Depression is probably the most common psychiatric disorder today. As a result, it is a commonly encountered pre-existing condition during pregnancy. Additionally, women have it twice as often as men, and among women, there is an increased tendency toward it during the reproductive years. How the menstrual cycle fits in as a contributing factor is still unknown, as we've only just scratched the surface of the PMS mystery. Certainly borderline depression can be affected by the hormones associated with the menstrual cycle and by pregnancy, too.
Pregnancy is a particularly fertile field for depression to either begin or worsen, if already a problem. There are extra physical, financial, marital, and sexual stresses that come along with pregnancy whether one is ready or not. On top of that, any new, poor self-image feelings associated with pregnancy can reinforce a depressed person's existing negative self-perceptions.
An obstetrician is qualified to handle mild depression, anxiety, "the blues," and general moodiness. But severe depression can be life threatening and is a serious illness that requires the additional care of a psychiatrist. (I'm talking about suicidal tendencies; so all moodiness should be questioned.)
Diagnosing depression can be challenging. For instance, a common cause of depression is thyroid disorder. Many women who have hypothyroidism will present first as a depressed patient, so testing thyroid function is a good idea in any patient complaining of depression. Also, depression can be over-diagnosed. For instance, if a woman's husband has just died in a car crash, her house has burned down, she's been mugged and beaten up recently, and she's seeking medical attention for depression. Her condition is probably not an illness but a reasonable reaction to recent events. The point of this ridiculous example is that it's not inappropriate to be "bummed out" over really bad events in one's life. Clinical depression, on the other hand, often causes inappropriate reactions to things, known or unknown.
There are predisposing factors that make depression more likely.
- Childhood trauma, like the death or illness of a parent or sibling
- Childhood sexual abuse, which distorts the well-being of a person on many levels
- Family history of depression
- Lower socioeconomic status (poverty)
- Substance abuse
In any depression during or after pregnancy, it's important to tell the difference between merely "feeling depressed" and clinical depression