Depression: Is depression during pregnancy hormonal?

I am 29 years old and 21 weeks pregnant. I have been feeling blue for some time. I assumed I would have a lovely pregnancy and be one of these women who blooms and feels just perfect. Instead, I am anxious about a lot of things, including my ever expanding belly. How can I differentiate between depression that needs treatment and a normal reaction to the onslaught of hormones?


Peg Plumbo CNM

Peg Plumbo has been a certified nurse-midwife (CNM) since 1976. She has assisted at over 1,000 births and currently teaches in the... Read more

Depression is one of the most common psychiatric disorders. Lifetime prevalence rates for major depression for adults are 5.8 percent, although the prevalence rates for women are about 8 percent. Depression postpartum is a well-recognized phenomenon. However, depression during pregnancy is less well understood.

Major depression is classified under the mood disorders in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). It is defined as the occurrence of depressed moods or loss of interest or pleasure in activities, along with at least four other symptoms during the same two week period. These symptoms may include disturbances in appetite, weight, sleep, motor activity, energy, concentration or the presence of suicidal thoughts and feelings of worthlessness or guilt. An episode of major depression can be categorized as severe, moderate or mild according to the degree to which the affected person's symptoms interfere with social and occupational functioning, including feeding, clothing and maintaining personal hygiene.

Depressive symptoms are usually of less intensity and duration than diagnosable depression. The boundary between diagnosable depression and depressive symptoms is sometimes unclear.

Prevalence estimates of depression during pregnancy varies between 4 and 7.6 percent. The incidence of prenatal depression seems to be increased in the first trimester, suggesting that this is a time of maximum vulnerability to depression. However, depressive symptoms occur in 8 to 38 percent of pregnant women.

It is common to get "the blues" from time to time. Sadness is a normal part of life. Pregnancy has been depicted in the media as a time when women bloom and get rosy complexions. In my experience, both personally and professionally, this is often far from the truth. Pregnancy is a life-altering event and a prelude to one of life's largest and most intense undertakings. Women can be overwhelmed with the spectrum of physical changes taking place and the psychological adaptation necessary to accommodate pending lifestyle changes.

Clients frequently share thoughts with me such as "I feel as if my body has been invaded" or "I can barely take care of myself; how can I take care of a baby?" Fear and trepidation walk hand in hand with joy and anticipation.

Women need an extraordinary amount of support from partners, friends and family during pregnancy, as well as several months postpartum. If there are other coincidental issues such as financial instability or marital or family discord, job dissatisfaction or maternal or family health concerns, this "pile-up" of stressors can induce a chronic state of sadness and hopelessness known as clinical depression.

Counseling, as well as medication, have been shown to be very effective in lessening depression and reducing the incidence of postpartum depression. There are several tools that are helpful in determining if this state of mind necessitates a consultation with a primary care provider or a mental health professional.

If you answer "yes" to more than two of the following questions, you may be suffering from clinical depression:

  1. Much of the time, do you feel...
    • sad?
    • lethargic?
    • pessimistic?
    • hopeless?
    • worthless?
    • helpless?
  2. Much of the time, do you...
    • have difficulty making decisions?
    • have trouble concentrating?
    • have memory problems?
  3. Lately, have you...
    • lost interest in things that used to give you pleasure?
    • had problems at work or in school?
    • had problems with your family or friends?
    • isolated yourself from others, or wanted to be isolated?
  4. Lately, have you...
    • felt low energy?
    • felt restless and irritable?
    • had trouble falling asleep, staying asleep or getting up in themorning?
    • lost your appetite -- or gained weight?
    • been bothered by persistent headaches, stomach aches or back aches?
    • been bothered by muscle or joint pains?
  5. Lately, have you...
    • been drinking more alcohol than normal?
    • been taking more mood-altering drugs than you used to?
    • engaged in risky behavior, such as not wearing a seat belt or
    • crossing streets without looking?
  6. Lately, have you been thinking about...
    • death?
    • hurting yourself?
    • your funeral?
    • killing yourself?

If you are uncertain about your state of mind, I would seek the opinion of your obstetric care provider who could direct you to some counselling resources in your area.

I wish you the best with this difficult situation.

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