Depression doesn’t always wait until the baby comes PRE-BIRTH BLUES

By Alison Bowen

Chicago Tribune (TNS)

Kate Moser waited until the night before her due date to set up the nursery.

Dark emotions had persisted throughout her pregnancy, despite the 32-year-old’s efforts to be positive. Thus, the eve of her 2014 due date found Moser and her husband piecing together the crib.

Moser did not have a glowing pregnancy. After two wrenching miscarriages, the Chicago teacher felt fraught with anxiety and fear that she tried to suppress. Strangers commenting on her growing belly left her feeling wilted or incensed. Driving to a doctor’s appointment seemed impossible.

“I felt like I was walking a plank every time,” she said.

Moser is one of many women who suffer depression and anxiety while pregnant. The American College of Obstetricians and Gynecologists estimates one in seven women experience depression during pregnancy or within 12 months of delivery.

“It’s very, very common,” said Dr. Marcela Almeida, director of the Women’s Mental Health service at the University of Illinois at Chicago, which treats hundreds of women from multiple states.

But despite growing awareness of postpartum depression or “the baby blues,” anxiety and depression during pregnancy remain underreported, with no standard screening procedures in place, experts say.

And yet, “it’s the most psychologically vulnerable time in a woman’s whole life,” said Kellie Wicklund, a Philadelphia psychotherapist specializing in reproductive mental health.

Hormones, stress, infertility, previous experiences with depression or anxiety – all act as triggers, experts said, with isolation often exacerbating them. Facebook CEO Mark Zuckerberg shared recently that he and his wife, Priscilla, are expecting a baby girl after three miscarriages. Their pregnancy journey was “a lonely experience,” he said, adding that he hopes sharing their struggle will foster openness.

Behind smiling belly shots floating across social media, many say they feel pressure not to be negative about their pregnancy.

Although many women report a range of mental health issues while pregnant – from suicidal thoughts to poisonous, persistent unhappiness – fewer than 20 percent of women diagnosed during postpartum had self-reported symptoms, according to the American College of Obstetricians and Gynecologists.

“You’re supposed to be enthralled with being pregnant and excited and have all positive feelings about it, and a lot of women are just ridden with anxiety,” said clinical psychologist Dr. Gina Hassan, who offers therapy for pregnant women at her California practice. “It’s very hard to speak openly about that with others.”

Recently, the U.S. Preventive Services Task Force recommended that pregnant women be screened for depression.

The U.S. Centers for Disease Control and Prevention’s most recent relevant statistics, from the 2005-2009 National Survey on Drug Use and Health, show about 8 percent of pregnant women age 18 to 44 had reported depression during the past year.

Other studies paint an even more troubling portrait. Dr. De-Kun Li, a senior research scientist studying prenatal depression at the Kaiser Permanente Division of Research, estimates that as many as 20 percent may experience depression symptoms during pregnancy. The reality is likely even higher, he cautioned.

For Moser, it was hard to articulate her loss of happiness.

“You lose that joy that a lot of women and families experience during a first pregnancy, and strangers don’t realize that,” she said. “They just see you being pregnant and feel like it’s acceptable to rub your belly and talk to you about the baby.”

Many see awaiting a child as magical and merry, Hassan said, and that cultural expectation contributes to feelings of guilt and shame when hopelessness creeps in instead.

An unexpected positive pregnancy test can spur stressors, like planning for a new phase of life, perhaps marriage or moving – those alone being enormous life changes. And even a pregnancy both orchestrated and welcomed can deal a blow.

“Women are caught off guard,” Hassan said. “They planned the pregnancy and anticipated it, and it’s not what they expected.”

SIGNS

As a birth doula, Eleanor Turner looks out for small signals: disinterest in a baby shower, perhaps, or a dismissive attitude about the baby’s progress.

Maybe a client casually says, “I don’t really know that I’m bonding,” as an example, said Turner, who owns Lemonade Babies in Wisconsin, which offers services before and after pregnancy. Or, “I haven’t really felt the baby move, so I don’t really even know there’s anything in there.”

Almeida said signs of depression, which experts caution can be mistaken for typical pregnancy changes, include less energy, changes in sleep or appetite, and feelings of guilt, helplessness and hopelessness.

Strong negative emotions during pregnancy can domino, spiraling into fears of motherhood.

“It does bring up sort of self-doubt, ‘Maybe I wasn’t meant to be a mother, maybe I shouldn’t be a mother, maybe this is a sign,’” Hassan said. “As opposed to, ‘This is how my body is responding and something I’m going through, and it’s not necessarily permanent.’”

FINDING HELP

The first step toward help, Almeida said, is openness about feeling down.

Regular screening is needed, Almeida said. The Women’s Mental Health service encourages a collaborative approach, involving nurses, social workers and psychiatrists.

But not every doctor brings up mental health in a prenatal exam. There is no standard question or protocol to screen for depression during pregnancy.

“Ideally that should be part of the routine prenatal care,” Almeida said. “In clinical practice, it really varies a lot.”

After birth, doctors typically use the Edinburgh Postnatal Depression Scale to gauge mothers’ mental health. About a five-minute questionnaire, it asks about the past week with statements like “I have felt scared or panicky” or “I have been so unhappy that I have been crying.”