By Annie Heath, CNM
There are times when we all feel down, have little energy, are anxious or overwhelmed. It's normal to feel this way occasionally, but if these feelings persist, they may indicate clinical depression. Depression affects approximately 19 million Americans each year, according to the Mental Health America (www.nmha.org). Depression is more common in women, and 1 out of 8 women develops clinical depression in her lifetime, according to a report from the American Psychiatric Association and the American College of Obstetricians and Gynecologists that was published in 2009 in the journal Obstetrics and Gynecology. The report suggests depression is most common in women ages 25 to 44, and for women who are pregnant, the incidence is higher: 14 to 23 percent of women experience depression during pregnancy.
The article supports what I have witnessed in my midwifery practice: Left untreated, depression can affect a woman's enjoyment of her pregnancy. It can also place her at increased risk for postpartum mood disorders.
The good news is there is help for women who suffer from depression during or after their pregnancy. Treatments for depression include lifestyle changes, alternative therapies and medications. Women who are appropriately treated are more apt to cope well with the challenges of pregnancy and parenthood.
Q: Does depression affect the fetus?
A: It is unclear how depression during pregnancy affects an unborn child. Some women fear their emotions can cause miscarriage, preterm labor or other complications. But there is no research that confirms this concern.
There are studies, however, that have found babies born to depressed mothers are apt to be more irritable, less active and attentive and more prone to developmental delays. The studies do not conclude whether this is due solely to the mother's emotional state during pregnancy or if other factors are involved.
Q: How is depression in pregnant women treated?
A: Options include exercising for 30 minutes most days, ingesting Omega-3 oils and taking St. John's wort supplements, although there is medical research for and against taking St. John's wort, according to the 2009 report. Psychotherapy or counseling can also be effective. In extreme cases, electroconvulsive therapy and transcranial magnetic stimulation have been used.
Q: What if a woman who is already taking antidepressants becomes pregnant?
A: Approximately 13 percent of pregnant women have taken an antidepressant during pregnancy, according to The American College of Obstetricians and Gynecologists Committee Opinion paper No. 453, which also encourages screening before and after a woman's pregnancy. It is important to consult with a doctor before taking antidepressants while pregnant, since the medication may be associated with increased risk of miscarriage, low birth weight, preterm delivery, birth defects or behavioral changes in the newborn. The effects depend on the particular medication and when in pregnancy the medication is taken. Some pregnant women hear this and abruptly stop their medication, but that could bring on a psychiatric crisis. Women taking antidepressants should discuss treatment options with their health care providers.
Q: Is there more research being done?
A: The American College of Obstetricians and Gynecologists and the American Psychiatric Association convened in 2009 to gather information about depression in pregnancy and recommend methods of treatment. To read a copy of the report, please click here.
The management of depression during pregnancy: a report from the American Psychiatric Association and the American College of Obstetricians and Gynecologists