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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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

Aunt Becky from Mommy Wants Vodka on Being Depressed & Pregnant

pregnancy depressionI’ve only met Becky Harks — known all over the blogosphere as Aunt Becky from the blog Mommy Wants Vodka — virtually, but I’m a big fan and can’t wait for the opportunity to meet her in person. She’s raucous and side-splittingly funny, with a wide following she calls her band of “Merry Pranksters”. She also created an amazing site called Band Back Together, where people who’ve struggled through everything from bullying, miscarriage or divorce to postpartum depression or having children with special needs can come together and find support. Below, Becky shares her story of experiencing depression during pregnancy, also called antepartum or antenatal depression. I’m so VERY PLEASED to have her as a guest here today.

The only thing I’d wanted was another baby. So when, after meeting a good guy, marrying him and buying a house in the suburbs with a yard (like I was Suzie-freaking-Homemaker), I found myself knocked up once again just like I’d wanted, I couldn’t begin to understand why I was so miserable. After living through my first pregnancy — something that can only be described through a particularly bad country song — raising an autistic child, escaping my alcoholic parents and finally having another baby, this time the way I thought it was “supposed to be,” my feelings were beyond bizarre to me.

Certainly, my life was stressful. But my life has always been stressful. I’d had to quit my job and money was tight, something my new husband worried about often and loudly. When we’d moved to the ‘burbs, we’d left behind our friends so my support system of single friends was gone. We’d occasionally talk on the phone but it became more and more obvious that we were no longer on the same page. It stung more than I’d thought it would.

Day after day during this pregnancy I sat alone on the couch, or praying to the porcelain gods, while my husband worked 14-hour days. My distant son, never a source of emotional comfort anyway, was in school all day. These were the days before I’d adopted the internet as Your Aunt Becky, so I was Becky, As Herself. I had no one to confide in, no Band of Merry Pranksters to confess my feelings to, and now neatly severed from all of my support systems, I floundered.

I’d been depressed before, but the feelings I was experiencing were new. I felt like I was mired in quicksand, rooted in one spot, unable to move forward. Always a social beast, I could barely leave my house. A simple phone call became too much to handle. The isolation bred isolation and now a trip to the store exhausted me for days beforehand and afterward. It was all I could do to get out of bed in the morning.

Sleep was an elusive mistress. Night after night, as my son churned in my belly, I tossed and turned, unable to ever fall into that deep REM sleep that the doctors insist we need to survive. I remembered that sleep deprivation was a technique that soldiers used on POW’s to drive them slowly insane, which was precisely what was happening to me. Each morning, I dragged myself out of bed, unrefreshed and sad, filled with a sense of impending doom.

Finally, untrusting of my OB, I turned to Dr. Google for advice. While I wasn’t yet Your Aunt Becky, I was a blogger and I knew that the beauty (and horror) of the internet is that there’s always one soul that no matter how depraved you’re feeling, can sympathize with you. Setting my search to “antepartum depression,” I was confident that I would find something.

Nothing came up. Well, okay, there were a couple of things, but mostly with “antepartum” and “depression” mentioned in the same article.

Not exactly helpful, Dr. Google.

Fine, I thought. I’m a freak.

Ben, my first, had been born after Andrea Yates had her bout with postpartum psychosis, so I’d had no end of pamphlets shoved at me to help me combat any urges to hurt myself or someone else after he was born. We’d studied the spectrum of postpartum mood disorders in nursing school as well. But antepartum depression was a big question mark.

So what did I do? NOTHING. I wore a groove on the couch where I sat miserable and sad until my second son, Alex, was born squalling and healthy. Almost instantly, my mood improved.

When I got pregnant with my daughter, I expected the antepartum depression to return and it did. By this time, I had become Your Aunt Becky and shared my troubles with my Pranksters. Many stepped up and said that they, too, had experienced the same types of feelings. It was wonderful to feel less alone; less like a circus freak. I went onto an SSRI in my second trimester to try to combat the antepartum depression, but even with that on board I didn’t feel much better. Pregnancy, it seems, doesn’t agree with me.

What shattered me was after I shared my experiences about antepartum depression, the usual search terms that brought people to my blog (boring things, aunt becky sucks, mommy wants a vodka) were replaced by these: “antepartum depression,” “depression during pregnancy,” and “sadness in pregnancy.” Knowing that there were other women sitting on their own couches struggling the way I had broke my tiny black heart into a billion pieces.

The isolation I experienced was devastating and while I ended up walking away from the experience with only a little darkness on my back, I hate to imagine others out there suffering the way that I did. I’m thrilled that postpartum depression has gotten so much support. It should get all that it does and more. Women supporting other women is beautiful. I want antepartum depression, which they now call antenatal depression apparently, to get some of that support, too.

I hope that for the next pregnant woman who sits on her couch, crying and feeling as desperately alone as I did, I hope that she can find the light. Because there is light. And it is so, so good.

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

Participate In Survey On Treatment Decision-Making For Depression During Pregnancy

Researchers at Columbia University are conducting a survey as part of a research study designed to understand the treatment decision making process for women with depression during pregnancy and after birth. To participate, you must be of childbearing age, 18-44 years of age, and either pregnant or have recently given birth to complete the survey. Your participation is voluntary and you may stop the survey at any time. The survey is anonymous; no identifying information will be obtained from you, your responses will not be traceable back to you and no attempts will be made to re-contact you. It may take up to 15 minutes to complete all of the questions.

To participate and add to the valuable knowledge gained by these researchers, click here.

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

Miscarriage Risk Increases With Antidepressant Use During Pregnancy

A new article from the Massachusetts General Hospital's Center for Women's Mental Health reports on the risk of miscarriages (characterized by their medical term "spontaneous abortion" in the article) when taking antidepressants during pregnancy. In research recently carried out by Motherisk, "theauthors conclude that there appears to be a small but statistically significant increase in the incidence of spontaneous abortion in women with antidepressant exposure during pregnancy …" Learn more by visiting the link above.

How To Get Information About Specific Meds & Pregnancy Or Breastfeeding

medications and pregnancyI got a question from a reader with PPD today about specific medications and breastfeeding. Wouldn’t you know it, over at Perinatal Pro, Susan Stone just wrote a piece about OTIS, the Organization of Teratology Information Specialists. Here’s the really cool part:

Expectant or lactating mothers, healthcare providers and those who love them can call a toll free number – 866-626-6847 to ask questions about medication exposure during pregnancy and lactation!

Go read Susan’s story to learn more about OTIS and how it works.

You can also visit the MGH Center for Women’s Mental Health and their section on breastfeeding and psychiatric medication.

And you can visit Motherrisk’sresource on breastfeeding and medication, and their page on medication during pregnancy. These sections include information on all drugs, not just psychiatric ones.

Also, click here for more stories on breastfeeding and PPD.

Photo credit: Fotolia – ©Greentree