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Joyful. Glowing. These are words that typically describe moms-to-be. But what
about the other possibilities: blue, anxious, pregorexic? Pregnant women’s
struggles may slowly be coming out of the closet, but many moms-to-be still
suffer in silence with emotional issues, and the majority are never diagnosed
or treated. The result can be problematic for their babies as well as
don’t screen for mental health issues, and a lot of expectant women don’t
reveal their problems to their doctors, says Heather Flynn, Ph.D., an associate
professor and director of the women’s mental health program at the University
of Michigan Medical School’s department of psychiatry. “Women attribute what
they’re feeling to hormonal shifts, and many fear they’ll be judged,” she says. Those who
are diagnosed often don’t seek treatment because they’re afraid to take
medication, think their symptoms are normal or lack the time and money for
blame the emotional extremes on wildly shifting pregnancy hormones combined
with the physical, social and even existential challenges that come with
pregnancy—a changing body shape, a new identity as a mom and fears of being
responsible for a child. Some women are blindsided by a sudden onset, but in
many cases, pregnancy triggers an exacerbation of a condition they were already
untreated, psychological ills during pregnancy are linked to an increased risk
of prenatal and delivery complications, a greatly increased risk of postpartum
depression, and possible cognitive and behavioral issues in children down the
road. So whether you have borderline symptoms or a full-blown problem, don’t
suffer in silence: Help is available. Here’s how some mothers coped with their
emotional issues during pregnancy and what the experts recommend.
Depression. “I felt really sad, had no energy and
fell into this strange state where I thought, ‘What’s the point of anything?’” Kelly Judge, 32, an orchestra teacher in Kirkwood, Mo., describes herself as
an extremely happy, positive person. About two weeks after she found out she
was pregnant with her second child, Judge felt her good mood disappear. “I had
a fabulous marriage, a wonderful 3-year-old, no financial stress, the pregnancy
was planned, so life should have been great,” she recalls. “But I felt really sad,
had no energy and fell into this strange state where I thought, ‘What’s the
point of anything?’”
At the same
time, Judge began to feel very anxious, but not about anything in particular.
Caring for her child or keeping the house in order became difficult. After
several weeks, she called her OB. “I knew that this was not me and that
something was wrong,” she says. Her OB referred her to a psychologist, whom she
began to see regularly. Judge also started taking the antidepressant Lexapro.
Within weeks, her mood lifted.
birth to a healthy baby girl in January. Her daughter shows none of the
possible side effects of the antidepressant, and Judge is staying on the drug
until she’s out of the postpartum woods, albeit reluctantly. “I was fortunate that
I was able to recognize that something was wrong and was not afraid to ask for
help,” she says.
happens: An estimated
14 percent to 23 percent of moms-to-be experience serious (clinical)
depression, and about 40 percent have some symptoms. It may be set off by the
steep rise in pregnancy hormones, worries about the life changes a new baby
will bring, or both.
signs: Feeling sad for
several weeks; loss of interest in activities you normally enjoy; feelings of
guilt or hopelessness; difficulty concentrating. You can take a self-test
called the Edinburgh Postnatal Depression Scale, which is used to screen for prenatal
depression as well; you should also talk to your doctor or midwife.
most at risk: Women
who have suffered from depression or anxiety in the past, especially during
pregnancy, or had postpartum depression (PPD) or a family history of
depression (the mother, in particular); women with a low income or poor social
not treating: Increased risk of preeclampsia, preterm delivery, having a low birth-weight
baby or one with low Apgar scores, and PPD; poor cognitive, neurologic and
motor skill development and long-term behavioral effects in children.
works: Many expectant
women are reluctant to take antidepressants because of concerns that the drugs
may harm their babies, but drugs aren’t your only option:
Depression-specific psychotherapies, such as cognitive behavioral therapy, have
been shown to be just as effective in treating mild to moderate cases.
College of Obstetricians and Gynecologists (ACOG) states that pregnant women
with mild to moderate depression should seek therapy and support first,
especially in the first trimester. Then, if that’s not effective, discuss
adding an antidepressant, says Diane Sanford, Ph.D, author of Life Will Never Be the Same: The Real Mom’s
Postpartum Survival Guide.
advice for the many women with major symptoms who are already on
antidepressants when they become pregnant is to stay on their medication. “We
do not recommend that women with severe depression go off their
medication—unless it is known to be hazardous to their babies, as certain
bipolar medications are,” says Sanford. Studies show that almost all such women
who discontinued their medication relapsed by their third trimester, putting
them at an increased risk for PPD.
To help keep
depression at bay, exercise regularly and get enough sleep, which is crucial in
how well you respond to any treatment, says Flynn. You can also undergo
acupuncture: A recent study found that 63 percent of women who had major
depression during pregnancy experienced a 50 percent or greater reduction in
symptoms after acupuncture treatments, compared with 44 percent of women who
received sham acupuncture or got massages. Several studies have also shown that
omega-3 fish oils can be effective in easing depression.
IMAGE GONE AWRY
automatically went back to the one thing I could control—food and my body. All
those old obsessive-compulsive voices came back strongly.” Ann Marie Hopwood,
34, had struggled with anorexia on and off for 20 years, and the worst of
it—carrying a mere 63 pounds on her 5-foot-6-inch frame—was behind her. She was
up to 113 pounds, newly married and had just gotten her master’s degree in
counseling so she could help others with eating disorders. And then, despite
her thinness and many months of missed periods due to her anorexia, she got
“I was a new
wife and starting a new career and [being pregnant] was going to change my
whole perception of who I was,” says Hopwood, who lives in Omaha, Neb. “So I
automatically went back to the one thing I could control—food and my body. All
those old obsessive-compulsive voices came back strongly.”
In her first
trimester, between morning sickness and her anorexia, Hopwood lost 5 pounds.
“It was a daily struggle to eat enough,” she says. She kept her eating disorder
secret from friends, but her husband supported her through the pregnancy and
made her promise to gain weight. “He checked in every day to make sure I was
eating,” she says. She also self-treated with reiki, an energy healing
technique, and turned to prayer for strength.
second trimester, with much effort, Hopwood managed to eat about 1,200 calories
a day, still far below the 2,300 calories recommended for the average pregnant
woman. Making matters worse, she over-exercised to burn calories. But by the
end of her pregnancy, she had gained 17 pounds. Her son was born two weeks
early, but healthy. Immediately after his birth, though, Hopwood lost 25 pounds
and developed postpartum depression. She reluctantly started taking an
antidepressant, which she says helped immensely.
currently breastfeeding and is worried about the possible weight gain when she
stops. But she’s trying not to obsess about it. “It helps being a role model,
knowing that I have this little boy to take care of, and I have to be alive and
healthy for him,” she says.
taps directly into the very issues that contribute to eating disorders—concerns
about weight gain, changes in body shape and a loss of control over what’s
happening to your body and your life. But these disorders, which include
anorexia (extreme weight loss, often achieved by starving yourself), bulimia
(binging and purging) and binge eating often go undiagnosed during pregnancy.
While up to
4.5 percent of pregnant women have diagnosed eating disorders, the actual
numbers are probably much higher because so many cases are undiagnosed or
unreported. The good news is that between one-quarter and three-quarters of
women who have a pre-existing eating disorder “get better” during their pregnancy;
the bad news is that up to half relapse after delivering.
signs: An increased
focus on body shape and weight or a seriously negative body image and negative
self-talk; inability to admit that you’re hungry or your eating habits have
changed (including binge eating or extreme dieting); using laxatives, purging
or exercising more than an hour a day specifically to burn calories.
most at risk: Women
who’ve had any of the symptoms described above, even if they were never
officially diagnosed or treated for an eating disorder; those who are anxious
about how their body will change during pregnancy; pathological dieters (about
one-quarter of such women develop an eating disorder).
not treating: Increased risk of miscarriage, preterm labor, Cesarean section, intrauterine
growth restriction, postpartum eating disorders and depression; having a
low-birth-weight baby or one with low APGAR scores, respiratory problems,
delayed development and disturbed feeding behaviors.
behavioral therapy (CBT), which helps you work through negative thoughts and
destructive behaviors, offers the quickest response for eating disorders.
Dealing with long-term issues, such as poor self-esteem or chronic
perfectionism, will take more time to address, says clinical psychologist Sari
Shepphird, Ph.D., an expert on eating disorders and author of 100 Questions and Answers about Anorexia Nervosa.
Experts recommend tackling the most harmful symptoms first. “For example,
addressing such extreme behaviors as purging and laxative abuse is key,” says
medication to treat eating disorders is not typically recommended during
pregnancy because CBT is so often effective. It’s also helpful to practice relaxation
techniques like deep breathing and yoga, and to join a support group, as women
with eating disorders tend to isolate themselves because of shame and
disorders. “I was
always looking for subtle cues, like when the doctor said, ‘Everything’s OK
right now,’ I’d think, ‘But what about tomorrow?’” A few weeks after she
found out she was pregnant, Rebecca Thomas, 29, of Detroit started to feel
paralyzing fear. “I was afraid to move the wrong way, change the sheets, to
exercise,” she says. Before the pregnancy, she’d worry from time to time, but
she had never had anxiety grip her like this. “I remember one evening I didn’t
move at all because I thought if I didn’t move, I could keep something from
going wrong,” Thomas says.
nothing high risk about her pregnancy to trigger the anxiety, and no amount of
reassurance from her doctor made her feel any better. “I was always looking for
subtle cues, like when the doctor said, ‘Everything’s OK right now,’ I’d think,
‘Right now it’s OK, but what about tomorrow?’” Thomas never sought help
because she thought these were normal pregnancy fears, so she just suffered
through her pregnancy, unable to enjoy any of it.
gave birth to her daughter, the anxiety remained; even worse, she developed
postpartum depression on top of it. “I had fears I would do something wrong
with the baby, and then I began to feel that I didn’t fit in anymore socially
or that people were talking about me behind my back,” she recalls. When her
daughter was about 4 months old, Thomas finally reached out to a therapist for
became pregnant again about a year later, and recognized feelings of depression
at about 16 weeks. She waited another month to talk to her doctor, who gave her
a prescription for the antidepressant Lexapro. It still took her a few more
weeks before she used it.
point I decided that I didn’t want to not enjoy another pregnancy, so I filled
the prescription,” she says. Thomas began to feel much better and sailed
through the rest of her pregnancy. “I wish I had taken it even sooner,” she
happens: Almost every
pregnant woman has moments of worry about her developing baby, especially when
it’s time for prenatal testing. But for some women, the fears are constant and
affect their ability to function normally. The stress hormone cortisol and
other hormones that increase during pregnancy may be associated with the surge
in both anxiety and depression. Experts believe that anxiety disorders are at
least as common during pregnancy and postpartum as depression, possibly even
more so, and the two often go hand in hand.
signs: Anxiety that is
persistent, intrusive or out of proportion; irritability; inability to sleep
because of fears; waking up with a racing heart; difficulty concentrating.
most at risk: Women
who have experienced anxiety or depression in the past.
not treating: The
elevated cortisol is thought to affect a baby’s developing nervous system, says
Tom O’Connor, Ph.D., a professor of psychiatry and psychology at the University
of Rochester Medical Center in New York. Children whose mothers experienced
higher levels of stress during pregnancy tend to have poorer cognitive functioning,
are more reactive or more fearful, or have more behavioral problems like
attention deficit or hyperactivity than children of mothers who were less
stressed while expecting.
behavioral therapy can be very effective in reducing anxiety, especially when
the therapy focuses on teaching relaxation and coping skills.
Some of the
same SSRI medications that are prescribed for depression are also used to treat
general anxiety disorder, but women should talk to their doctors about their
risks and benefits. Calming drugs like benzodiazapenes are typically avoided
during pregnancy because of known risks to the fetus.
ANTIDEPRESSANTS SAFE DURING PREGNANCY?
babies’ risks from commonly used SSRI antidepressants, such as Prozac, Lexapro
and Celexa, are conflicting, as are the opinions of experts. “The majority of
patients who have been studied have had no clinically significant effects or
measurable risks during pregnancy,” says Heather Flynn, Ph.D., director of the
women’s mental health program at the University of Michigan Medical School’s
department of psychiatry. The decision to take antidepressants should be made
based on history and severity of illness, previous response to treatment and
discussion with your heath care provider, she advises.
recent Canadian study found that women who took antidepressants during
pregnancy had a higher chance of miscarriage, researchers reported that some of
the increased risk could be ascribed to the depression itself. And some studies
have showed a link between SSRI use and heart defects in babies, though the
actual risk is still very low—0.9 percent in women who took an SSRI, compared
with 0.5 percent in the control group, according to one study.
been documented that newborns who were exposed to SSRIs in utero may experience
temporary withdrawal-like effects, including hypoglycemia, unstable body
temperature, irritability and a weak cry. “I’m concerned about the risks of
antidepressants, especially when, for many women, there’s a perfectly
reasonable option, which is cognitive behavioral therapy,” says Tom O’Connor,
Ph.D., a professor of psychiatry and psychology at the University of Rochester
Medical Center in New York.
PROBLEMS ARE PRE-EXISTING
already have a psychiatric problem, major life changes, transitions and
stresses—such as pregnancy—can increase the intensity of your symptoms or the
likelihood of relapse, says Heather Flynn, Ph.D. Here’s how some common mental
health issues may be affected by pregnancy:
women and new mothers with this disorder have an increased risk of
hospitalization and of having a recurrent episode. (Note: Lithium, Depakote and
a few other drugs frequently prescribed for this and other conditions are off
limits because of the risk of birth defects.)
DISORDER (OCD) A Yale
University study found that among women with preexisting OCD, symptoms worsened
one-third of the time during pregnancy. It also found that 32 percent of the
women who had ever been pregnant had their first OCD symptoms during or soon
DISORDER According to
Flynn, an estimated 9 percent of women experience this condition during
pregnancy, though some expectant women report improvement in their symptoms.
STRESS DISORDER (PTSD) This can result from rape or other abuse, an accident or other traumatic
experience in a woman’s life. The prevalence in pregnancy may be 1.5 percent to
6 percent, Flynn says. Symptoms often worsen during pregnancy, and new cases
can arise as a result of a previous traumatic childbirth or loss of a baby.
While these and other conditions can be safely treated during pregnancy,
locating a qualified care provider can be difficult.