Pregnant and Depressed

It's not uncommon to feel sad and anxious during this "happy" time, but you can get help to feel better

By Anne Miller

On Thanksgiving weekend 2011 Sarah Mirock was 27 weeks pregnant with her first child when she became paralyzed with fear. Mirock knew she would be at high risk for postpartum depression because she had been sexually abused as a child and also because her Army husband was currently away in Afghanistan. But she had never heard of prenatal depression until she started thinking about abandoning her baby after delivery and realized something was very wrong.

"I caught myself thinking, 'after the baby's born I should just leave it in the hospital and walk away, because that's better for Kevin and the baby,'" says Mirock, a 34-year-old high school teacher living outside Chicago at the time.

Though it's rarely talked about, depression during pregnancy (also known as prenatal depression) happens almost as frequently as postpartum depression (PPD). According to Laura Miller, MD, director of the women's mental health division at Boston's Brigham and Women's Hospital, 10 to 15 percent of women suffer prenatal depression. And those women are more likely to go on to develop PPD.

Why you should get help
You deserve to enjoy pregnancy and to feel good about the change that is coming to your life. Plus, women who are depressed during pregnancy aren't the only ones that suffer. Depression can elevate the stress hormone cortisol, which can increase the risk of preterm delivery, says Miller. And when you're depressed during pregnancy, you're more likely to eat poorly, skip doctor visits, forget to take vitamins, or turn to drinking or smoking, all of which can be harmful to the baby.

On the other hand, early treatment of prenatal depression not only helps you feel better and reduces your risk of complications, but it can also mean you're less likely to develop PPD. Experts want to increase awareness of prenatal depression, so doctors catch the disorder earlier and women realize help is available. That way, pregnant women and their unborn children are more likely to get the help they need to be strong and healthy.

Why you may not realize you are depressed
Recognizing depression in pregnancy is difficult because some symptoms of depression – such as moodiness, crying jags, excessive sleep or insomnia – are the same as normal pregnancy symptoms.

The difference is the extent of the symptoms, says Samantha Meltzer-Brody, MD, director of the Perinatal Psychiatry Program at the Center for Women's Mood Disorders at the University of North Carolina in Chapel Hill. "Anyone who feels like, 'this is a significant departure from how I usually feel and it is impacting my life in a significant way' should seek help," says Meltzer-Brody.

In addition, crying daily, never feeling happy, or being unable to concentrate on work for weeks are all symptoms of depression, not pregnancy.

Women also may not think that they are depressed because symptoms of depression during pregnancy can more closely resemble symptoms of anxiety. That's what blindsided Naomi Seldin, a 38-year-old copy editor at, during her first pregnancy.

She had been taking medication for depression but quit when she conceived. Then, during a routine exam, a counselor at the hospital asked how she was feeling and Seldin burst into tears, releasing the flood of worries she had been drowning in. 

"I worried about whether my baby would be healthy, whether he might have Down syndrome or something else might be wrong with him because of my age, whether we could afford a baby, how I was going to balance work and being a mom for the first time, and whether I'd be a good mom," she says.

Feeling the pressure to be happy
Sometimes women are reluctant to admit how awful they feel because society tells them they should feel good. "When you're pregnant there's that image that you're supposed to be happy and glowy," says Kate Robinson (not her real name), 37, who lives in Washington, D.C. That pressure kept her from getting help right away.

Robinson knew the signs of depression because she had struggled with the condition as a teen after the deaths of her mother and grandparents, but she still waited to get help. Finally, at the beginning of her second trimester when she began sleeping and crying too much and couldn't concentrate on work, she started therapy. Immediately she felt better.

Even Mirock, who had been through years of therapy before getting pregnant, kept her troubles a secret. "I was trying to do it all myself," she says. Slowly she recognized that her thoughts were slipping back into their old depressive habits. She forced herself to share her concerns with people close to her and found a counselor who specialized in prenatal and postpartum depression.

Taking antidepressants during pregnancy
With her doctors' support, Seldin took the antidepressant Celexa but stopped during her third trimester out of concern that her son could suffer withdrawal after birth.

Many doctors are reluctant to prescribe medication during pregnancy, even though many studies show that certain antidepressants are very unlikely to harm a developing baby. "If you look at all studies, en masse, they are very reassuring," says Meltzer-Brody. But "we get [pregnant] women who come to UNC all the time who cannot get prescribed antidepressants."

That's because doctors fear exposing a child to a powerful drug – and worry about putting themselves at risk of a lawsuit if the child has any medical problems, according to Meltzer-Brody. "It's a much more complicated conversation [with a pregnant woman]," than it is with someone who is not pregnant. "The treatment has to include an assessment of the mother and the baby. There are many providers who are uncomfortable doing this."

And making the choice to take prescription drugs is even harder for a pregnant woman. "You feel like you're damned if you do, damned if you don't," says Seldin. Not treating your depression could have repercussions for you and your child, but choosing to take medication can make "you feel like you're being a bad mom." Seldin chose to treat her condition and taking medication helped. So did making sure to get enough sleep after her son's birth.

Learning that she was not alone was also an important part of Seldin's recovery. "It helped me to know I wasn't the only woman to experience this," says Seldin. "There are reasons why it happens, and you can do things to get through it."

For Mirock, therapy during pregnancy was key, but her greatest relief came right after her daughter was born – a month early by c-section. "I'd just had major abdominal surgery, and I had a kid in the NICU I couldn't hold," says Mirock, "yet I was feeling so much better."

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