Depression in Pregnancy

Pregnancy is a particularly fertile field for depression to either start anew or worsen if already a problem. The extra physical, financial, marital, and sexual stresses come whether one is ready or not. On top of that, any new feelings of poor self-image can reinforce depression's already negative self-image problems.

An obstetrician is qualified to handle mild depression, anxiety, "the blues," and general moodiness. But severe depression is a very serious illness that requires the additional care of a psychiatrist, because many people die from it! I'm talking about suicide, so all moodiness should be questioned.

Depression diagnosis can often be a confusing challenge. For instance, a common cause (co-illness?) of depression is thyroid disorder. Many women who have hypothyroidism will present first as a depressed patient, so thyroid function testing is a very good idea in anyone complaining of depression. Also, depression can be over-diagnosed. For instance, if a woman's husband has just died in a car crash, her house has burned down, and she's been mugged and beaten up recently, depression is probably not an illness but a reasonable reaction to these things.

The point of this ridiculous example is that it's not inappropriate to be bummed out over really bad things in one's life. Clinical depression, on the other hand, is when there is an inappropriate reaction to things, known or unknown.

• Childhood trauma, like death or illness of a parent or sibling
• Childhood sexual abuse, which will distort the well-being of a person on many levels
• Family history of depression
• Lower socioeconomic status (translated, poverty)
• Stress
• Substance abuse

After delivery, feeling depressed may respond to an understanding ear and a reassurance that this is common. What a new mother (and father) fail to anticipate is a selfish inner rebellion to the fact that they've been pushed to the #2 (or #3) position in the family and can't just do whatever they want anymore. For instance, let's take movies. As a couple you pretty much see all of the movies you really want to see either at the theater or on cable or tape. Along comes baby.
Forget movies. No movies for about two years! And this is a colossal drag since life has been one big date up till now. Now, you can even forget seeing a movie at home uninterrupted by feedings or diapers or just checking on a suspiciously quiet baby. And if you go someplace, no more just hopping into the car and goin'. You've got to haul all of this stuff along: packages of diapers, wipes, blankets, clicky toys, and the like. And as the baby gets older, add to this haul of paraphernalia collapsible rolling pods, strollers (two varieties the deluxe and the umbrellas), medicines, and snap containers of gruel.

It won't get any better until you realize and accept the new world order:

You just have to put your life on hold for a couple of years.

During pregnancy, feeling depressed is usually a problem in which a woman, once feeling fit, experiences nagging physical complaints caused by something she has no control over. As a woman's abdomen expands in the mirror, this physical sign is symbolic of a shift from seeing herself as a woman to seeing herself as a mother. From seeing herself as a sexual being to seeing herself as a maternal one.

"What have I gotten myself into?" isn't a question with a remedy, unfortunately, except for the cruel, "Deal with it." And because, I'm told, men are from Mars, they're often not the most sympathetic persons and often fail to come through. However, a couple who are pregnant for all of the right reasons or who have put themselves into the big picture of what pregnancy is all about will ultimately find a way to stay afloat on this endless sea of uncertainty. It's a "sea-legs" sort of thing and a matter of self-perspective. If the relationship between the expectant parents is good, mild depression need only be a temporary reaction to a permanent change in one's life.

Alterations in thinking, delusions, or hallucinations, however, push the diagnosis of depression, categorically, into a psychosis. After delivery, postpartum depression is a serious illness to be distinguished from the "postpartum blues." Thought disorder can get fairly creepy in that the mother starts having threatening thoughts about the baby. But a woman so afflicted isn't any more afflicted after birth than she would be any other time if she's got a history of mood disorders. According

to the American College of Obstetricians and Gynecologists, Technical Bulletin 182, "Depression in Women,"

"Major clinical depression has been thought to be more common following childbirth than during other periods of a woman's life. However, current studies do not substantiate this belief. Women at risk for significant postpartum depression are more likely to have a family history of depression, a previous postpartum depression, or significant adjustment problems with childbirth. It has been demonstrated that women who have a planned pregnancy in a secure environment, enjoy a supportive relationship with their partner, and have manageable levels of life stress are less likely to experience postpartum depression."