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The Truth About Depression During Pregnancy

I’m a little embarrassed to admit this. Ok a lot embarrassed. I watch reality TV shows….a lot!

It all started when I was in graduate school and after a long day of seeing clients in therapy, I needed something lighthearted to distract me while I was catching up on session notes.

This week, however, the latest episode of Real Housewives of Orange County crossed into real life. I had such a strong reaction that here I am writing to you about it.

One of the ladies of RHOC (yes we’re on an acronym basis!), Meghan King Edmonds, shared with the viewers her personal struggle with depression and especially depression during pregnancy.

What made my jaw drop to the floor was when she shared this:

“I go and I tell him ‘Hey Doc. I’m feeling a little bit depressed. He goes, ‘That’s strange. Most people who are in their early pregnancy are very happy.’”

“WHAT?!” I actually yelled at the TV.

As a clinically trained therapist, half of my brain was screaming, “How is this person allowed to be a mental health professional when he invalidates his patients like that?”. As a high-risk pregnancy expert, the other part of my brain was yelling, ”NO!! It’s not strange at all!”

While shows like Real Housewives are meant to be entertaining, I cannot stand by silently while such egregiously incorrect information is disseminated to millions of viewers.

Here’s the truth about depression during pregnancy.

With so much misinformation out there about depression during pregnancy, here's what you really need to know....

Depression during pregnancy happens to many women.

According to the American Congress of Obstetrics and Gynecology 14-23% of women experience depressive symptoms during pregnancy. That’s approximately 50,000 - 90,000 women per year in the United States. So no, it’s not strange at all that that women like you or Meghan King Edmonds are experiencing it.

You do not need a history of depression to feel depressed during pregnancy.

A history of depression prior to pregnancy puts you at higher risk for antepartum depression but it’s not a requirement to develop pregnancy during pregnancy. Other factors such as lack social support, being on bed rest, having a high-risk pregnancy or high levels of stress can also contribute to feeling depressed while you're pregnant.

Depression looks different in everyone.

This is one of the reasons perinatal depression goes undiagnosed and is undertreated. Some women experience sadness, low mood and frequent bouts of crying. For other women, depression shows itself as insomnia or sleep disturbances. Overwhelm is another face of depression, leaving some women thinking, “I can’t do this” or feeling inadequate. Still other women experience depression as guilt or frequent outbursts of anger. Because of this highly varied expression of depression, it’s critical that you listen to your body.

Pregnancy hormones will make you feel different than your pre-pregnancy self, but they will not make you feel like a completely different person. (Tweet that!)

So if you are feeling off from your typical baseline, reach out to a mental health professional for an assessment so you can receive treatment early.

Anti-depressants aren’t the enemy.

For mild to moderate depression, you may be able to manage your symptoms without medication. However, if you are trying everything, working with a mental health professional and you’re still not feeling symptom relief, you may want to speak with a psychiatrist about starting some medication.

Many women fear that the medication will hurt their baby. However, there are medications on the market have been shown to be safe during pregnancy.

On the flip side, untreated or mismanaged depression during pregnancy has been shown to affect your baby as well. Research has shown that depression doubles your preterm birth risk and is associated with poor fetal growth as well as developing pregnancy complications such as gestational diabetes.

The question isn’t a simple one to answer. Talk with your doctor about weighing the pros and cons of taking anti-depressants during pregnancy, understand alternatives to medication that may help and make an informed decision that’s best for you and your baby.

But don’t write off anti-depressants as all bad because what’s most important to your baby’s health and development is a happy, healthy you. (Tweet that!)

Postpartum depression begins during pregnancy.

Half of women who experience depression after the baby is born had symptoms during pregnancy. Postpartum depression impacts your ability to bond with your baby, affects breastfeeding and how much milk you produce and alters your baby’s social and cognitive development. This is another compelling reason to manage your depression effectively while pregnant to lower your risk of postpartum depression and the effects it has on you, your baby and your family.

More than half of women on bed rest show signs of depression.

If you are on bed rest, you must take extra precautions to manage your mood. Because you likely have pregnancy complications that have put you on bed rest, you are already considered high-risk and may have increased risk of delivering early.

Depression can exacerbate that risk. It takes more creativity to manage your depression on bed rest since you are not allowed to exercise or go out, but it is absolutely possible.

You are not ungrateful, weak or a bad mom for being depressed during pregnancy.

Just as you are not to blame for your high-risk pregnancy you are not to blame for being depressed. Also, healing from depression is far more than, “Just stay positive!”

Remove the self-judgment and replace it with self-compassion. (Tweet that!)

Remind yourself that you’re doing the best that you can and that you may just need some extra support during this time. Asking for that support is what will make you supermom, not trying to push it under the rug or telling yourself to “tough it out”.

If you find yourself having thoughts of hurting yourself, call 911 or the Suicide Hotline 1-800-273-TALK immediately.

Whether you’re pregnant after fertility treatment, on bed rest, facing pregnancy complications or are having a healthy pregnancy but feeling down, depression is not your fault and there is so much hope for healing.

Depression during pregnancy increases your risk of pregnancy complications

I don't share this to scare you but to show you why it's so important to your pregnancy health to effectively manage this quickly. Research has shown that depressive symptoms during pregnancy is tied to an increased risk of low-birth weight in babies, gestational diabetes, preterm labor and preterm delivery.

It's not enough to reach out for support. It's critical to reach out for support that provides you physical and emotional relief to give you and your baby the best possible outcome in your particular situation.

Sometimes it's not depression at all but unresolved trauma

To complicate it even further is this game-changer.

Unresolved trauma can look a lot like depression and if you look at your life as a cross-section, as in, what's happening right now, the symptoms might point you (or even a mental health provider) to a depression diagnosis and treatment. However, if there is a history of trauma (for example, a trauma from recurrent pregnancy loss or multiple failed cycle or pregnancy complications or previous preterm delivery), depression is likely not the issue.

We often think of trauma as anxiety, hypervigilance, and overwhelm - being amped up and on alert. However, another response to trauma is to go low, meaning there has been so much "amped-up-ness" for so long that your body's only way to cope is to turn the dial all the way down. In doing that, the way we feel can be very similar to depression, but treatments for depression will not help because the problem is not clinical depression it is unresolved trauma.

What happens now?

If you have experienced trauma on your family-building journey, and you think that unresolved trauma is showing up as depressive symptoms for you now, I'd love to support you. This is exactly why I created the Hold My Hand program, a deeply personalized, private program specifically for women who want to improve the health of their pregnancy so they can give their baby a strong start to life.

It's not enough for you to feel better emotionally. I want that to translate to improved pregnancy health so you can stay pregnant as long as possible and when you join the Hold My Hand program, you'll have support from me all the way through your estimated due date so you never have to navigate these waters alone.

I hope to hear from you soon!

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