Depression and Anxiety in Pregnancy: What You Need to Know

Beyond the Blues: Understanding and Treating Prenatal and Postpartum Mood & Anxiety Disorders is a highly readable, and respected book recommended by childbirth educators for information on depression and anxiety in pregnancy and postpartum.  Its co-author, Pec Indman, EdD, MFT is the Director of Women's Health for Regroup Therapy  an new, innovative therapeutic support resource for childbearing women who have concerns regarding depression, anxiety, PTSD, or other mental illness issues. I recently asked Pec to share some information regarding perinatal depression/anxiety.

What are current rates of depression and anxiety in pregnancy?

While commonly thought of as a happy time, pregnancy does not protect women from mood (depression or bipolar disorders) or anxiety disorders. Women who have had neonatal losses often experience sadness and anxiety in a subsequent pregnancy. Some women enter pregnancy experiencing depression or anxiety, and we  know that up to one out of every five pregnant women suffer during pregnancy.  These rates are higher in teens and women of low socio-economic status.  Women who have had neonatal' losses, may experience sadness and anxiety in a subsequent pregnancy.

To put it into perspective, gestational diabetes occurs in 2-10% and high blood pressure occurs in pregnancy in 2-3%.  Pregnant women are screened for these illnesses on every prenatal visit.  Maternal depression and anxiety occurs in up to 20 % of women and are not routinely screened.  Unfortunately, most prenatal depression and anxiety is undetected and untreated. Even those women who are treated are often undertreated.  The goal of treatment is to restore wellness and optimal functioning.

How does a mom know if she is depressed or anxious in pregnancy?

Sometimes women describe being "hormonal" during pregnancy.  It's normal to have mild mood swings and occasional doubts and worries during pregnancy. It's not normal or healthy to be worried or down on a regular basis or to have more bad days than good ones. Depression/anxiety can cause difficulty falling or staying asleep, can cause appetite changes (sometimes with poor weight gain), irritability, self-doubt, a decrease in self-care and attention to nutrition, and a sense of loss of joy and pleasure.

 Who is likely to develop a depression or anxiety disorder in pregnancy?

• A woman who has suffered before in pregnancy
• A woman who has a personal or family history of a mood or anxiety disorder (remember this may not have been diagnosed or treated)
• A woman on medication who stops it before or during the pregnancy

What can I do if I have a mood or anxiety problem during my pregnancy?

Get Help! There are many kinds of treatments for mood and anxiety problems in pregnancy. Counseling, or talk therapy, is very effective. In particular, Cognitive-Behavioral Therapy and Interpersonal Therapy have been shown to helpful for perinatal mood and anxiety problems. Other scientifically studied treatments include: social support, light therapy (these are special lights), exercise or physical activity, Omega 3 fatty acids, and massage. Most women use a combination, for example, counseling and walking regularly. Some women need to continue or begin medications during pregnancy.  There are medications that can be used pregnancy.  Growing inside a depressed or anxious mom isn't good for the fetus or for the mom.  Each mom, with accurate information, must make the right decision for her and her family.

What are some of the effects of untreated depression or anxiety in pregnancy on baby?

Women with depression in pregnancy are more likely to have preterm deliveries, low birth-weight babies, and babies requiring care in a Neonatal Intensive Care Unit (NICU).  The newborns of mothers with depressive symptoms had higher cortisol levels and lower dopamine and serotonin levels, thus mimicking their mothers' prenatal levels. The newborns of moms with prenatal depression have depressed scores on the Brazelton Scale. Anxious moms are more likely to deliver babies who are more difficult to console and have more difficulty with sleep.

What treatment options are available?

It's always important before starting any kind or form of treatment, to know what it is you are treating. That's especially important if you are using herbs or medications. Risks of all kinds need to be considered. We now know that not treating a woman suffering from depression or anxiety has negative consequences on both the mom and baby. It's always important to remember that all pregnancies have a 3-5% risk of birth defects. Anti-depressants do not seem to increase the risk of birth defects above the 3-5% rate.

Share with us about Regroup Therapy. How could Regroup Therapy help a pregnant mom?

Women are told that pregnancy is or "should be" the happiest time of their life. Many women feel shame and guilt if they feel anything besides overjoyed. Support groups have been found to be highly effective in helping pregnant and postpartum women on the journey to wellness. Support groups help women feel that they are not alone, and provide a safe place to talk about their feelings in a non-judgmental atmosphere. Regroup Therapy has designed a way for women to join a video support group, led by a therapist trained in perinatal mood/anxiety disorders. Not all women have access to a community based support group.  Regroup offers women the ability to connect from wherever they are.  Women can find a support group at http://regrouptherapy.com.

About Beyond the Blues:

Newly updated, Beyond the Blues contains the current information about risk factors, diagnosis, treatment, and prevention of mood and anxiety disorders in pregnancy and postpartum. Straightforward yet compassionate, it is required reading for all who work with pregnant and postpartum women, as well as for those suffering before or after the baby is born. This book is being used and recommended by the The United States Department of Health and Human Services, US Navy, Spectrum Health in Michigan, Durham Regional Health Department of Canada, New York State Department of Health, Broward Healthy Start Coalition of Florida, the International Childbirth Education Association, and many other organizations.