Although studies suggest that untreated depression during pregnancy can harm mother and child, the problem is not widely diagnosed -- perhaps because of embarrassment or confusion with other bodily changes.
SYMPTOMS
Common symptoms of depression, including fatigue, sleep difficulties, changes in eating behavior or weight, can be difficult to distinguish from normal pregnancy-related changes, particularly in the first and third trimesters.
"Up to 70 percent of women report some kinds of depressive symptoms at times during their pregnancy," says Catherine Monk, an assistant professor of psychiatry and co-founder of the Pregnancy and Postpartum Resource Center at Columbia University in New York. Symptoms that continue daily for more than two weeks may be cause for concern.
Less-mistakable hallmarks of depression during pregnancy include: low self-esteem, feelings of hopelessness, feeling inappropriately guilty, harshness toward oneself or self-criticism, a diminished interest in or enjoyment of normally pleasurable activities, recurrent thoughts of death or dying.
Those considered most at risk include women who:
 | have been depressed or have a family history of depression |
| are young, especially in their teens |
| have limited social support |
| live alone or have several children already |
| experience marital conflict |
| are ambivalent about being pregnant |
| have had difficult relationships with their own mother |
| are uncertain about whether to stay home with the child. |
TREATMENTS
Drugs most likely to be prescribed are selective serotonin reuptake inhibitors (SSRIs) or tricyclic antidepressants; none are risk-free in pregnancy, but the greatest amount of safety data exists for fluoxetine (Prozac), citalopram hydrobromide (Celexa), sertraline (Zoloft), paroxetine (Paxil) and venlafaxine HCL (Effexor). Side effects may warrant particular concern for patients already uncomfortable because of pregnancy and depression. Shaila Misri, a clinical professor of psychiatry and obstetrics and gynecology at the University of British Columbia in Vancouver, avoids tricyclics because of side effects, which can include dry mouth and constipation. Some drugs may also depress appetite.
Counseling or psychotherapies that may be helpful include "interpersonal" psychotherapy, cognitive-behavioral therapy and couples counseling. Experts also recommend other activities that may reduce stress, such as meditation, massage and moderate exercise. Some research suggests eating foods rich in omega-3 fatty acids (salmon, tuna) may also help.
Herbal supplements, such as St. John's wort -- used widely for mild depression -- are not advised during pregnancy. "I don't recommend herbal supplements because they're psychoactive -- meaning, they work in the central nervous system -- and there's virtually nothing known about their safety [in pregnancy] or possible effects on the fetus," says Vicki Hendrick, director of the pregnancy mood disorders program at the Neuropsychiatric Institute at the University of California, Los Angeles.
RESOURCES
The Web site of Postpartum Support International, www.postpartum.net, offers information about depression during and after pregnancy.
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