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When Rachel from Detroit, MI learned she was pregnant after battling infertility for three years, she was thrilled. But soon, her excitement vanished. All she could do was lie in bed and stare at the ceiling. She stopped eating and lost three kilos in her first trimester. She even began to wish she wasn’t pregnant.

“I don’t recognize myself”, Rachel says. “I told my husband I didn’t want the baby anymore. He had no idea how he could help me. I couldn’t stop crying. After all that we had been through to have a baby, it was a terrible blow”.

Confiding in her ob-gyn didn’t help. “At ten weeks, I told her I was afraid of what I was doing to myself. But she kept telling me I’d be okay”, Rachel says. It wasn’t until the hormonal surge of early pregnancy stages began to subside at around 14 weeks that she started to feel better. The experience haunts her: “I still feel guilty that I wasn’t more joyful in those early days”. It was only after Rachel switched to a new ob-gyn and gave birth that she learned she’d suffered from prenatal depression - and could have got help.

Her experience isn’t rare. “Major depression is one of the most common complications in pregnancy stages”, says Dr. Shaila Kulkarni Misri, M.D., author of Pregnancy Blues: What Every Women Needs to Know About Depression During Pregnancy. At least 10 percent of pregnant women are likely to get the blues during pregnancy (and many will go on to have post-partum depression), yet two-thirds go untreated, according to a study at the University of Michigan Depression Center, US.

“SHAMEFUL” SYMPTOMS

The signs of prenatal depression are often similar to those of post-partum depression - extreme fatigue, irritability, anxiety, crying, sleep problems, decreased energy, appetite changes, lack of excitement about having a baby, disinterest in activities, obsessive thoughts and worries, lack of concentration, feelings of guilt, worthlessness and hopelessness. “The most troubling symptom is probably the feeling of detachment from the baby”, says Child advisors. Many pregnant women are , however, either unaware of the significance of these symptoms or are too ashamed to ask for help. “So many people believe that pregnancy protects women from depression”, says Sonia Murdock, Executive Director, Post-partum Resource Center, New York, US. “They say, ‘Why would a woman be miserable during such a happy time?’” Many depressed moms-to-be never discus their emotions with anyone because they are afraid of being ridiculed, or worse, judged. Post-partum depression, considered less taboo, receives much more attention - even celebrities talk about it.

Some experts believe the medical community doesn’t screen vigorously enough for depression in expectant moms. They argue that most prenatal visits are focused on how the mother and baby are doing physically, even though depression affects a woman’s overall health. “Psychological issues get attention only when they become severe”, says Dr. Misri. “Doctors and patients usually dismiss symptoms of depression”.

THE IMPACT ON MOM AND BABY

Keeping moodiness and anxiety a secret - or brushing them off - can have serious consequences for both the mother and the baby. Depressed women may not seek regular prenatal care and are more likely to self-medicate with alcohol, cigarettes and even drugs; in extreme cases, they may even consider terminating the pregnancy or become suicidal”, says Dr. Diana Lynn Barnes, Psy. D., founder of the Center for Post-partum Health in California, US.

One-third of women who are diagnosed with post-partum depression in pregnancy stages, also struggle with the blues while they were pregnant. Experts believe that post-partum depression cases could be avoided if prenatal symptoms are identified and treated. And it is not just the mother’s mental and physical health that’s at stake. Research shows that a woman’s depression affects her unborn child (since they share the same bloodstream - and the same elevated levels of stress hormones), increasing the risk of preterm birth and low birth weight. “A baby born to a depressed or anxious mother is also more likely to suffer from anxiety after birth”, says Dr. Misri. Prenatal depression can interfere significantly with mother-infant bonding and cause developmental delays and behavioral problems in the child.

ARE YOU AT RISK?

Pregnancy itself probably doesn’t cause depression, but it can be a trigger in women who are already genetically prone to it. The most vulnerable women are those with a family or personal history of depression or those with previous post-partum depression. Other risks include an nonsupporting partner, an unplanned pregnancy, infertility treatments and problems prior to pregnancy like a miscarriage. “Sometimes the stress of pregnancy brings on depressive symptoms”, says Dr. Joanne, “Physical discomfort due to water retention, morning sickness, aches and pains as well as a sense of exhaustion are contributory factors”. Hormones play a big role (depression tends to emerge during the hormonal surges of the first and third trimesters), though experts aren’t yet sure of the exact nature of how or why this happens and why depression hits some expectant mothers and spares others.

TREATMENT OPTIONS

Since almost all women feel tired and emotional during pregnancy stages, it can be hard to know whether you have prenatal depression. “But if your symptoms last for at least two weeks, interfere with work or affect your relationships, you should see your doctor”, says Dr. David Fassler, M.D., co-founder of the Walden Behavioral Care in MA, US. Fortunately, prenatal depression is treatable. Your ob-gyn will examine you to rule out other health issues and then refer you to a psychiatrist or another mental-health professional. If you have mild or moderate symptoms, therapy alone may be enough. But in moderate or severe cases, antidepressants may be necessary. This could seem scary, considering news reports about how the drugs might affect a foetus. Experts don’t know that these medications are 100 percent safe to use during pregnancy stages: Recent studies show that some newborns experience hypertension or withdrawal symptoms. “However, the risks of antidepressants are small compared with the negative impact of untreated depression on you and your baby”, says Dr. Misri. Ultimately, you should talk to your doctor to make the decision that’s right for you and for your unborn baby.