Research has shown that up to 33 percent of women experience clinical depression or an anxiety disorder at some point during pregnancy. Yet some studies indicate that fewer than 20 percent seek treatment, and that treatment is often inadequate, says Healy Smith, M.D., a reproductive psychiatrist at the Women's Mental Health Clinic at New York-Presbyterian Hospital in New York City. "The myth that pregnant women must be happy is still really prevalent," Dr. Smith explains. "Because of that, treatment providers may be less likely to inquire into a woman's mental state, and a woman might feel ashamed to bring it up." But you don't have to suffer -- there are safe ways to treat depression and anxiety during pregnancy.
Symptoms of Depression and Anxiety
It can be tricky to diagnose mood disorders during pregnancy because "some of the symptoms can overlap with symptoms of pregnancy, such as changes in appetite, energy levels, concentration, or sleep," Dr. Smith says. "It's also normal to have some degree of worry over the health of the pregnancy." But if you experience persistent symptoms of depression and/or anxiety, especially if you're unable to function normally, get help.
Symptoms of depression include:
The symptoms of anxiety vary by type of anxiety disorder, and include:
Generalized Anxiety Disorder:
Risk Factors for Anxiety and Depression
Anyone can experience depression or anxiety during pregnancy, but women with these risk factors are especially susceptible:
Risks of Untreated Anxiety and Depression During Pregnancy
"There are well documented, but often overlooked, consequences of untreated depression and anxiety during pregnancy for the fetus and the mother," Dr. Smith says. Risks to developing babies whose mothers have untreated depression or anxiety during pregnancy include:
Risks to the mother include:
There are several therapies that don't involve medication and are therefore considered generally safe for a developing baby. For women who need medication, there are low-risk options that can deliver real relief.
The following treatments have been shown to help pregnant women with mild to moderate depression.
If you're currently taking medication for depression or anxiety, consult your psychiatrist before you stop. A 2006 study published in the Journal of the American Medical Association showed that "women who discontinued an antidepressant around conception had a 68 percent chance of recurrence of depression during pregnancy, compared to 26 percent for those women who continued their medication," says Stephanie Ho, M.D., a reproductive psychiatrist in private practice in New York City. Of those that relapsed, the majority had to restart their medication during pregnancy.
Finding Support and Specialists
If you're pregnant and you're having depression and/or anxiety symptoms, talk to your ob-gyn or midwife. She should be able to treat you directly, or connect you with the appropriate mental health care provider. These organizations can also offer confidential help:
Postpartum Support International will connect you directly to a local coordinator who can help you find local resources, offer support, and give you tips on managing mood and anxiety disorders during and after pregnancy (www.postpartum.net).
Women's Mental Health Consortium maintains a database of mental health care providers who specialize in treating women; search using the key word "pregnancy" (http://womensmentalhealthconsortium.org/).
The MGH Center for Women's Mental Health offers credible information on the risks of untreated depression or anxiety during pregnancy, as well as evaluation and treatment options (www.womensmentalhealth.org).