrician, primary care physician, or mental health professional is an important first step.”

Treating Depression During Pregnancy: Weighing the Advantages and Costs

There are a few worries about treating antepartum depression with drugs — top among them the danger of birth defects, Quentzel says. Some antidepressants have been proven to increase the likelihood of withdrawal symptoms in the infant at birth, and have already been linked to a condition called pulmonary hypertension, or high blood pressure in the arteries of the infant’s lungs.

“But what’s often underappreciated is the cost of not treating depression during pregnancy, and just using a careful analysis can we determine if therapy with drugs is the very best response,” he says.

Among the serious potential effects of not treating depression during pregnancy are:

• Poor prenatal care. “A woman with depression during pregnancy is more inclined to use substances like tobacco and alcohol and not as likely to stick to your wholesome regimen that makes for a wholesome pregnancy, like appropriate nutrition, hydration, and exercise,” Quentzel says.
• Risk of blood clots. “Pregnancy raises risk of blood clots, and depression also increases this hazard, which means you’ve got a double-whammy,” he clarifies.
• Low birth weight. “Stress hormones of depression can cause the placenta to age quicker, just just like a president who comes out of the office four years after seeming considerably older,” Quentzel says. This aging causes reduced flow of blood and nutrients to the infant, leading to a lowered birth weight.
• Postpartum depression. “The number one risk factor for postpartum depression is depression during pregnancy,” Quentzel says.

Picking the Safest Treatment for Antepartum Depression

You have choices if your health care team determines that treatment is in order. First to consider are non-drug treatments such as psychotherapy, meditation, yoga, eating a balanced diet, and receiving regular exercise. Many hospitals and medical centers offer health education classes dedicated especially to expecting parents, as well as individual and group therapy sessions for women with depression

“In some women, these non-drug treatments work too as antidepressants,” Quentzel says. “Nevertheless, herbal drugs to take care of depression during pregnancy are frowned upon because they haven’t been well-examined.”

In case you want medication to get your condition in check before you got pregnant or if you’re taking drugs for depression, there remain alternatives. “As a rule of thumb, the selective serotonin reuptake inhibitor (SSRI) class of antidepressants has a good track record in not creating problems in the infant,” Quentzel says. The SSRI that appears to be safest is sertraline (Zoloft), and the one with the greatest danger is paroxetine (Paxil), he says.

If at all possible, attempt to go into a pregnancy as healthy as you can, so you could potentially prevent taking the baby drugs for depression, Quentzel adds.

The Very Best Possible Health for Mom and Baby

Depression during pregnancy is treatable, as well as a significant factor in treatment success is recognizing depression symptoms. “A mother’s acknowledgement of her melancholy and motivation to get better are essential for the treatment process to work,” Quentzel says.

This was certainly true for Dowling — her acknowledgement of her depression symptoms early on in her pregnancy was instrumental in her ultimate recovery. She spoke up after she understood the severity of her depression. She went in her second trimester on a low dose of Zoloft, before her baby girl was born stopping it shortly. She did not develop postpartum depression, as so many girls with depression during pregnancy do.

“Some doctors advocate tapering the antidepressant during the third trimester to reduce risk of pulmonary hypertension and withdrawal, but this could raise the chance of postpartum depression,” Quentzel notes. “Again, you have to weigh the expense and benefits for the individual situation.”

Dowling, however, is living proof that girls with depression during pregnancy can become emotionally secure, excellent parents. “It’s difficult to believe I felt the way I did when I was pregnant because I am so filled with love, gratitude, and delight about the life we’ve created, and for my daughter’s future,” Dowling says. “I want other women with depression during pregnancy to know they are not alone in their battles, plus they are able to move forward and be loving, capable mothers.”