Prenatal Depression: Why the Occasional Emotional Misery
Pregnancy is supposed to be a time of joy, excitement and optimistic anticipation for that bundle of joy, right? Sadly, for some women, pregnancy and the thought of motherhood cause sadness, feelings of vulnerability, fear, and distress. Considering the prevalence of major depression is two times higher in adult women than men, it’s not surprising, that depression is a common issue during pregnancy. Clinical depression can become evident for the first time during pregnancy and preexisting depression may be exacerbated.
Symptoms of depression including fatigue, sleep disturbances, tearfulness, diminished appetite and libido, to name a few, can mimic common pregnancy symptoms; thus many clinicians, in good faith, may fail to recognize, diagnose and treat depression in pregnancy. This combined with the fact that many pregnant women won’t report “feeling down” to their health care providers because they feel shame or guilt, further limits recognition. These women suffer, wondering why they are feeling so low when other mothers to be, who are clearly elated, surround them. It is unclear why pregnancy may prompt the onset of depression or worsen an existing diagnosis; factors likely include dramatic hormonal shifts and anticipated psychosocial changes.
Risk factors for prenatal depression include a history of depression or anxiety prior to pregnancy, unintended pregnancy, ambivalence towards the pregnancy, lower income and education levels, smoking, living alone, poor relationship, family history of depression, and discontinuation of antidepressants.
Diagnosis of prenatal depression requires that other medical conditions, such as thyroid or metabolic abnormalities be ruled out. Women should be evaluated for illicit and prescription drugs as well as for use of herbal and over the counter products that may exacerbate psychiatric disorders or cause mood changes.
Antenatal depression has implications for mothers and offspring alike. Pregnant women with depression are at higher risk for alcohol, tobacco and drug use, poor weight gain, insomnia, impaired maternal infant bonding, post partum depression and non-initiation of breastfeeding. Suicide is, of course, the most serious consequence. Depression during pregnancy may cause fetal growth restriction, impaired infant language acquisition and psychiatric issues, including depression in offspring. Genetics as well as other environmental exposures are likely causative factors in as well.