Coping With Anxiety and Depression During Pregnancy

Research has shown that up to 33 percent of women experience clinical depression or an anxiety disorder at some point during pregnancy. Yet some studies indicate that fewer than 20 percent seek treatment, and that treatment is often inadequate, says Healy Smith, M.D., a reproductive psychiatrist at the Women's Mental Health Clinic at New York-Presbyterian Hospital in New York City. "The myth that pregnant women must be happy is still really prevalent," Dr. Smith explains. "Because of that, treatment providers may be less likely to inquire into a woman's mental state, and a woman might feel ashamed to bring it up." But you don't have to suffer -- there are safe ways to treat depression and anxiety during pregnancy.

Symptoms of Depression and Anxiety

It can be tricky to diagnose mood disorders during pregnancy because "some of the symptoms can overlap with symptoms of pregnancy, such as changes in appetite, energy levels, concentration, or sleep," Dr. Smith says. "It's also normal to have some degree of worry over the health of the pregnancy." But if you experience persistent symptoms of depression and/or anxiety, especially if you're unable to function normally, get help.

Symptoms of depression include:

    Being in a depressed mood most of the time for at least two weeks
    No longer enjoying the things you used to enjoy
    Decreased interest in the world around you
    Guilt
    A sense of worthlessness
    Low energy
    Poor concentration
    Appetite changes
    Feeling hopeless
    Thoughts of suicide
    Getting too much sleep, or not enough sleep

The symptoms of anxiety vary by type of anxiety disorder, and include:

Generalized Anxiety Disorder:

    Excessive worry that's difficult to control
    Irritability
    Tension/muscle aches
    Disrupted sleep patterns
    Feeling restless inside
    Fatigue
    Poor concentration

Obsessive-Compulsive Disorder:

    Recurrent, persistent, intrusive thoughts
    Compulsions to relieve those thoughts through repetitive thoughts or behaviors

Panic disorder:

    Recurrent panic attacks
    Persistent fear of having a panic attack

Risk Factors for Anxiety and Depression

Anyone can experience depression or anxiety during pregnancy, but women with these risk factors are especially susceptible:

    A personal or family history of a mood disorder, such as depression or anxiety
    A history of premenstrual dysphoric disorder (PMDD)
    Being a young mother (under the age of 20)
    Having poor social support
    Living alone
    Experiencing marital conflict
    Being divorced, widowed, or separated
    Having experienced traumatic or stressful events in the past year
    Feeling ambivalent about being pregnant
    Pregnancy complications
    Having a low income
    Having more than three children

Risks of Untreated Anxiety and Depression During Pregnancy

"There are well documented, but often overlooked, consequences of untreated depression and anxiety during pregnancy for the fetus and the mother," Dr. Smith says. Risks to developing babies whose mothers have untreated depression or anxiety during pregnancy include:

    Low birthweight
    Premature birth (before 37 weeks)
    Low APGAR score (which rates a newborn's health after delivery)
    Poor adaptation outside the womb, including respiratory distress and jitteriness

Risks to the mother include:

    Suicide
    Pregnancy termination
    Postpartum depression or anxiety
    Use of substances such as alcohol or drugs
    Impaired attachment to the baby
    Not taking good care of her physical health
    Preeclampsia
    Preterm labor
    Having a C-section

Treatment Options

There are several therapies that don't involve medication and are therefore considered generally safe for a developing baby. For women who need medication, there are low-risk options that can deliver real relief.

Nonmedicinal Approaches
The following treatments have been shown to help pregnant women with mild to moderate depression.

    Psychotherapy, such as cognitive behavioral therapy (CBT), in which a skilled therapist teaches new approaches to managing thoughts and emotions
    Omega-3 essential fatty acids, which are found in foods such as oily fish and walnuts, and can act as a natural mood-booster
    Light therapy, in which patients are exposed to artificial sunlight at specific times of the day to help relieve depression symptoms
    Acupuncture, a Chinese practice that (in this case) involves placing tiny needles into areas of the body thought to influence mood

Antidepressant Medication
If you're currently taking medication for depression or anxiety, consult your psychiatrist before you stop. A 2006 study published in the Journal of the American Medical Association showed that "women who discontinued an antidepressant around conception had a 68 percent chance of recurrence of depression during pregnancy, compared to 26 percent for those women who continued their medication," says Stephanie Ho, M.D., a reproductive psychiatrist in private practice in New York City. Of those that relapsed, the majority had to restart their medication during pregnancy.

    Is it safe to take antidepressants during pregnancy?
    Is it okay to take antidepressants during my first trimester?
    Are antidepressants especially risky during the third trimester?
    Is it okay to take more than one antidepressant during pregnancy?
    Will taking antidepressants during pregnancy affect my child later in life?

Finding Support and Specialists
If you're pregnant and you're having depression and/or anxiety symptoms, talk to your ob-gyn or midwife. She should be able to treat you directly, or connect you with the appropriate mental health care provider. These organizations can also offer confidential help:

Postpartum Support International will connect you directly to a local coordinator who can help you find local resources, offer support, and give you tips on managing mood and anxiety disorders during and after pregnancy
 (www.postpartum.net).