Pregnancy is a time of excitement and joy for most women. It’s also a period of great physical, mental and emotional upheaval, which is why doctors have cautioned women for years about the dangers of postpartum depression.
Now, an increasing number of Ob/Gyns are advising pregnant women to be on the lookout for similar symptoms before the baby comes.
“Most new moms are vigilant about looking for postpartum depression, but not as many watch for antepartum depression, which is a mood disorder that occurs during pregnancy,” says David Jaspan, DO, chair of the Department of Obstetrics and Gynecology, Einstein Healthcare Network. “Fortunately, we’re starting to better understand, diagnose and raise awareness about it.”
The American Congress of Obstetricians and Gynecologists estimates that up to 23 percent of pregnant women will experience antepartum depression. That’s not far behind the number of women who will battle postpartum depression, but antepartum depression lags behind postpartum depression in a number of important ways, including research, screenings, and public perception.
For some, it’s hard to untangle normal physical and emotional changes from depression.
“It can be hard for others to recognize the symptoms in the expecting mother since changes in sleep, appetite, mood, and libido are a normal part of pregnancy,” Dr. Jaspan says. “Even if it’s recognized, it can be hard for women to reach out for help because they may feel that they should be nothing but excited and grateful. Of course, depression is the result of problems with the brain’s chemistry—it’s not a character defect.”
Antepartum depression has not been definitively linked with birth defects or other developmental abnormalities. Left untreated, though, it can have dangerous effects on a pregnancy.
“It’s not that the depression itself will hurt the baby,” Dr. Jaspan says. “Instead, there’s a risk of the mother not caring for herself properly or even engaging in destructive behaviors that could lead to problems for the developing child.”
CAUSES & SYMPTOMS
Women who have experienced depression before becoming pregnant are at greater risk for antepartum depression. Other risk factors include stress, abuse or domestic violence, and drug and alcohol use.
“Beyond those risk factors, pregnancy causes drastic changes psychologically and hormonally, right out of the gate,” Dr. Jaspan adds. “While we can’t always pinpoint an exact cause for every woman, we can help them recognize and treat it.”
Dr. Jaspan cautions pregnant women and their friends and family to watch for symptoms of depression, such as feelings of sadness, helplessness or hopelessness, difficulty concentrating, changes in appetite, fatigue, insomnia, and a loss of interest in everyday activities.
“It’s normal to feel apprehensive or worried about a pregnancy, but if you’re overwhelmed with feelings of sadness or anger or irritability, it may be time to reach out,” Dr. Jaspan says. “In many cases, the sooner you talk to your doctor about these symptoms, the more successful you’ll be at managing them.”
Treating antepartum depression early is also key to reducing the likelihood of postpartum depression.
“Antepartum depression is the number one risk factor for postpartum depression,” Dr. Jaspan says. “If a pregnant woman and her healthcare team address antepartum depression early, they’ll be in a much better place after the baby comes.”
Pregnant women with antepartum depression have a host of treatment options available, including non-drug treatments like psychotherapy, meditation, and changes in diet and exercise.
“Many hospitals offer health education classes, prenatal yoga classes, and other individual and group workshops to help women connect to the mental health care they need,” Dr. Jaspan says. “Here at Einstein, we offer a group model of prenatal care that can help women and their families address the many stressors associated with pregnancy. We also provide social workers and psychiatric services, and we’ve partnered with a local university to offer our patients access to psychology services.”
For others, antidepressants may be prescribed. Though there are concerns about the risks of birth defects or withdrawal symptoms in the baby, not all antidepressants are equally risky. Dr. Jaspan notes that selective serotonin reuptake inhibitors (SSRIs) have the best track record with developing infants.“Prescribing medication is usually a matter of weighing the risks associated with antidepressants against the risks of not properly treating antepartum depression,” Dr. Jaspan says. “Some women will need to take medication to have the healthiest pregnancy possible, and that’s a decision best left to them and their health care team.”