15% Get Pregnancy-Related Depression

Depression and pregnancy may not seem to go together, but
a new study shows that more than one in seven women are depressed in the nine
months before pregnancy, during their pregnancy, or in the nine months after
giving birth.

The new research expands on information already known about depression after
childbirth.B "People have known for quite a while that postpartum
depression is a serious, sometimes devastating event," says researcher
Evelyn Whitlock, MD, MPH, senior investigator at the Kaiser Permanente Center
for Health Research inB Portland, Ore. "One of the things we were able
to do is look across the spectrum -- nine months before pregnancy, the nine
months of pregnancy, and the nine months postpartum. I think this is the first
study to do that."

The results also seem to confirm that women with a history of depression are
at higher risk for postpartum depression. "I think it's important that
women realize that postpartum depression doesn't just come out of the
blue," Whitlock tells WebMD. "About 54% of women [in the study]
identified as having postpartum depression had also been identified either
before or during pregnancy as being depressed."

The study, with an accompanying editorial urging more research, is published
in the October issue of the American Journal of Psychiatry.

(Have you felt depressed
during your pregnancy ? Talk about it on WebMD's Pregnancy: Friends Talking
message board.)

Depression and Pregnancy

Whitlock and her colleagues evaluated 4,398 women, all members of the Kaiser
Permanente HMO, who had given birth between 1998 and 2001.

Before pregnancy, 8.7% were identified as depressed by their health care
providers; 6.9% were classified as depressed during the pregnancy, and 10.4%
were depressed in the nine months after delivery. In all, 15.4%, or more than
one in seven of the women, were depressed during at least one of the three
periods.

About half of the women who had postpartum depression also were depressed
before the pregnancy occurred or during pregnancy. More than half of those
depressed before pregnancy became depressed during the pregnancy, suggesting
the condition is not temporary or relieved by getting pregnant or by giving
birth.

Whitlock also found that 93.4% of those with pregnancy-related depression
had seen a mental health provider and/or gotten antidepressants. About 77% of
women took an antidepressant before becoming pregnant, 67% during pregnancy,
and 82% after giving birth. Since the study, reports of possible side effects
of antidepressant use during pregnancy, including lung problems and heart
problems in newborns, have been published. As a result, doctors emphasize that
a careful evaluation of the risks and benefits is crucial before deciding on an
antidepressant during pregnancy.

In the study, women most likely to be depressed were not married, had
delivered three or more children before the current pregnancy, smoked
cigarettes during the pregnancy, were white, and had Medicaid health
coverage.

A woman's age or education did not seem to play a role in whether she got
depressed; nor did the time at which she began prenatal care.

The percent of women depressed before, during, or after pregnancy didn't
surprise Whitlock. "I think it is in line with what we could expect, from
what we know about depression," she says. "In the general population,
about 9% of adults are depressed in a 12-month period," she says, citing
national statistics. Previous research has shown that one in 10 women is
depressed during pregnancy or within the first year after childbirth.

Second Opinion on Pregnancy-Related Depression

Nor do the results about depression throughout the prepregnancy and
postpartum period surprise another expert, Diana L. Dell, MD, assistant
professor of psychiatry and obstetrics and gynecology at Duke University
Medical Center inB urham, N.C.

"My sense has always been that pregnancy doesn't provide any protection
[against depression]," she says, although the notion that it does is
prevalent.

Another widespread notion, she says, is that hazards during pregnancy are
all external -- such as drinking alcohol or smoking cigarettes. "Being
depressed during pregnancy isn't a neutral impact," says Dell, who tells
women that internal hazards, such as depression, can be as harmful as external
ones.

When untreated, depression during pregnancy is associated with many
problems, including higher rates of miscarriage, stillbirth, and low birth
weight, according to the American College of Obstetricians and Gynecologists.
If untreated, postpartum depression can make it difficult for women to bond
with their infants. While the exact causes of depression during and after
pregnancy aren't known, the fluctuation of hormones is thought to
contribute.

Treating Pregnancy-Related Depression

Women who suffer depression before, during, or after pregnancy are not
likely to acknowledge it, says Whitlock. "I think it can be difficult for
women to admit to themselves they aren't feeling happy."

Dell agrees. "They see themselves as being bad mothers."

Whitlock urges women who feel they may suffer pregnancy-related depression
to share the information with their doctor "and not try to be
supermom."

Treatment can be very effective, agree Dell and Whitlock. "Cognitive
therapies [talk therapy] have been proven to be helpful for mild to moderate
depression," Dell says. "If it is severe, that person should be
evaluated for medication."

The use of one antidepressant, Paxil, should be avoided during pregnancy,
ACOG advises, due to potential health risks to the baby.

By Kathleen Doheny
Reviewed by Louise Chang
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