There are many reasons for stress during pregnancy, including a troubled relationship, worries about career, financial stability or the change of life that is bound to occur with the birth of a child. All of these stresses can make depression more likely or more severe. In addition, doctors now believe that depression may be linked to the rapid change in hormones that occurs during this time.
Symptoms such as fatigue and trouble sleeping occur to healthy women during pregnancy, but when they are combined with feelings of sadness, hopelessness, difficulty concentrating, changes in appetite or an inability to function, it may be depression that is involved. Prompt recognition and treatment are crucial.
One recent study found that women with severe symptoms of depression during the first trimester were twice as likely as other mothers to have premature delivery. Of 791 women interviewed at around 10 weeks into their pregnancy, 41.2 percent reported significant symptoms of depression while 21.7 percent had severe symptoms. The risk of preterm delivery increased in direct correlation to the severity of depression.
Severe depression was more likely in women who were under age 25, unmarried and African American. Depressed mothers also tended to have less education, lower income and a history of fertility problems or preterm delivery.
Physical effects that may accompany depression include nausea, headache, stomach pain, shortness of breath, palpitations and dizziness. These symptoms–coupled with the emotional effects–could affect a woman’s motivation to protect her health and that of her baby during the prenatal period.
More than 30 percent of women who are depressed during early pregnancy remain depressed or experience a recurrence during the postpartum period–creating ongoing challenges.
Because of the concern about the effect of medication on the fetus, treatment of depression during pregnancy is a complex matter.
For mild to moderate depression, there are numerous options that do not require medication. Regular exercise is a proven way to relieve stress and lift mood. According to one study, women who exercised during the first and second trimesters were less likely to have symptoms of depression than those who didn’t.
In order to relieve stress, Fran tried to eliminate obligations that were crowding her life. Using vacation time, she took early leave from her job and limited her activities to those centered on the coming birth–Lamaze classes, pregnancy yoga and a support group that included other mothers suffering from depression. She talked to her mother by phone every day and planned quality time alone with her husband.
Managing stress and getting social support was enough for Fran, but in many cases depression is severe enough to require psychotherapy as well.
One controlled trial found that more than half of pregnant women receiving interpersonal therapy achieved remission. Other studies have found cognitive behavioral therapy to be as effective as medication for mild to moderate depression.
Bright light therapy, usually reserved for seasonal depression, is another option that has been found effective, even for women with non-seasonal depression.
As for antidepressant medications, studies regarding safety are inconclusive. Several observational studies found no risk of major birth defects in children exposed to antidepressants in the womb, but none of these followed children over a period longer than four years. Since 2006, some studies have found an increased risk of miscarriage and preterm birth associated with SSRI antidepressants. In one study, one third of infants exposed to SSRIs during the last trimester had withdrawal symptoms such as jitters or irritability after birth.
The American College of Obstetricians and Gynecologists recommends that decisions regarding medication be made on a case-by-case basis. Whatever treatment is used, it should be adequate to control the symptoms.
Tana N. Kaefer, PharmD
