Pregnancy and Depression

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Pregnancy and depression are not uncommon. 

Antenatal depression, also known as prenatal or perinatal depression is present in millions of women. Although in the past we thought that women who had experienced depression might be protected against relapse by their hormones, evidence and studies over the last twenty years have shown that the opposite is true. 

Pregnancy should be a time of happiness and joy, or at least that's what women are told. For women who have a history of depression, pregnancy may be a trigger for a new episode. In fact, women who have experienced depression in the past are three times more likely to experience depression during pregnancy. Depression during pregnancy is also a threat for those who are genetically predisposed for depression, have extra stress, or whose hormones go awry. Pregnancy is a vulnerable time. According to the Mayo Clinic, approximately 7 percent of women will experience a pregnancy with depression. 


You may be suffering from depression if you are experiencing: 

  • Fatigue or loss of energy 
  • Feelings of worthlessness or guilt 
  • Impaired concentration or indecisiveness
  • Difficulty sleeping or difficulty not sleeping
  • Lack of interest or pleasure in most activities
  • Feeling keyed up or slowed down
  • Recurring thoughts of death or Suicide
  • Feeling hopeless or sad
  • Feeling irritable or angry


We don't completely understand why hormonal changes play a role in the fact that women are more at risk than men of depression. Women are at double the risk of depression early in life, but rates of depression become the same between women and men after menopause. Because mood changes are so often bound to hormones, during pregnancy, each trimester of pregnancy presents special challenges for women with depression. 

Distinguishing between pregnancy and depression symptoms can be hard.  For example, mood swings and tiredness are commonly reported by many pregnant women. Also, some depression symptoms are ones that a pregnant mother likely does not want to acknowledge or is ashamed to disclose. The truth is, we live in a society that makes it hard for women to share feelings that are anything but joyful when it comes to pregnancy. Due to the social networking portrayal of life's perfect moments, the pressure on women to appear joyful during all of pregnancy is worse than ever. Additionally, depression still carries a stigma making it less likely that women who are experiencing symptoms will fell comfortable disclosing them. 


This presents a special challenge for women who can be deeply ashamed, confused, and embarrassed by depressive episodes during their pregnancy. If you find yourself in this situation you may be asking yourself "Why am I depressed during a time of my life when I would be expected to be happy and what can I do about it?" If you are struggling with this issue please know there are millions of women who are going through the same thing, there is help, and it is not your fault that you were vulnerable to depression.  

Pregnancy and Depression. Should I stay on my antidepressant?

Fact: Women who are on an antidepressant when they become pregnant and discontinue their antidepressants are five times more likely to experience depression than those who discontinue it.

If you have been on an antidepressant, it's important to consider whether to continue or discontinue staying on your antidepressant. Although it is your decision and many women make the choice not to stay on your medicine or not, specialists in pregnancy and depression often provide women with the above facts and information below when making choices about what to do. 

At a recent workshop delivered by experts in pregnancy and depression and at Massachusetts general, I learned that there is a great deal of evidence about SSRIs in pregnancy. The most recent studies have shown that many of the dangers that we originally thought SSRI's posed to fetuses have been unfounded.

A recent review of the literature found no evidence or increase overall of congenital malformations, cardiac defects or heart malformations in babies who were prenatally exposed to SSRIs (Huybrechtset al 2014).

Additionally, the most recent findings are that there are no findings linking autism to antidepressants, which was once a serious concern.  

However, there are known risks. For example, in 25- 30 percent of newborns who were exposed to antidepressants ( SSRI's) they are agitated and jittery after they are born. But, this side effect is found to soon go away with no intervention.

The biggest concern with a mother continuing to take medication for their depression may be that there haven't been enough studies on infants exposed to antidepressants long term to determine their impact. So researchers don't know conclusively, if babies exposed to antidepressants have difficulty with things such as speech, or motor skills, or have trouble in school. 

You may be asking yourself why would I take an antidepressant if I don't know what would happen to my child over time if they are exposed to it? 

Depression and Pregnancy: Depression causes known harm to the baby

The newest knowledge that HAS accumulated over the last 20 years about depression and pregnancy  has to do with the relationship between the mother and her baby and the power of bonding begins in utero. Everything that a mother experience is transmitted to her baby. 

We now understand that the impact of maternal depression and stress on the developing fetus is significant.

What do we know about depression and anxiety and its impact on babies?

Mothers who have untreated depression may give birth to babies who have

  • low birth weight
  • Smaller gestational age babies
  • Preterm babies

and 

  • Recent scans of babies' brains show that the structure of a baby's brain is different when the mother is depressed. 

So while we do know that a depressed mother changes the structure of a baby's brain for sure, and not for the better, we don't know that an antidepressant ( which makes the mother well) changes a baby's brain because we have no studies that show that.

Staying healthy and undepressed during pregnancy is important so that weighing the risks of antidepressants against the risk of depression something you need to consider. Most professional psychiatrists who work with maternal depression will help you as the mother weigh these risks and benefits. A good doctor will  being support  your own personal preferences to help you make the best decision about what's right for your baby when making this choice.

It's also important to note that women who are depressed in pregnancy have the highest risk of being depressed postpartum, and this poses a whole range of new risk factors for a child. 

Staying depression free during pregnancy is extremely important. 


Depression in Pregnancy References



Huybrechts KF, Palmsten K, Avorn Antidepressant use in pregnancy and the risk of cardiac defects. N Engl J Med. 2014;370(25):2397–2407. 

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