When Depression Strikes During Pregnancy

Prevention

There are things you can do to minimize your chances of experiencing postnatal depression:

• Let your family know how you are feeling
• Join a support group
• Exercise regularly
• Get enough sleep
• Eat well

Some women may not be able to avoid prenatal depression. Sometimes no matter what you do, people get depressed. It's important to understand that it's not your fault if you do find yourself battling with depression.

"Since stress and a lack of social support can contribute to depression in general it would make sense that increasing social support and reducing stress could potentially be beneficial," says Dr. Roca. Dr. Bennett concurs, adding that having a plan in place and making sure that Mom is receiving the proper amount of nutrients, like protein and omegas which help keep serotonin levels even, is helpful. "Scheduling things for themselves, getting together with friends and family is important," says Dr. Bennett. "Scheduling this time so you know you'll be having a respite is important."

Getting Help

There is no universal screening for prenatal depression by physicians. "There has been some effort to raise awareness of primary care physicians about prenatal depression and some clinics use screening tools, such as the EPDS (Edinburgh Postnatal Depression Scale)," says Dr. Roca.

The American Pregnancy Association (APA) says support groups, private psychotherapy, medication, and light therapy are all treatments for depression during pregnancy. "The particular circumstances need to be discussed with the woman's physician," says Dr. Roca. "It is not a simple matter of 'what is safe' because it depends in large part on the severity of depression, what kind of treatment someone has responded to in the past, etc."

The FDA warns that babies exposed to certain medications used to treat depression may be at greater risk of developing birth defects. In a December 2005 alert, the FDA reports that, "Early results of new studies show that paroxetine (Paxil) increases the risk of birth defects, particularly heart defects, when women take it during the first three months of pregnancy." The report says that paroxetine should usually not be taken during pregnancy, but for some women who have already taken the drug the benefits of continuing with it may outweigh the potential risk to the baby.

While the FDA provides no definite answers to long-term effects of other medications that treat depression such as Zoloft, they are continuing with drug evaluations, research and labeling of certain medicines. You should discuss all risks with your physician and determine what is right for you.

"I'm never in favor of just giving medicine," says Dr. Bennett. "Even though medicine can be helpful, the doctor should make sure [the patient] is talking with someone. She needs to process what is happening to her and take a look at her wellness plan." Dr. Bennett says the use of medicine ultimately depends on the severity of symptoms.

Medication can be required in some cases to help people engage in therapy. Research has found that interpersonal therapies, focusing on relationships, and cognitive therapies—ones that focus on how people affect their moods, are successful means of treatment for depression.

"Interpersonal therapy focuses role transitions which occur in pregnancy," says Dr. Roca. General counseling can also be helpful; with the most important thing being getting access to treatment. Meetings with women's healthcare providers that highlight prenatal depression could result in an increase of screenings and treatments options. "Small business grants have been given to companies working on modules for professionals," says Dr. Roca. "Continuing education is being offered for lactation specialists, nurses, and other healthcare professionals to determine how to screen and what to do if someone screens positive."