Pregnancy & Depression: Warrior Moms of the Week

This week, Warrior Moms of the Week is focusing on antenatal depression, or depression in pregnancy. It’s just as common as PPD but is even less talked about, if you can imagine. There are lots of people starting to speak up about this illness, which is very important. It can be very difficult to make decisions about treatment when you are carrying an unborn child, and to go through the experience of everyone wanting to celebrate the upcoming birth while you are miserable. Here are two stories on depression in pregnancy that appeared this week:

Erin Margolin on antenatal depression (depression during pregnancy)

Babble on antenatal depression

You don’t need to feel alone. It can help to see how many others have been through this, and that their stories are similar to yours. For more Warrior Moms stories on antenatal depression, check these out:

On How It Feels to Be Depressed During Pregnancy

The Black Hole of Antenatal Depression

Aunt Becky from Mommy Wants Vodka on Being Depressed & Pregnant

Antenatal Depression: Robbed of the Joy of Pregnancy

How It Feels To Be Depressed When You’re Pregnant

And if you are a survivor of antenatal depression and want people to know they can make it, too, pick up your survivor badge here:

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The Black Hole of Antenatal Depression

pregnancy depressionIt hurts me to see people I care about suffer from perinatal mood and anxiety disorders like postpartum depression and antenatal depression. In fact, it hurts me to see people I’ve never even met suffering from perinatal mood and anxiety disorders. I want to jump across time and space, right into their living rooms, and hug them and hold their hands and spend untold hours offering hope and giving them support. Sit with them at three in the morning when they can’t stop their minds from running. Recount the countless success stories I know. Show them the pictures of the Warrior Moms.

There should be a way to do that, right? Jump across time and space? Didn’t Einstein say that somewhere?

This is the case with Casey. I’ve been out of town, so I only just now read her post about antenatal depression (aka depression during pregnancy) over at Moosh in Indy. I hate this for her because even though both she and I know that she’ll get through it, being in the middle of antenatal depression (or any other mental illness related to pregnancy or childbirth) is like being in the middle of a black hole. All the light is sucked out. Anything that matters or is made of matter is ripped to shreds by massive forces. It’s hard to imagine that something in that many pieces could ever be put back together again.

It will be, though. It takes time. Help. Patience that it’s just so unfair to even ask someone to have.

Just hold on Casey. Hold on.

Photo credit: c Andrea Danti – Fotolia.com

Research Roundup: Antenatal Depression & Its Impact on Babies

Some perinatal mood and anxiety disorder research in the news this week …

A study from the University of Michigan was published on the impact of depression during pregnancy (antenatal depression) on infants. The study finds differences between infants whose mothers were depressed during pregnancy and those whose mothers were not, having to do with things like muscle tone and levels of stress hormones. You can read about them by following the link, but DON'T freak out though: "While cautioning against alarm, the researchers recommended that mothers experiencing symptoms of depression during pregnancy talk to a therapist. They also noted that interventions aimed and mother-child bonding after birth can act as countermeasures, stimulating children’s neurological development and lowering the possible effects of stress hormone production early in life." The key takeaway for me is that you shouldn't ignore depression when pregnant. Reach out for help.

Also, an interesting little study from BioMedCentral Public Health which covers, among other things, how the conduct of the nurse offering PPD screenings has an impact on the women being screened. I like the comment that the EPDS should be more like a "springboard for conversation" than an inquisition. The comments from the women in the study are fascinating.

… and in this roundup, I'm also throwing in a nice piece from Psychology Today on the difference between postpartum depression and postpartum PTSD (even though it's not research)…

… and a story from KevinMD on how antidepressants can sometimes hurt patients, which goes to show how important follow up is.

Warrior Moms of the Week, 12/5/10

Lauren Hale from My Postpartum Voice with "Wrangling the Guilt Monster Postpartum Depression Built" on guilty, guilty guiltiness

Molly from A Day In Mollywood, appearing on Band Back Together with "Like Sands Through the Hourglass" on her experience with antenatal depression

Kate Kripke with "When All You Want Is Out" on wishing you could just run away

Darline Turner-Lee of Mamas on Bedrest, appearing on Science & Sensibility, with "Who Is At Risk? A Call for Universal Antenatal Depression Screening", on the important of identifying and treating depression during pregnancy

Hannah at Counter Obsession with "Vogue & Postnatal Depression: Apparently It's a Punchline", on Vogue Australia using PPD to sell magazines

Getting Help for Depression During Pregnancy

Last week Alexis wrote a poignant piece about depression during pregnancy, and judging by some of the comments I'm glad she did. There are a lot of women out there who feel as though no one understands what they're going through when they have antenatal depression. They are right that it isn't discussed as much as postpartum depression, but we are workingto change that here. If you are depressed and pregnant, please know that you have a temporary and treatable illness, it is as common as PPD, and you don't have to continue to suffer because there are treatments available even when you are pregnant. If you find your doctor isn't supportive or willing to help you, email me so that I can connect you with specialists who may be in your area. They can inform you of the various treatment options and the risks and benefts of each, and work with you throughoutyour pregnancy.

The last couple of weeks, the MGH Center for Women's Mental Health has posted articles that are very pertinent to women who may be depressed and pregnant right now. The first is calledThe Importance of Proper Dosing of Antidepressants During Pregnancy. The second is Should SSRIs Be Tapered Prior to Delivery? Both will help you better understand some recent researchon taking antidepressant medication for depression while you are pregnant.

Also, here's a story from Lauren Hale at My Postpartum Voice where she writes about her own experience with antenatal depression.

Antenatal Depression: Robbed Of the Joy of Pregnancy

pregnancy depressionWhen my first son was a little over fifteen months old, my husband and I decided to try for another baby. I was terrified; I had just come through a bout of severe PPD, and I was finally feeling good mentally. Others might have questioned my reasoning in choosing to have another child, but we just knew it was the right thing for our family. I can’t fully explain what propelled me to make that decision, but whatever it was, I’m thankful for it today. My second son brought astounding light into so much darkness, and I could never regret choosing him, even when the choice brought me a great deal of pain.

After doing a lot of research on the possible effects of using antidepressants during pregnancy and consulting with my doctor, I decided to wean myself off the antidepressants I was on, knowing full well there was a chance the depression would return once I was unmedicated.

My first pregnancy had been as good as I could have asked for. Although I did have a miscarriage scare early on and was extremely tired during my last trimester, I don’t feel as though I had a lot to complain about. My second trimester was especially good, as I had huge amounts of energy, wasn’t feeling the morning sickness of the first trimester, and didn’t yet have to deal with the fatigue and discomfort of the third trimester. I naively expected things to be at least sort of similar in my second pregnancy.

The first trimester my second time around was as I had expected. I was nauseated all day, but was able to function. I still took my son on playdates and gave him all the love and attention he needed, and I felt all right mentally. I was more tired than I remembered being during my first pregnancy, but I attributed it to the fact that I was a mother this time around. I kept waiting for my first trimester to be over so I’d stop feeling sick and start experiencing the euphoric energy I’d felt the first time.

That energy never came; I only became more and more fatigued as the pregnancy progressed. I started to develop insomnia so bad that I’d only sleep two or three hours a night. The lack of sleep started to get to me; my moods fluctuated wildly, and I had to quit my part-time editing job due to complete apathy towards the work.

Eventually, the exhaustion became so marked I was nearly unable to rouse myself during the day. I’d wake up and feed my son breakfast, then lie down at the foot of my bed and drift in and out of sleep. He would drag his toys into the hallway in front of my room so he could see me as he played. I felt like an utter failure when I would start awake and see my beautiful baby sitting alone in the hallway, chirping happily to his toys.

The last three or four months of my pregnancy were decidedly awful. I felt so disconnected from my life, completely unmoored from reality. I existed solely in my own head, telling myself over and over that I’d been insane to think I could handle being the mother of two children. I felt little attachment to the life growing within me, and I looked to his due date with trepidation.

When he was born, it took me hours to process the fact that I was his mother. I went through the motions of oohing and aahing and nursing him, but I wasn’t really present. I would fall asleep in my hospital bed and wake up bewildered, forgetting for a moment why I was there and what had just happened.

Gradually, I came to love my son so intensely the love scared me with its ferocity. I didn’t come by that love easily, and for that reason I cherish him dearly. I’m still sometimes saddened by the fact that depression stole much of my pregnancy from me, but I cling to the happy ending, my incredible son.

I haven’t spoken much about this to anyone because antepartum depression is still such an unmentionable affliction, at least in our society. A woman is supposed to be joyous and glowing when she’s pregnant; if she’s not, she may feel as though the very thing that makes her a woman is broken. Rationally, I knew I was depressed and that if I could just hold on until the end of my pregnancy, everything would be OK. Emotionally, though, I felt hopeless.

I don’t feel any shame talking about this, because I know who I am and what I am capable of–I know my ideal pregnancy was taken from me by force by depression. I’ve chosen not to write about it up until now because I know it can make other people uncomfortable. It’s a difficult thing to explain, and probably even more difficult to understand.

I write for the woman who does understand, who knows what it is to have her brain taken over by a silent intruder, who cowers in the dark recesses of her own mind, trying to escape the overwhelming feelings of inadequacy and doubt. To that woman I say, come out. There is no shame in what you are hiding from.

For more information on antepartum depression, feel free to start by checking out Postpartum Progress’ previous posts on depression during pregnancy.

Alexis Lesa

Note from Katherine:I’m never sure whether to call itdepression during pregnancy, antenatal depression or antepartum depression, but I am sure of one thing: it’s very common. Thank you Alexis for sharing this, because there are so many women out there who need to see they are not alone.

Photo: Fotolia - © Bianca de Blok

How It Feels To Suffer Depression During Pregnancy

pregnancy depressionA columnist from the Daily Mail newspaper in the United Kingdom wrote a nice piece about her antenatal depression, also known as depression during pregnancy.

Since depression during pregnancy is not something I get the chance to write about as much (not that I don’t want to), I wanted to link to it and share some of it here. This is part of how Lucy Taylor described her experience:

“I desperately wanted to feel overjoyed and excited. Probably because I have read too many magazines over the years and looked at too many pictures of pregnant celebrities, I had dreamily imagined that pregnancy would be a nine-month-long bliss-fest.

I had assumed that the moment I conceived I would be strolling around Mothercare, gazing lovingly at all the cute newborn stuff. Instead, what I felt was that my life was coming to an end. I felt as if the woman I’d known for nearly 40 years – the free, independent, risk-taking, fun-loving, adventurous woman – was dying.

Of course, I then felt full of guilt and self-loathing for having such thoughts. I even began to worry that my negative thoughts would cause another miscarriage or some birth defect.

I remember once reading about a pregnant woman who said she felt as if she’d been hijacked; that there was a tiny terrorist wreaking havoc inside her. This rang true for me. But because the pressure to sound upbeat while pregnant is immense, I found it difficult to share these complex feelings.

Although my partner was comforting and supportive, part of me wondered if he thought it was just the raging hormones that were making me so emotional. I didn’t want to keep complaining to him, but I was still secretly struggling.

There were days when I couldn’t stop crying and all I wanted to do was stay in bed.”

For those of you who’ve been through depression during pregnancy, does her description ring true or was it different for you? Please share.

Photo credit: © Bianca de Blok – Fotolia

Brace Yourselves: ParentDish Covers Antidepressants During Pregnancy

So a while back I heard from Julie Rosenberg, a writer for ParentDish who was doing a story on PPD. Honestly it's hard to remember when it was, and I'm not trying to be a butthead when I say that, it's just that I already have no memorywhatsoever.

Recently she emailed again asking me for a pic for the story and I said sure no problem and sent one of me with my gorgeous boy. Yes, that boy.

Then I saw the story came out today and it was ALL about using antidepressants during pregnancy. I didn't remember that being the focus, though I'm sure it was … I had just forgotten. And I thought to myself, "Oh goodness, here we go." Brace yourselves.

The story is actually very balanced, but I can see howthose with preconceived notions will think I'm promoting taking antidepressants during pregnancy. I can see how some of the quotes from mothers who did choose to take psych meds during pregnancycould be misconstrued by some as though these womenwere all happy-go-lucky about the decision. As if it was an easy decision to make.

I can't say anything about antidepressants without being accused of pushing them. Or selling them. Or being addicted to them. Or some other such claim. I do take one for my OCD/anxiety and am not ashamed of that in any way whatsoever. NOT ASHAMED, EMBARRASSED, or any other kind of stigma someone would like me to accept but that I will refuse to.

I did take meds when I had postpartum OCD, but I also went to therapy, so I can't tell you whether one was more responsible than the other for my recovery — or maybe both equally so. I think if you need medication and it works for you, good.It works for me. If you do something else that works for you, good too. Do what is right for you. But now that I've been quoted inParentDish's article on taking medication during pregnancy, I'm sure none of whatI just said will have any bearing on how certain people will respond.

It was anerve-wracking decision for me to make, to continue with my antidepressant when I was pregnant with my daughter.There are always risks when you are pregnant, with taking anything at all. There are also risks — onesof which many people are unaware — that can come with suffering from clinical depression or anxiety while pregnant. When you face a risk no matter what you do,you just have to come to accept that and make a choice. I made the choice to take meds based on the research available to me at the time, and on the fact that I didn't want my daughter swimming in anxiety inside my belly, and that I didn't want my family to suffer if I had postpartum OCD again which was likely.I chose to put the oxygen mask on myself first.Considering the positive outcome, it feels like in the end it was the right choice for me.

Sadly, there isn't enough research to make it easy for people to make a risk-free decision. There is a huge relapse rate for women who've suffered previous mental illness who go off their meds during pregnancy. There are also studies that show that babies can be negatively affected when women take antidepressants and then to make things even more confusing, there are studies that refute those studies and state that the risks to babies are minute. It's hard to navigate through it all.

I'm grateful that researchers who care about this issue are looking into as many avenues as possible fortreatments of mental illness during pregnancy, including light therapy and acupuncture. I'm grateful to the ones that are continuing to look closer at the effect –or lack thereof, whichever the case may be — of psychiatric medication on infants. I am also grateful to organizations like ACOG that realize there is no cut-and-dry answerand offer guidelines to doctors who are often uninformed about the spectrum of risk.

I hope one day it will be easier for those of us with mental illnesses like PPD to makethese kinds of decisions without worry. That will be a great day indeed. As for now, I'm comfortable with the decision I made and I hope that every other mother has as much information as possible and is supported in the decision she makes, whatever it is.

Itwill be interesting to see what kind of comments Julie's story gets. Hope you'll join the discussion.

Update: Strollerderby on Babble.com has weighed in on the topic now as well.

Also, click here for more stories on pregnancy and depression.

Advice for Depression During Pregnancy

A future grandmother recently wrote to Lisa Belkin, blogger of the New York Times' Motherlode blog, sharing her worries over her daughter's antepartum depression.

She was seeking advice from other mothers who've been through depression during pregnancy. I wanted to sharethe storywith you, in particular because I just loved some of the comments offered. I was particularly impressed by the knowledge of some of the commenters:

"Give her the space, without expectation, to feel however she is feeling about this pregnancy. Get her help, certainly. But don't judge her feelings or compare her experience to your expectations of her experience. It's not fair or helpful."

"As for her husband, he will have to stay patient and stay strong. If he needs professional help to get through this and be the support that his wife needs, then he should seek that out."

"I assume that her getting medical help means an evaluation by a good psychiatrist experienced with helping pregnant women manage mood disorders. They exist. Don't settle for the OB. As earlier posters have suggested, being supportive of her medical/therapeutic program is very important … Please also try to discern what are your anxieties and spare her them–get your own therapy to deal with the (totally understandable) issues around your daughter's difficulties."

"Many resources on the internet that say they are for "postpartum" mood disorders have resources that are broadly useful for mental health across the perinatal period. A good place to start is http://www.postpartum.net/"

Way to go New York Times readers!!!

Also, click here for more stories on pregnancy and depression.

Do Antidepressants During Pregnancy Lead to Developmental Delays?

Last week came research published on the effect of taking antidepressants on the developmental milestones of infants for those women who have depression during pregnancy.

As reported by Jennifer Thomas of HealthDay:

Using data on more than 81,000 babies born in Denmark, researchers found that children whose mothers took antidepressants during the second or third trimester sat without support later and walked later than children of depressed mothers who did not take medication. This was especially true for boys.

Despite the delays, the children's progress was still well within the bounds of normal development, the researchers noted. Children whose mothers took antidepressants sat about 16 days later and walked nearly a month later than the children of mothers who didn't take the drugs …

Despite some concerns, Dr. Diane Ashton, deputy medical director of the March of Dimes and an ob-gyn, urged women not to make any hasty decisions about discontinuing the drugs and to consult with their doctors first.

"For the most part, we feel it's important for women to be adequately treated for depression during pregnancy," Ashton said. "Depending on the severity of the symptoms, you may not have a choice. If the mother is depressed or suicidal to the point of hurting herself, she needs treatment."

ParentDish interviewed perinatal mood and anxiety disorder expert Dr. Ariel Dalfen to get her feedback on this new study. They wrote:

Dr. Ariel Dalfen, who is a psychiatrist and expert on postpartum depression at Mount Sinai Hospital in Toronto, says that although it's prudent to pay attention to these kinds of studies, it's important to emphasize to patients that the results were inconclusive because "people get very scared." And while she acknowledges that every patient's situation is different, she says that women on antidepressants should never decide to go off their medication on their own.

"When people need to be on these medications, you have to balance the very small potential for side effects that haven't been well-documented with the need to treat their problem," she says. "We never want to take any prescribed treatments lightly, because there is always a small possibility that there could be negative effects on the fetus. But you need to make sure you're balancing all the risks and benefits, including the risks of having an untreated depression during pregnancy."

Also, click here if you are interested in more stories on the topic of pregnancy depression.