Coping With Anxiety and Depression During Pregnancy

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:

• Being in a depressed mood most of the time for at least two weeks
• No longer enjoying the things you used to enjoy
• Decreased interest in the world around you
• Guilt
• A sense of worthlessness
• Low energy
• Poor concentration
• Appetite changes
• Feeling hopeless
• Thoughts of suicide
• Getting too much sleep, or not enough sleep

The symptoms of anxiety vary by type of anxiety disorder, and include:

Generalized Anxiety Disorder:

• Excessive worry that's difficult to control
• Irritability
• Tension/muscle aches
• Disrupted sleep patterns
• Feeling restless inside
• Fatigue
• Poor concentration

Obsessive-Compulsive Disorder:

• Recurrent, persistent, intrusive thoughts
• Compulsions to relieve those thoughts through repetitive thoughts or behaviors

Panic disorder:

• Recurrent panic attacks
• Persistent fear of having a panic attack

Risk Factors for Anxiety and Depression

Anyone can experience depression or anxiety during pregnancy, but women with these risk factors are especially susceptible:

• A personal or family history of a mood disorder, such as depression or anxiety
• A history of premenstrual dysphoric disorder (PMDD)
• Being a young mother (under the age of 20)
• Having poor social support
• Living alone
• Experiencing marital conflict
• Being divorced, widowed, or separated
• Having experienced traumatic or stressful events in the past year
• Feeling ambivalent about being pregnant
• Pregnancy complications
• Having a low income
• Having more than three children

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:

• Low birthweight
• Premature birth (before 37 weeks)
• Low APGAR score (which rates a newborn's health after delivery)
• Poor adaptation outside the womb, including respiratory distress and jitteriness

Risks to the mother include:

• Suicide
• Pregnancy termination
• Postpartum depression or anxiety
• Use of substances such as alcohol or drugs
• Impaired attachment to the baby
• Not taking good care of her physical health
• Preeclampsia
• Preterm labor
• Having a C-section

Treatment Options

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.

Nonmedicinal Approaches
The following treatments have been shown to help pregnant women with mild to moderate depression.

• Psychotherapy, such as cognitive behavioral therapy (CBT), in which a skilled therapist teaches new approaches to managing thoughts and emotions
• Omega-3 essential fatty acids, which are found in foods such as oily fish and walnuts, and can act as a natural mood-booster
• Light therapy, in which patients are exposed to artificial sunlight at specific times of the day to help relieve depression symptoms
• Acupuncture, a Chinese practice that (in this case) involves placing tiny needles into areas of the body thought to influence mood

Antidepressant Medication
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.

• Is it safe to take antidepressants during pregnancy?
• Is it okay to take antidepressants during my first trimester?
• Are antidepressants especially risky during the third trimester?
• Is it okay to take more than one antidepressant during pregnancy?
• Will taking antidepressants during pregnancy affect my child later in life?

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).