Important Piece on Depression in Pregnancy in The New York Times

Let's all join this critical conversation

by Christiane Manzella, PhD, FT
May 29, 2015

Andrew Solomon did an incredible service to women, mothers, and families with his latest piece in the New York Times Magazine, "The Secret Sadness of Pregnancy With Depression." Solomon offered a compassionate, nuanced, and well-researched look at the reality of depression in pregnancy. The transition to motherhood is a tremendous physical and emotional challenge that, as a society, we refuse to see in its entirety. As Solomon so eloquently explains:

"Something sentimental in us likes the notion that the physical discomfort of pregnancy is outweighed by the thrill of nurturing a new life within your own body. At a time of opening social mores, when mental illness is more readily acknowledged, when feminism has won women a wider range of career options, when some women's choice not to have children is validated, when the right of gay men and lesbians to be parents has pushed the frontiers of fatherhood and motherhood, this monolithic perception of pregnancy persists."

Pregnant women are pinned down by that monolithic perception. The idea that women should be happy during pregnancy is so pernicious that the women we see at the Seleni Institute are often shocked (and so often ashamed) when they are not. And yet their suffering and struggle is common.

At least 10 to 15 percent of pregnant women experience depression during pregnancy. This is the same percentage of women who struggle with postpartum depression, and that's not a coincidence. More and more research shows that postpartum depression often starts in pregnancy. And if we are able to successfully treat it then, we can actually prevent postpartum depression.

But there is tremendous pressure on mothers to be happy and make sure that nothing jeopardizes the health of their growing baby, which makes women afraid to speak up and afraid to seek the treatment they need.

The research on the damaging effects of untreated depression in pregnancy is clear: Besides the suffering it causes for the women who experience it, untreated depression in pregnancy puts babies at risk of preterm birth, complications after delivery, and lower birth weight.

The information on the safety of antidepressants during pregnancy is incomplete, but growing. And the class of antidepressants known as SSRIs are among the most well-researched medications prescribed in pregnancy. Increasingly, research is finding that many of the health issues that have been associated with their use are unfounded or manageable.

Prenatal anxiety and depression can be crippling, and the gold standard for treatment is medication combined with talk therapy. We need to end the stigma associated with depression in pregnancy by elevating the health of a mother to the same level as her unborn child, so women can access the treatment they need and deserve.

Solomon's piece is a great step forward in that direction. His portrait of depression in pregnancy shows us the complete picture – that a mother and her child are two parts of a whole, and we need to treat them as such during and after pregnancy. Making sure moms are healthy is how we give birth to a healthy society.

We also need to acknowledge the common obstacles to that: the expectations we place on moms to be joyful, the way we celebrate self-sacrifice as a hallmark of great mothering, and the assumption that happy families just happen.

Struggle is a universal part of life. No less so (and actually more so) during pregnancy. It involves a tremendous physical challenge and an unprecedented identity shift for which no one can be fully prepared. To accomplish those feats easily is the exception, not the norm. What is normal is to have ambivalence during and after pregnancy. It's normal to take time to bond with your baby. And it's actually normal to need help. Even women whose struggles do not feel dangerous to them benefit from good mental health care and strong societal support.

When we talk about the experience of pregnancy and motherhood as honestly and openly as Solomon did, we pry open a door that has been shut for too long. The result? Better research on safe and effective treatments for perinatal mood disorders, and more women who feel comfortable seeking them.

If you need help, or if you know someone who does, please read 6 Steps to Getting Help for Depression During Pregnancy.

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Christiane Manzella, PhD, FT

Christiane Manzella, PhD, FT, is the Seleni Institute's clinical director and has been a therapist and grief counselor in New York City for more than 20 years. Dr. Manzella earned both her master's degree in clinical psychology and doctorate in counseling psychology from New York University and carried out her doctoral dissertation research at Beth Israel Medical Center hospice, with postdoctoral supervision in grief and bereavement work. She was named a Fellow in Thanatology: Death, Dying and Bereavement (FT), awarded from the Association of Death Educators and Counselors (ADEC), and is completing the third year of a three-year term on their Board. 

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