Dear Doctor: My daughter is 16 weeks pregnant with her second child. Her father and I can tell that she's really feeling down, even though she's been trying to hide it. I thought that women get the baby blues after giving birth, not during pregnancy. Is there anything I can do to help her?
Dear Reader: We read and hear a lot about postpartum depression, a form of clinical depression related to the physical, emotional and hormonal changes that accompany childbirth. However, the changes to mood that take place during pregnancy itself, known as perinatal depression, are not nearly as well known. That's unfortunate because an estimated 14 to 23 percent of pregnant women experience some level of depression during pregnancy.
For most of them, it will go unaddressed. Some women say that having symptoms of depression during pregnancy, a time that popular culture associates with joy and anticipation, causes them to feel shame. For many, the physical changes that take place while carrying a baby can obscure the bigger picture of their mental health. That's because a surprising number of symptoms that are common to pregnancy, such as changes to sleep patterns, decreased energy levels, a loss of appetite and a drop in libido, are also common to pregnancy.
Whether it's due to a reluctance to admit to depression, or that the symptoms of the condition have been obscured, the end result is that a significant percentage of women who experience depression during pregnancy don't get help. This can be dangerous to the mother and her baby, and it can adversely affect her family as well. Regular prenatal care is important to the well-being of both mother and child. When someone is depressed, though, making and keeping a series of appointments can be overwhelming. The same goes for eating a healthful diet and getting proper exercise, both of which can take more attention and planning than someone who is depressed can muster on a daily basis. Depression during pregnancy can adversely affect existing relationships, such as with children and spouses. It can interfere with a mother's ability to bond with her new infant after birth, and it is linked to an increased risk of going on to develop postpartum depression.
The American College of Obstetricians and Gynecologists recommends that women get screened for depression at least once during pregnancy. However, anyone who suspects she is experiencing perinatal depression shouldn't wait for her health care provider to take the lead. In the case of your daughter, the fact that she hasn't been successful at hiding her underlying distress from the family makes it likely she realizes something is amiss.
One of the things you can do to help is start talking to her about it. Urge her to open up to her doctor, and if possible, offer to take her to the visit. When people are depressed, necessary self-care can often fall by the wayside.
Should depression be diagnosed, her doctor will discuss treatment options. These include individual psychotherapy, support groups, bright light therapy and, in certain cases, medication. The important thing is to start the conversation and let her know she won't be going through this alone.