Leigh Ann Alexander always thought of herself as an upbeat, social person. Strangely enough, a happy event -- her first pregnancy -- changed all that. "I was nearing the end of the first trimester, and I became consumed with worry," says Alexander, who lives in Smithville, Texas. She stopped seeing friends, gave up exercising, and began indulging in junk food.
"I didn't want to go anywhere or do anything. I was very isolated and withdrawn," she says. "I was really surprised. I'd always thought that pregnancy would be a happy time." Unfortunately, Alexander is far from alone. Postpartum depression may grab all the headlines, but research shows that 12 to 20 percent of pregnant women are depressed. And the mother-to-be isn't the only one who suffers; depressed women are less likely to eat well, exercise, and get enough sleep. They're also more likely to smoke, drink alcohol, and miss prenatal appointments, all of which can compromise the health of their unborn baby.
Doctors once thought that all of those hormones rushing around a woman's body during pregnancy would shield her from depression. We now know that for some moms-to-be the opposite is true. But while experts agree that hormones play a role in depression, the exact mechanisms are unknown.
"It may be triggered by any number of physiologic or life stressors," says Sheila Marcus, MD, director of the Women's Depression Program at the University of Michigan Depression Center in the department of psychiatry. "In women with a genetic predisposition to depression, the hormone changes may be one of these stressors," Dr. Marcus says. Not surprisingly, a history of depression doubles the odds of its recurring during pregnancy.
Difficult life circumstances can bring on depression as well, says Diane Ashton, MD, associate medical director of the March of Dimes in White Plains, New York. "Women who feel they don't have marital support or social support are at greater risk," she says. Concerns about your baby's health, your changing body, and the impact motherhood will have on your life are also sources of stress that may impact your mood.
A 2003 study led by Dr. Marcus at the University of Michigan found that only 13.8 percent of pregnant women who scored high on a questionnaire testing for depression were getting the help they needed. The truth is, depression in pregnancy is tough to treat. Many women suffer through the symptoms, chalking them up to pregnancy highs and lows, and never seek help.
Angela Hogate of Tracy, California, is a perfect example of this. She barely recognized the depression that set in during her third trimester. "I just didn't want to get out of bed, and I had a horrible time sleeping," she says, "but it was hard to know if my troubles were from all the stress I was feeling about the baby, or the fact that I was so uncomfortable and big," she says. And even if a woman wants help, says Dr. Marcus, she may be reluctant to discuss it with her doctor out of sheer embarrassment; after all, pregnant women are supposed to be eagerly anticipating the joyous event of having a child.
Other women want to seek help but aren't able to get it. For example, women on pregnancy bed rest are prone to depression, but since they can't leave their bed, they often can't get the help they need.
Experts agree that depression requires medical attention. But deciding how to treat the disease in pregnancy is a real challenge, particularly in more severe cases. Medication is by and large the most effective way to treat severe depression. "But many doctors and mothers-to-be are afraid of the medications," says Gideon Koren, MD, director of the Motherisk program at the Hospital for Sick Children in Toronto.
Their concerns? The majority of drugs have never been tested on pregnant women, so doctors are unsure of their effects on unborn babies. Angela Francisco of Long Island City, New York, went off her Prozac when she first learned she was pregnant, "because I was concerned it would harm the baby," she says. "It was a huge mistake. Four months into my pregnancy, I became so angry and irritable, I could barely function. I went back on the Prozac and felt better."
Fortunately for Francisco, Prozac is considered one of the safer antidepressants out there. According to a study published in the American Journal of Psychiatry in 2002, fluoxetine (Prozac) had no subsequent negative effect on the development of IQ, language, or behavior in children up to age 6.
And research on selective serotonin reuptake inhibitors (SSRIs), which include Prozac, suggests that they may be one of the best options because they don't cause birth defects. (Other medicines, such as monoamine oxidase inhibitors [MAOIs] are contraindicated for pregnant women.)
But other studies have found that these drugs may have at least some short-term effects on the baby. One recent study, published in the February 2004 issue of Pediatrics, found that newborns exposed to SSRIs during pregnancy had more tremors and short-term behavioral problems. They also slept more and had more abnormal heart rhythms than babies who were not exposed to SSRIs.
"How long these effects last, I can't tell you," says Philip Sanford Zeskind, PhD, coauthor of the study and director of neurodevelopmental research in the department of pediatrics at Carolinas Medical Center in Charlotte, North Carolina. "But I've received numerous phone calls from parents saying their children were exposed and still showing tremors at 2." He says the babies' symptoms may be due to SSRI withdrawal or too much serotonin, a neurotransmitter whose levels are increased by the drugs.
A milder case of depression may not warrant medication; some women report that psychological therapy to cope with emotional issues is helpful, as is regular exercise, which helps release endorphins, chemicals in the brain that can help combat moodiness and depression. And a recent study found that for pregnant women, sitting in front of a light box may also provide some relief.
The bottom line? There is help available, and it's vital that depressed mothers-to-be get treatment. Some hospitals even have programs specially designed for depressed pregnant women. Jackie Vaccaro of Providence, Rhode Island, enrolled in one. She also took Zoloft, an SSRI. "When it all kicked in about six weeks later, I started to feel better," says Vaccaro, whose depression was so severe she felt unconnected to her unborn baby.
If you think you're suffering from depression, discuss it with your ob-gyn immediately. "There is no way to prevent it," says Dr. Marcus, "but there are lots of things that can minimize it."
Winifred Yu is a mother of two and a writer in Voorheesville, New York.
Originally published in American Baby magazine, September 2004.