Departments
Health Matters
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Week of 10 September 1999 |
Vol. III, No. 5 |
Health Matters
Pregnancy blues: feeling discouraged and down
I'm expecting my first child and have been feeling depressed lately. Is this unusual, and is there any safe treatment?
It's quite common for a pregnant woman to be diagnosed with clinical depression when she is carrying her first child, even if she has never previously experienced the disorder. With the dramatic fluctuation in hormones and the stress pregnancy inevitably brings, women often find themselves feeling blue, says Wendy Smith, M.D., assistant professor of obstetrics and gynecology at Boston University School of Medicine and obstetrician gynecologist at Boston Medical Center. Indeed, current statistics reveal that approximately 24 percent of pregnant women are diagnosed with clinical depression, compared to approximately 8 to 10 percent of women who are not pregnant.
According to Smith, if you think you are clinically depressed, consult both with your obstetrician and with a mental health worker (a psychiatrist or psychologist) for diagnosis and treatment. "While we want to treat the depression, we also want to protect the baby," she says, "so we try to treat the depression first through counseling and therapy. However, if the depression is severe, especially if there's any hint that the mother might be at risk of suicide, then we may prescribe medications to help."
Physicians are most concerned about medicating pregnant women during the critical first trimester of pregnancy. While there is no conclusive evidence to suggest that babies born to mothers taking antidepressants are at a higher risk of malformations, most doctors are not inclined to take any risks during this crucial stage of fetal development. In fact, if a woman who is currently on antidepressant medications becomes pregnant, she may be encouraged by her doctor to try to gradually reduce the amount of medication.
If medications are needed, most antidepressants put the fetus at minimal risk. These include selective serotonin reuptake inhibitors, or SSRIs, such as Prozac™, Paxil™, and Zoloft™, as well as tricyclic antidepressants, or TCAs, such as imipramine, nortriptyline, and amitriptyline. However, one class of drugs, known as monoamine oxidase inhibitors, or MAOIs, cannot be used. These drugs, such as Nardil™, Parnate™, and Eldepryl™, increase blood pressure and are associated with side effects that could harm the baby.
If medications are ineffective, your physician may recommend electroconvulsive, or electroshock, therapy. Still in common use, electoconvulsive therapy has been shown to be an effective treatment for depression and has no impact on fetal development.
More widely experienced than prebirth blues is postpartum blues, which affects as many as 70 percent of mothers a few days after childbirth and usually lasts one to two weeks. Some common symptoms include crying spells, insomnia, fatigue, anxiety, and headaches.
While postpartum blues unnerve new mothers, Smith says, they should not be worried. "Many women are caught by surprise by postpartum blues. They feel that childbirth is going to be a wonderful, great experience -- and it is. But sometimes women can feel a huge letdown and failure after the euphoria of childbirth, and they should understand it's a normal response."
However, if the symptoms last for several weeks, women are considered to have postpartum depression, which is treated as a "classic" depression case, including antidepressant medication if necessary. Only a small minority of mothers, some 3 to 4 percent, experience postpartum depression.
What can help you through the tough moments before and after you have your baby? One simple, nonmedical solution is to lean on your family and friends. "Depression is a normal response to this remarkable change in life," says Smith. "A solid support network can be a tremendous advantage during this time."
"Health Matters" is written in cooperation with staff members of Boston Medical Center. For more information about depression during pregnancy or other health matters, call 638-6767.