What happens when instead of a glow, pregnancy brings depression?
While much-needed attention to postpartum depression is increasing, depression during pregnancy isn’t talked about much. And we need to be talking about it. According to the American Congress of Obstetricians and Gynecologists, between 14 and 23 percent of women deal with depression during pregnancy.
A recent Northwestern Medicine study showed that among women who experience depression during their childbearing years, in over a third, the onset of depression came during pregnancy. The study theorizes that untreated depression before and during pregnancy could lead to more severe cases of postpartum depression, and the authors of the study recommend women be screened and treated at the first onset of depression.
But many pregnant women are hesitant to treat their depression with medication during pregnancy—and I was one of them.
When I found out I was pregnant with my son, I was taking Citalopram, an SSRI commonly used to treat depression. I obsessed over the fact that the medication could hurt my unborn son. Like most anti-depressants, Citalopram is a class C drug, which means there’s not enough research to determine that they’re either safe or unsafe.
Whose health should come first? I wondered. Mine, or his?
When I brought up my depression medication, the nurse told me it was up to me what I did. That was when I started to get the sense that I was alone.
My frantic Googling only made it worse, as I came across reports of birth defects linked to antidepressants. Whether the articles were from reputable sources or not didn’t seem to matter—the possibility that I could be harming my son lodged deeply in my nervous mind. I weaned myself down to a sub-therapeutic dose, worsening my anxiety and possibly contributing to the postpartum depression I’d be slammed with after delivery.
The questions at the heart of the dilemma facing pregnant women dealing with depression include: What are the risks we’re most willing to take—the unknown risk of a medication potentially hurting our unborn babies? Or the increasingly researched, known risks of depression on a developing fetus? This dilemma butts up against both our innate and cultural concerns about putting the welfare of our children above our own.
And so often, we don’t have qualified help in answering these questions.
Like me, Jeanne Sager had experienced depression in the past. When she became pregnant with her daughter, now 11, she faced a similar decision of whether to stay on the SSRI anti-depressant she was taking. Sadly, her care providers weren’t much help. “They wouldn't schedule an appointment to confirm pregnancy until I estimated I was past the 12-week point, and when I brought up my depression medication, the nurse told me it was up to me what I did,” Jeanne says. “That was when I started to get the sense that I was alone.”
After looking at the available research, Jeanne decided to stop taking her meds. But a difficult pregnancy complicated matters. “I developed hyperemesis gravidarum—basically, it's morning sickness on steroids. I was throwing up 'round the clock, hospitalized twice and unable to go to work for about a week,” she says. “By the time I finally got on a medicine that helped me hold down enough food to function, my body was absolutely worn out, and I was severely depressed.”
Jeanne struggled through until her eighth month of pregnancy, weighing the decision to risk possible health issues to her baby if she went back on her meds against the risk of her baby having problems due to her depression. At this point, she went back on an antidepressant, but without much clarity from her care provider. Her obstetrician was competent at his job, Jeanne says, “But when it came to treating my depression, I feel like he was completely out of his depths. When I brought up my anxiety and depression, he literally told me that he could not place me on an SSRI unless I expressly asked because of medical liability.” She continues, “He also admitted that he was not versed on the drugs that are used to treat depression.”
This is, unfortunately, common.
“OB care is designed to care for the developing baby—it’s not about the emotional and mental health of the mom,” says Suzette Cyr, a Psychiatric Nurse Practitioner who works in women’s health care and often sees women experiencing prenatal depression. “We can’t separate the two—and when we do, the mental health needs of moms aren’t being taken care of.”
Once Jeanne resumed taking medications, she started feeling better. “But not surprisingly, I just fell into postpartum depression after her birth,” Jeanne says.
Like Jeanne, I was slammed with postpartum depression after my son was born. Would it have been easier if I’d not decided to wean down on my meds? Probably. Had my decision potentially put my son at risk by exposing him to stress and anxiety throughout my pregnancy? Possibly.
Had I suffered more than I’d needed to?
I really was operating blindly, and I'm more than a little horrified now that I look back on that whole time.
Getting help from a care provider who’s knowledgeable about perinatal mood disorders, like a psychiatrist, is key, says Cyr. “If you’re being treated by a PCP or an OB and not a mental health specialist, it’s like having a heart condition but not seeing a cardiologist. Find a specialist that can cross-check the information you’re getting.”
Jeanne’s experience echoes Cyr’s advice. “I got very little info from the doctor regarding risks to my fetus versus risks to me, the mother,” she says. “I really was operating blindly, and I'm more than a little horrified now that I look back on that whole time.”
Cyr also suggests that women struggling with mental health issues before and during pregnancy talk to other women who’ve been in similar situations. While this may sound like trying to find a needle in a haystack, it’s not—approximately 13 percent of women take antidepressants during pregnancy.
“Network with other women who had treatment during pregnancy,” Cyr recommends. “Don’t be afraid to talk about it with people who could give you some unbiased information.”
“Be kind to yourself,” Jeanne advises women struggling with prenatal depression. ”Remember that in the long run, a baby needs a healthy mom. Putting yourself first isn't selfish. It's part of being a good mom.”