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In the past decade, postpartum depression has been heavily studied by doctors, covered in the media, and treated in psychologists’ offices. Many new mothers know what signs to look for and feel comfortable seeking help.
But prenatal depression — depression that occurs during pregnancy — carries something of a stigma, and has received significantly less attention.
Doctors once believed that hormonal surges during pregnancy elevated a woman’s mood, and many women are still under the mistaken impression that pregnancy should yield nothing but happy feelings.
Consequently, women who experience depression during pregnancy may feel guilt, doubt their ability to be good mothers, and may not seek and receive effective treatment.
Rest assured, prenatal depression is treatable and often preventable.
Causes
As with depression that is unrelated to pregnancy, there are competing theories about the causes of prenatal depression. A combination of environmental and biochemical factors are believed to be at play.
While anyone can develop prenatal depression, a woman may be at increased risk when:
• She has previously experienced major depression. The risk increases if a woman stops taking antidepressants during pregnancy.
• The pregnancy was unplanned, or the woman has mixed feelings about the pregnancy.
• She has little social support, or a partner who is ambivalent about the pregnancy.
• She has other health problems.
• She is in an abusive relationship, or has a history of abuse.
• She experiences a major life stress, such as job loss or the death of a loved one, during the pregnancy.
Prevention
Outreach programs that provide support to pregnant women are highly effective at preventing the isolation and overwhelming stress some women feel during pregnancy.
Because depression is a major risk factor, women who are pregnant or who are contemplating becoming pregnant should discuss their mental health histories with their doctors. Their physicians may be able to make recommendations about treatments that are safe during pregnancy.
Because overall health can play a role in the development of prenatal depression, comprehensive health care examinations and consultations before pregnancy, and excellent prenatal care, may help reduce the risk.
Treatment
Prenatal depression is treatable. Women who experience symptoms of depression during pregnancy should consult a therapist who has experience treating pregnant women, and should also talk with their obstetricians.
While every medication carries some risk, the risks of depression to both mother and baby may significantly outweigh the possible consequences of taking antidepressants that are approved during pregnancy.
Maternal anxiety and depression are significant predictors of health problems in both mother and baby, but treating depression can reduce the possibility of complications.
Some selective serotonin reuptake inhibitors are deemed safe, including Zoloft, Prozac, and Celexa. Tricyclic antidepressants — an older generation of antidepressants — may also be safe.
Some doctors also prescribe Wellbutrin to pregnant women. As always, discuss any concerns you may have about these medications with your physician.
It can take several tries to get the right combination of medication. Don’t lose hope just because one doesn’t address your needs.
Psychotherapy also can be extremely helpful, especially for women who are anxious about becoming mothers or who experience major life shifts during pregnancy.
The earlier prenatal depression is treated, the sooner pregnant women can get past the fog and begin looking forward to being a parent.
References:
Grose, J. (n.d.). Not just the pregnancy blues. Slate Magazine. Retrieved from
http://www.slate.com/articles/double_x/doublex/features/2012/why_isn_t_a...
Harwood, R., Miller, S. A., Vasta, R. (2008). Child psychology: Development in a changing society. Hoboken, NJ: John Wiley & Sons.
Mayo Clinic. (2012, January 10). Antidepressants: Safe during pregnancy? Mayo Clinic. Retrieved from
http://www.mayoclinic.com/health/antidepressants/DN00007
Edited by Jody Smith
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Maternal depression can cause deleterious effects on the fetus, but so can antidepressants. For example, mothers who take Prozac during the third trimester of pregnancy risk premature delivery and also put their infants at risk of "poor neonatal adaptation", according to a report from the Center for the Evaluation of Risks to Human Reproduction (CERHR). CERHR is part of the federal National Toxicology Program at the National Institutes of Health. Only 30% of patients respond initially to an antidepressant. 40% do not respond to antidepressants at all. Psychotherapy is effective, without side effects, but takes time. Electroconvulsive therapy (ECT) is effective, safe, but has significant side effects and is reserved for the severe, treatment-resistant patient. A new treatment, transcranial magnetic stimulation (TMS) is safe, effective, but expensive. Similar to TMS, transcranial direct current stimulation (tDCS) uses a tiny, imperceptible amount of electricity from a portable stimulator to facilitate the under-functioning area of the brain which results in depression. tDCS is safer than TMS, easier to do, without side effects and can be done by the patient at home. tDCS improves cognitive function with the initial 20-minute treatment and depression lessens within a week. In a study published earlier this year, tDCS reduced depression 50% for patients unresponsive to multiple courses of antidepressants. The lifetime cost of tDCS is less than the cost of an antidepressant for a year and less than a quarter of the cost of a single TMS protocol.
September 28, 2012 - 4:08amThis Comment