For three out of her four pregnancies, Rebecca Hartley-Woods struggled with dark, anxiety-filled thoughts. “I thought I was crazy, hormonal, and that if I gave voice to what I was feeling, someone would say, ‘You’re supposed to be happy, aren’t you excited?’ ” says Hartley-Woods, a doula in the Tampa Bay, Fla., area. “But for many women, that’s not always the reality.”
Although she was never officially diagnosed, Hartley-Woods, 31, is certain she experienced prenatal depression during those pregnancies. No longer afraid to speak up about it, she’s now the president of the Seventh Mom Project, a nonprofit dedicated to providing assistance to mothers and family members dealing with pregnancy and postpartum mood disorders.
Postpartum depression is often discussed, but prenatal (or antenatal) depression is only starting to be mentioned outside of medical circles, despite the fact that between 14 and 23 percent of women cope with depression symptoms during pregnancy, according to the American Congress of Obstetricians and Gynecologists. In January, the US Preventive Services Task Force started recommending that physicians begin screening for depression among expecting mothers.
Women at a greater risk of developing the condition include those who experienced depression prior to a pregnancy, as well as women on prolonged bed rest and those who’ve experienced miscarriages.
Although a variety of nonpharmacological treatments are available, including aerobic exercise, yoga and cognitive behavioral therapy, antidepressants can also play a role under the supervision of a doctor and a therapist. Selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs) are the two classes of drugs that are prescribed, and while they do pose some risk to the baby, that may be preferable to doing nothing to treat the mother.
“The risk of untreated moderate-to-severe depression can be significant, and in the face of that, I do suggest SSRIs. Not [using them] puts both [mother] and baby in harm’s way,” says Dr. Carly Snyder, a physician who specializes in reproductive psychiatry. “We know from considerable data that untreated illness is associated with an increase in preterm delivery, low birth weight, gestational diabetes, pre-eclampsia. Outside the medical concerns, I stress to women that pregnancy is such a unique time that if you are suffering from depression, you really risk losing that bonding experience with the unborn baby.”
Snyder also says that moms-to-be who are already taking antidepressants should not attempt to lower the dosage themselves when they become pregnant. “A lot of times, women want to be on the lowest dose,” says Snyder. “Either under poor guidance or [on] their own, they lower the dose so that they are symptomatic [for depression].
“In order to be the best mom, you need to take care of your emotional and physical health,” Snyder adds, “whatever that looks like for you.”