In the last decade, awareness about postpartum depression and anxiety has blossomed. Support communities have sprung up. Celebrities like Hayden Panettiere and Drew Barrymore have revealed their personal struggles. Public health officials have pushed for better screening, recognizing that postpartum depression is a serious mental health issue that affects a sizable proportion of new mothers.
A somewhat separate, but equally serious type of maternal depression has yet to garner the same type of attention. Depression during pregnancy, often called prenatal or antenatal depression, affects roughly 15 to 25 percent of expectant mothers, upending the neat cultural narrative that pregnancy is a time of excitement and joy for all women. So many mothers-to-be are left to navigate serious depressive symptoms almost entirely on their own.
"I’d argue that postpartum depression still isn’t exactly getting the attention that it deserves, but if you compare that discussion to the discussion about depression during pregnancy, there are far fewer stories, and there’s much less discussion,” said Katherine Stone, founder of the blog and non-profit Postpartum Progress, which regularly covers the topic.
"I had no idea you could be depressed when you’re pregnant,” echoed Keryn Means, 35, who has 6- and 3-year-old boys, and who developed debilitating depression while carrying her youngest. “I figured you just have all these happy endorphins, and I was really shocked when I couldn’t figure out what was wrong with me.”
Means didn't necessarily love being pregnant the first time, but toward the end of her first trimester with her second baby, she began to sense something was different.
"I wanted to curl up on the couch and just do... nothing," she said.
Some days, Means was able to talk herself into getting up, showering and taking her son to the park. Other days, she couldn’t function. She would drop her son off at preschool, then collapse on the couch, watching movie after movie. Small things, like her husband coming home a few minutes late from work, sent her into hysterical crying fits. In an essay describing the experience for Mom.me, Means says she worried she would feel no connection to her baby boy.
"I had no idea you could be depressed when you're pregnant."
Yet she was reluctant to ask for help. For one thing, it was difficult for Means to determine what was a typical pregnancy symptom and what was not. Was she exhausted simply because she was growing a tiny person while chasing after another? Or was it something more?
"The symptoms of pregnancy can, on some level, look like the symptoms of depression. So a pregnant mom may go into her doctor and say, 'I'm feeling tired. I don't have any energy. My body feels awful.' And the OB may say, 'Oh, well, you're pregnant!'" explained Kate Kripke, a clinical social worker and founder of the Postpartum Wellness Center of Boulder. Doctors should ask their patients for their personal mental histories, and take seriously signs of depression, Kripke urged. Fatigue is a common symptom of pregnancy, exhaustion is not. Same goes for things like consuming anxiety, and a lack of interest in day-to-day activities.
"If you're in the middle of your pregnancy, and you're thinking, 'I don't know what's happening. I don't recognize myself anymore' you need to talk to somebody," Stone said.
The DSM-5, the American Psychiatric Association's official manual of mental disorders, does not recognize antenatal and postpartum depression as separate things, instead including them both under the umbrella of "major depression" with a specifier of "peripartum onset." And the two can be closely intertwined: "Women who are depressed or anxious during pregnancy are 50 percent more likely than the general population to struggle postpartum," Kripke explained.
"Because of the potential stigma of taking antidepressants during pregnancy, many mothers-to-be do not get the help and support they need."
But even when the boundaries of a woman's depression are clear -- when it begins in pregnancy and ends soon after she delivers -- it carries potential risks. Studies have shown that prenatal depression can affect a baby's brain chemistry, for example, and there is evidence linking it to premature birth, low birth weight and birth complications, according to the American College of Obstetricians and Gynecologists. To say nothing of the simple fact that no woman should have to suffer through a major mental health crisis alone.
But the barriers that keep women from getting care are significant and deep-rooted. Many women feel there is a stigma that comes with being depressed during pregnancy, and to taking antidepressants to treat that depression. They're not imagining it. Studies have shown, for example, that medical and nursing students do feel a stigma toward depressed, pregnant women. "Who do you call when you’re stuck in a bottomless sadness, torturing yourself with the million-dollar question: 'Does this make me a bad mother?'" asks Anna Cranage Conathan in an essay for Babble.
While research generally supports the safety of antidepressants for pregnant women with severe depression, there are no easy answers. There are potential risks on both sides, which women should carefully consider with their doctor.
"It's very scary for women to think that at any time, in any way, they might be putting their child at risk," said Stone.
"If you feel as though you will be stigmatized," she continued, "why would you discuss it?" Stone added.
The U.S. Preventive Services Task Force (USPSTF) recently recommended that all adults be screened for depression, including pregnant and postpartum women -- a move the American College of Obstetricians praised, explaining in a statement that "fewer than 20 percent of women in whom perinatal depression is diagnosed self-report their symptoms." Experts who work in the area of maternal mental health, like Stone and Kripke, hope increased education and screening will help.
Means only sought treatment after two girlfriends who'd each suffered through their own bouts of maternal depression brought up the huge change in her personality. She began to take a very low dose of an antidepressant and noticed a change within several weeks. She no longer felt overwhelming exhaustion. She stopped having uncontrollable crying fits in front of her son.
"When you're pregnant, you're supposed to show you have this strength, that you can give life, and you're happy all the time," she said. "For me, admitting I was depressed was hard."
Before she got help, Means felt like she had sunk to the bottom of a hill she could no longer see the top of.
After, she said, she began to climb.
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