“Mayo Clinic Guide to a Healthy Pregnancy” by Myra J. Wick, M.D., Ph.D., contains information on a wide array of important topics related to pregnancy. Understanding both the body and the mind can create a more positive experience for everyone involved throughout a pregnancy. The following excerpt focuses on depression and anxiety, which are possible during pregnancy but need not be feared. Detailed information from Mayo Clinic experts explains symptoms, treatments and several ways to receive help if needed.
It’s not unusual to feel sad or low or worried once in a while. But if your low mood or worry lasts for longer than two weeks and it interferes with your ability to eat, sleep, work, concentrate, relate to others and enjoy life, you may possibly be experiencing depression or anxiety. These are common mood disorders that are serious but treatable. Unfortunately, they are also underdiagnosed and undertreated.
Depression and anxiety can be a problem during pregnancy, and they are especially common after pregnancy (postpartum). It’s estimated that about 1 in 7 people experiences postpartum depression or anxiety after delivery. Studies suggest that number is often higher in communities with lower-than average incomes.
During pregnancy, factors that can contribute to depression include:
◗ Stress.
◗ Insufficient social or emotional support.
◗ Pregnancy and birth complications.
◗ Losing a baby.
◗ Having a baby with health issues or needing to be hospitalized.
◗ Financial pressures.
◗ Unrealistic expectations of childbirth and parenting.
Certain personality traits and lifestyle choices can also make you more vulnerable. For instance, having low self-esteem or being overly self-critical, pessimistic or easily overwhelmed by stress can put you at increased risk of depression.
Signs and symptoms
Two of the main symptoms of depression are loss of interest in normal daily activities and feeling sad, helpless or hopeless. Other symptoms of depression, including fatigue, sleep disturbances, and impaired thinking or concentration, can often be mistaken for common problems of pregnancy. This can make depression during pregnancy easy to overlook.
Many people with depression also have symptoms of anxiety, such as persistent worrying or a sense of impending danger.
Treatment
Depression is a serious illness that requires treatment. Ignoring this diagnosis can put you and your baby at risk. Most often, depression that occurs during pregnancy is treated with counseling and behavioral therapy. Antidepressant medications may be used as well. Many of these medications appear to pose little risk to developing babies. If medication is needed, a health professional can prescribe one that is safe for you to take during pregnancy.
Having depression or anxiety before or during pregnancy can increase your risk of postpartum depression (see page 496). Untreated depression can become a chronic condition that can return before or during subsequent pregnancies. If you think you may be depressed, talk with a member of your healthcare team about it. It is often helpful to reach out to people that you trust, whether a friend or loved one, a close peer or minister in your faith community if you have one, or any health professional.
Emergency help
If you are having thoughts about attempting suicide or hurting yourself or others, call 911 or your local emergency number immediately. Also consider the following options:
◗ Call your healthcare team or a mental health professional.
◗ Go to your local emergency room for evaluation.
◗ Call a suicide hotline. In the United States, call the 988 Suicide and Crisis Lifeline by dialing 988.
◗ Contact a minister, spiritual leader or someone else in your faith community.
◗ Reach out to a friend or loved one.
Risks of stopping depression and anxiety treatment
In Pregnancy
People who take antidepressant medications are often concerned about how the medications may affect a pregnancy. For some people, it may be tempting to go off the medications while pregnant. But while taking any sort of medication may carry risk for the baby, you also need to consider what can happen if you don’t take medications that have been prescribed for you.
The physical changes and influx of hormones associated with pregnancy can have a strong impact on mood and emotions — which can especially affect a pregnant person with a history of depression or anxiety. In a large study of the use of antidepressants during pregnancy, investigators found that depression relapse was fairly common among pregnant participants in general, but it was significantly more common among those who discontinued their medications just before conception or in early pregnancy. Risk of relapse was also higher among women who opted to decrease their dose.
Untreated depression during and after pregnancy poses its own risks:
| For pregnant person | For baby |
| Worsening symptoms | Inadequate growth during pregnancy |
| Poor self-care | Low birth weight |
| Inadequate weight gain or weight loss | Developmental delay after birth |
| Suicidal thoughts or behaviors | Cognitive impairment after birth |
| Preterm labor | |
| Difficulty bonding with newborn | |
| Inability to cope with stress of parenting |
Research on the effects of antidepressants in pregnancy suggests the risks are low. Most people who take antidepressants during pregnancy have roughly the same outcomes as pregnant people who aren’t on antidepressants. Potential risks to the baby may range from temporary problems after birth, such as mild tremors or rapid breathing, to more serious lung problems or, rarely, heart defects. But the jury is still out on many of these possible complications, and more research is needed to make firm conclusions.
Most experts believe the benefits of maintaining treatment of moderate to severe depression in a parent carrying a pregnancy outweigh the risks of antidepressant exposure to the baby.
If you have mild depression, talk to your care team about nonmedication therapies. Examples include cognitive behavioral therapy, which focuses on modifying distorted beliefs and behaviors, and interpersonal therapy, which helps you better express your emotions and communicate with others.
Excerpted from “Mayo Clinic Guide to a Healthy Pregnancy” by Myra J. Wick, M.D., Ph.D.
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