antepartum depression

Mamas on Bedrest: “Pre-Partum Depression: What is it and what you need to know”

March 4th, 2013

depressed woman“Pre-Partum Depression: What is it and what you need to know”

This was the promo title for the segment on The Rikki Lake Show. As I was cleaning out my DVR this weekend I came across this show and watched.  Rikki had a young woman who was sharing that she felt overwhelmed about being pregnant with her second child at age 25. She was afraid that she wouldn’t have the energy to take care of both children, and she was particularly afraid that she wouldn’t love her younger child as much as her oldest daughter.  Another woman related that she was depressed about being pregnant because she had just gotten back to her pre-pregnancy weight and physical condition after her first pregnancy. An expert was present assuring the women know that what they were feeling was normal and how to deal with the feelings.  She discussed the difference between the “pre-partum blues vs. pre-partum depression”, and there were other support professionals there offering advice and tips.

Many people are unaware of the fact that many women suffer with depression during their pregnancies. According to the American Pregnancy Association, the American Congress of Obstetricians and Gynecologists (ACOG) estimates that depression during pregnancy occurs in 14-23% of pregnant women. Everyone agrees that depression in pregnancy can be a challenge to treat. One tries as much as possible to keep pregnant women off of medications. The expert on the show clearly stated that since depression is a major medical condition and can have negative effects on mama, the pregnancy and the baby, if medication is needed, it is prescribed. However, early identification and early intervention in the form of cognitive behavioral (talk) therapy and social support are the first lines of treatment in pregnant women with mood disorders.

The signs and symptoms of depression during pregnancy: (symptoms must persist for two weeks or more)

  • Persistent sadness
  • Difficulty concentrating
  • Sleeping too little or too much
  • Loss of interest in activities that you usually enjoy
  • Recurring thoughts of death, suicide, or hopelessness
  • Anxiety
  • Feelings of guilt or worthlessness
  • Change in eating habits (most notably weight loss)

As always, I approach issues in pregnancy with the lens of high risk pregnancy and Mamas on Bedrest, and again I was dismayed to see that Mamas on Bedrest were left out of this discussion. While I have not been able to find definitive numbers on rates of pre-partum depression in Mamas on Bedrest, Judith Maloni, PhD published extensively on the topic. In her publication, Antepartum Bed Rest for Pregnancy Complications: Efficacy and Safety for Preventing Preterm Birth, Maloni states in this journal article,

“In the presence of pregnancy complications, perinatal stress emanates, not only from having a high-risk pregnancy, but also from the increased threat to health, hospitalization, and obstetric treatments that are frequently physically and psychologically invasive and demanding and serve as a reminder of the precarious nature of the pregnancy…Exposure to chronic environmental stressors as well as anxiety, separation, and concerns for self and family contribute to behavioral stress response…The experiences of vigilant waiting for an important

future maternal or infant health outcome over which women have no control and of isolation likely compound maternal stress. Isolation has been identified as one of the major contributors to increased allostatic (emotional/behavioral stress) load.”

Treatment for Mamas on Bedrest who may be suffering with pre-partum depressive symptoms is no different than treatment for mamas not on bed rest. However, it is the isolation and lack of social contact that increases the likelihood that depression or depressive symptoms will be missed in Mamas on Bedrest. I posted the common signs and symptoms of pre-partum depression above and implore you, if any of these symptoms speaks to you or you have experienced them for 2 weeks or more, consult with your health care provider or at the very least, tell a trusted individual so that they can help you get help. One of the important nuggets the expert on the Rikki Lake show added is that most obstetricians are not skilled in treating depression of any sort. They are surgeons. So while it is important that you discuss your symptoms and situation with your obstetrician or midwife, if you are truly depressed (having symptoms for 2 weeks or more), ask for a referral to a mental health professional. They are more skilled at diagnosing and treating mood disorders and can offer suggestions on alternative forms of therapy besides medication.

Finally, the American Pregnancy Association also lists the following “alternative therapies” for the treatment of depressive symptoms in pregnant women.
  • Exercise–Exercise naturally increases serotonin levels and decreases cortisol levels. (Purchase our DVD Bedrest Fitness for and exercise program specifically for Mamas on Bedrest!!)
  • Get adequate rest–Lack of sleep greatly affects the body and mind’s ability to handle stress and day to day challenges. Work on establishing a routine sleep schedule that has you going to sleep and getting up at the same time.
  • Diet and Nutrition–Many foods have been linked to mood changes, the ability to handle stress and mental clarity. Diets high in caffeine, sugar, processed carbohydrates, artificial additives and low protein can all lead to issues regarding your mental and physical health. Make a conscious decision to start fueling your body with the foods that can help you feel better.
  • Acupuncture-New studies report acupuncture to be a viable option in treating depression in pregnant women. (Be sure to consult with an acupuncturist skilled in treating pregnant women!)
  • Omega-3 fatty acids–For years its been know that omega-3 can help with a number of health issues, but the newest studies are showing that taking a daily supplement of omega-3/ fish oils can decrease symptoms of depression. Pregnant women would want to make sure to take a mercury free version of fish oil and check with their care provider or nutritionist on a recommended amount. (send e-mail to info@mamasonbedrest.com for information on pharmaceutical grade fish oils and the recommended dosages in pregnancy)
  • Herbal remedies—There are a number of herbal and vitamin supplements known to affect moods and the hormone serotonin. Talk with your health care provider and nutritionist/ herbalist about the options of using St John’s Wort, SAM-e, 5-HTP, magnesium, vitamin B6 and flower remedies. Many of these can not be used in conjunction with antidepressants and should be evaluated on the dosage for pregnant women.

Unfortunately, pre-partum depression is a reality, and there is an increased risk of occurrence in Mamas on Bedrest due to the isolation and lack of social contact. If you are feeling sad, blue or truly feel depressed, please tell your health care provider or other trusted individual. If you don’t know who to tell, you can always send an e-mail to info@mamasonbedrest.com and we’ll help you get the support that you need.