Depression During Pregnancy

QUESTION

Dear Experts,
I need some help and I don't know where else to turn. I am 20 weeks pregnant with my first child at age 35 and feel I may have become seriously depressed. I first mentioned this to my OB at about week 8 and he basically blew me off. In all fairness though, it's a group practice and you don't really get to know any of the physicians very well.

To give you some background, I think the depression started almost from the time I found out I was pregnant. I just can't seem to get happy about having a baby and this has been very hard for my husband and family to understand. I feel very isolated and alone. I don't have any friends as my husband was transferred to another town 11 months ago and I haven't made any.

Anyway, I was quite sick with nausea (though not sick enough to warrant empathy from my medical providers) until about week 15. I have not felt supported by my physicians. I have been just barely hanging in there. Then, last Monday I found out that due to all of my absences I had involuntarily had my hours cut at work. I am not really surprised though as I don't have the concentration or energy to do the work anyway.

I am scared because I am not gaining any weight. I haven't taken vitamins due to the nausea. I almost feel incapable of taking care of myself and I can't even begin to imagine taking care of a baby in a few short months. I am afraid we will lose the house before the baby is born. My sadness and the fact that I have felt so bad have affected my marriage. I don't want sex and even intimacy of any sort turns me off right now.

I just don't know what to do. Usually I am pretty resourceful but my lack of energy and $ have me really feeling helpless. I was just hoping someone might have some suggestions out there. Thanks.

ANSWER

Dear Hoping,
Yes, you are right, it sounds as though you are experiencing serious depression. All of your physical and emotional symptoms, from lack of weight gain, disinterest in sex or intimacy, and lack of energy and concentration, to feeling scared, isolated, alone, unsupported and misunderstood, are all common symptoms of depression. While some women do become irritable and depressed during pregnancy, these are not typical pregnancy symptoms. When symptoms are as serious and continuous as yours, this indicates an antepartum (during pregnancy) depression.

Whatever the cause, depression isn't something you are able to "snap out of," nor is it your fault. Depression is caused by a chemical or hormonal imbalance in your brain, and a combination of therapy and medication can help you feel better and regain control over your life and the way you function. Antidepressant medication is commonly used during pregnancy, and has minimal risks, plus the benefits far outweigh any risk. Management of depression is nothing to be taken lightly. It is very important to get your symptoms under control -- for you and your baby.

Your first step is to ask a trusted friend or family member or your husband to set up and attend a special appointment with your obstetrician to specifically talk about your depression. These trusted helpers can also call your insurance company or call the therapists, counselors, and psychiatrists in your community to find the professional who can help you get the assistance you need. Ideally, try to find a "woman's health psychiatrist," and set up a consultation. When you have someone who is an expert in medication management during pregnancy, you will be able to more fully discuss your concerns and options, ask any questions that you may have, and devise a plan for treatment.

Getting support and perhaps medication for your depression may be the most important action you can take to ensure that you and your baby get the healthiest and happiest start.

-- Debbie and Mara
The Childbirth Complication Expert Team

Davis and Stein

Deborah L. Davis, Ph.D. and Mara Tesler Stein, Psy.D. are the authors of Parenting Your Premature Baby and Child: The Emotional Journey, a 2004 National Parenting Publications Awards "Gold Award" winner. They also collaborated on Parent: You and Your Baby in the NICU (2002), as part of the nationwide March of Dimes NICU Project. They.ve been invited to regularly contribute to Advances in Neonatal Care, a neonatal nursing journal; their first article appears in Spring 2005. They are the founding members of Partners in Perinatal and Pediatric Consulting, which promotes developmentally supportive care for babies and parents, as well as collaboration between families and health care professionals.

Dr. Stein is a clinical psychologist in private practice, specializing in the emotional aspects of coping with crisis and adjustment around pregnancy and parenting. She is regularly invited to lecture and give workshops on these issues throughout the country to conferences of physician and nursing groups, doulas, and lactation consultants. Since 1997, she has been consulting with organizations and providing training to health care providers, guiding their efforts to improve the level of psychological support and developmentally supportive care to families during and subsequent to perinatal crisis.

Dr. Davis is a developmental psychologist, researcher, and writer who specializes in perinatal and neonatal crisis, medical ethics, parental bereavement, parent education, and child development. Dr. Davis is the author of four books for bereaved parents, Empty Cradle, Broken Heart (Fulcrum, 1991; 1996), Loving and Letting Go (Centering, 1993; 2002), Fly Away Home (Centering, 2000) and Stillbirth, Yet Still Born (PILC, 2000). She is also on the Board of the Pregnancy Loss and Infant Death Alliance (PLIDA.org) and is regularly invited to write articles for professional periodicals and parent support materials.