Early in my first pregnancy, I was feeling rather blue. At Week 14, I wrote in my pregnancy journal:
I’m supposed to be feeling better — much better. I guess in some ways I am. The major vomiting is gone, but I’m still nauseous. And I’m still dragging. I’m tired all of the time, and I can’t seem to motivate myself to do anything.
My battle with morning sickness had taken a toll on me physically, mentally, and emotionally. I couldn’t talk to anyone about what I was experiencing because I was basically the “first one” in my circle of friends to become pregnant. So instead, I poured out my heart and soul to my diary.
I went on to describe the fact that I needed to find a temp job. After all, I couldn’t work for free anymore as an aspiring writer and filmmaker, because with a baby on the way I suddenly felt the need to be practical and make some actual income. And even though I was between jobs and was home with endless hours to spend writing, I found I was unable to concentrate and that my creativity had completely vanished. Unable to read, write, or work, I was frustrated, angry, and becoming increasingly depressed. I wrote:
I already feel like such a failure as a woman. I didn’t think that pregnancy would be so difficult. I’m beginning to think that maybe I can’t do anything right. God, I haven’t felt this self-deprecating since I was 17 years old. Are these hormones speaking or me? How come nobody else talks about this “pre-partum depression.” Am I the only one feeling this way?
I was a bit surprised to be feeling so blue during my pregnancy. The baby had more or less been planned (even though I didn’t expect it to happen on the first try, which it did), and I had imagined that having a baby would be a breeze. According to television and parenting magazines, I was supposed to be blissfully happy, not moody and depressed. And I longed to “glow.” Wasn’t it my right as a mother-to-be? Didn’t the world expect it from me?
But I wasn’t prepared for how disabling morning sickness would be or how quickly my life would be turned upside-down. Since I didn’t know any better, I blamed myself, feeling ashamed and unnatural. Focusing on my negative thoughts, coupled with my raging hormones, only fueled my dark mood. I was spiraling into a deep depression. And I felt isolated and completely alone.
I didn’t know it at the time, but I wasn’t alone at all. According to a study published in the May 2003 Journal of Women’s Health, nearly one in five pregnant women may show signs of depression. And like me, many of them remain silent about it.
Conducted by the University of Michigan’s Depression Center, the study “Depressive Symptoms Among Pregnant Women Screened in Obstetric Settings” involved 3,472 women who were an average of 25 weeks pregnant. Slightly more than 20 percent of the women in the study showed signs of depression based on their scores on a screening test.
In a press release from the University of Michigan’s Health Service, lead researcher Dr. Sheila M. Marcus reported, “Doctors used to think of pregnancy as a ‘honeymoon’ away from depression risk, but this is turning out to be a myth.”
Dr. Marcus hopes the study will raise awareness about depression in pregnant women, explaining, “We need to educate women about the signs of depression, and encourage them to be open about how they’re feeling during pregnancy and after delivery, rather than feeling guilty or embarrassed.”
Deborah Sichel and Jeanne Watson Driscoll investigate prenatal depression in their book, Women’s Moods: What Every Woman Should Know About Hormones, The Brain, and Emotional Health. They state, “Pregnancy is a time of enormous hormonal shifts, during which your body and brain are challenged as at no other point in your life.”
They go on to say, “Sadly, most obstetric caregivers buy into the myth of the joyous pregnancy and don’t appreciate just how much psychological distress can exist at this time in a woman’s life, often misconstruing depressive illness as merely an adjustment to motherhood. They frequently fail to recognize that their patient is having a serious but treatable problem.”
While ideally women would like to stay medication-free during pregnancy, those with life-altering symptoms should consider the benefits of antidepressants, called SSRI’s (serotonin reuptake inhibitors). Dr. Marcus believes that the under-treatment of depression in pregnancy stems from misconceptions regarding the safety of antidepressants. So far, preliminary research seems to show that SSRI’s do not increase the risk for birth defects or other major health problems.
In the press release, Dr. Marcus suggests, “Women with a history of depression should be targeted for more intensive assessment during early pregnancy,” and that “it may be useful for clinicians to watch for depression in those who are not working, are unmarried, have greater health complaints, and those who use alcohol and cigarettes during pregnancy.”
In Beyond the Blues: A Guide to Understanding and Treating Prenatal and Postpartum Depression, authors Shoshana Bennett and Pec Indman explain that during pregnancy women can develop an intimate relationship with their doctors. Bennett and Indman suggest that this provides an opportunity for healthcare practitioners to pro-actively screen every woman for depression, whether she is pregnant or planning on becoming pregnant, using a “Pre-Pregnancy and Pregnancy Risk Assessment.” Under this assessment, warning signs include:
* Missed appointments
* Excessive worrying (about her own health or health of fetus)
* Looking unusually tired
* Requires support person to accompany her to appointments
* Significant weight loss or gain
* Physical complaints with no apparent cause
* Flashbacks, fear, or nightmares regarding previous trauma
* Her concern that she won’t be a good mother
Bennett and Indman further suggest that women should be periodically screened throughout pregnancy as hormone levels and symptoms could change. And they believe that health professionals should be trained to ask pregnant women if they have ever suffered from a mood disorder, and whether or not they have a family history of mental illness.
After the birth of my first child, I bounced back from my pre-natal depression, and sailed along on a hormonal and emotional high. I still had no idea that women who experience depression during pregnancy are at an increased risk for postpartum depression as well. I was lucky, I guess, to avoid that risk the first time around.
I wasn’t so lucky with the birth of my second child, almost five years ago. After an entire year of postpartum mood swings and wicked PMS, I practically begged my gynecologist to tie my tubes, frightened of the remote possibility of ever becoming pregnant again. Because of my age (I was only 32), my doctor advised against such a permanent and drastic birth control solution. And yet, she didn’t try to assess the reason I had requested such a permanent and drastic measure. When I told her I was still struggling with my moods and that my libido was non-existent, she told me these things were normal and suggested exercise and dietary changes. She didn’t seem to hear what I was trying to tell her: that I knew I should feel lucky and content, but most days I felt as if I was sinking into a dark hole, and I didn’t know how to pull myself out.
I struggled for close to two years before I finally decided to seek the help of a therapist who helped me sort out my conflicting expectations about motherhood and myself. I also began paying closer attention to my menstrual cycle and realized that my debilitating migraines and incredible mood swings were tied to this cycle. I went back to my OB and requested a prescription for an antidepressant to treat my intense PMS symptoms. I also tried yoga and meditation, and found other ways to rejuvenate my mind, body, and spirit. In time, and with some adjustments to my medication, my moods began to stabilize. And I began to finally acknowledge and address some unfinished business from my childhood that had bubbled to the surface during this intensely stressful time.
Several years after battling my own bouts of depression, I’m feeling somewhat vindicated that the medical community is finally starting to acknowledge the severity of both pr-e and post-natal depression, rather than ignoring these as the “baby blues.” But this is little consolation for the pain I endured at the time. Still, I’m no longer embarrassed to admit that I suffer from depression. And I see now that the signs had been there all along. My family history and my own mood swings in puberty could have simply been assessed during my pregnancy, and I could have been warned that I was at high risk for both prenatal and postpartum depression. I could have received help for my depression a lot earlier and without the years of inner turmoil and self-doubt — if only my OB had been trained to look beyond my bulging belly.
RESOURCES AND REFERENCES:
“Many pregnant women show signs of depression, but few are getting treatment, U-M study finds.” May 20, 2003, University of Michigan Health Services Press Release.
Women’s Moods: What Every Woman Should Know About Hormones, The Brain, and Emotional Health. By Deborah Sichel, M.D., and Jeanne Watson Driscoll, M.S., R.N., C.S. First Quill Edition, published 2000.
Beyond the Blues: A Guide to Understanding and Treating Prenatal and Postpartum Depression. By Shoshana S. Bennett, Ph.D., and Pec Indman, Ed.D., MFT. Moodswings Press, published 2003.
University of Michigan Depression Center
Postpartum Assistance for Mothers
Center for Postpartum Health
Depression After Delivery
The North American Society for Psychosocial Obstetrics and Gynecology
Pregnancy and Depression Medical Articles
Ruth Rhoden Craven Foundation, Inc., for Depression Awareness
Postpartum Support International