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Depression and Pregnancy

I just read a fantastic article from Andrew Solomon:  http://www.newyorker.com/tech/elements/depression-and-pregnancy-dilemma.  I’ve quoted this writer’s book, “Far From the Tree” in a previous post.  He accomplishes the arduous task of presenting both sides of a dilemma beautifully.  Aside from his writing skill, you should read this because some of you are now suffering from depression, anxiety, or some form of mental illness.  This condition may have predated or been caused by your struggle to have a baby, but some of you may be surprised that the surge of hcg in your blood stream did not magically make it disappear.

I won’t reiterate the risks and benefits or taking antidepressant medication;  the article does a great job but ultimately you should speak to your own providers about your best treatment options.  I would like to add the two cents that it’s taken me years of experience to earn.  First, I’ve spoken in previous posts about why the pregnancy test, or first ultrasound, or second ultrasound may not make rainbows appear and all your lost socks found again.  Pregnancy can be a stressful time for anyone, especially after infertility, made worse by the fact that those close to you assume you’re “all better” and not understand the support you still need.

However, even if the stressors seem lifted and you are looking at color swatches for the nursery, depression is a real illness and takes time to heal.  With the recent suicide of Robin Williams, there’s been a lot of talk on social media and in main stream media that depression is a “real” illness.  I think using “real” is misleading, the correct phrase would be to say, depression is a physical illness.  The brain is part of the body.  There are neurotransmitters and chemicals that all interact to affect emotions and responses to stress.  To make an analogy:  a person developed diabetes from drinking a vat of soda every day.  Then he stops;  the cause of the diabetes is removed.  The diabetes generally doesn’t just go away without at least a significant amount of time, and probably some other lifestyle measures, such as other changes to the diet and exercise.  And his doctor recommended he take medication to keep his blood sugar under control while he was working on those other interventions.  Just like the diabetic, the biochemical reaction in your body that caused your psychological symptoms won’t suddenly snap back into place once the initial trigger is removed or resolved.

Am I advocating that every pregnant woman with depression stay on medication?  Not at all.  Just like other illnesses like diabetes and hypertension, there are other options.  Mental illness is a more difficult illness to treat because of the snowball effect into other aspects of your life.  You’re depressed or anxious so you can’t sleep, which in turn lowers your serotonin levels and increases your psychological symptoms.  If you’re anything like me, you stress eat and crave chocolate when depressed;  the effect of sugar on mood is being documented by more and more research.  Or you may want to try some stress relief activities like meditation or exercise, but when you can’t get out of bed, the treadmill’s not going to follow you!

My advice to all my patients is that mental illness, wether episodic or long-standing, is a multifaceted condition that requires more than one approach.  If you’re not taking medication, consider that you may need something at least to help you turn the corner and try eating healthy, sleeping well and exercising as an ultimate treatment.  If you’re on medication, try not to let that be your only treatment.  Like diabetes or any chronic condition, diet and lifestyle matter!  I’m not saying you need to start growing a farm on your veranda, but even modest changes of adding more fruits and vegetables and decreasing processed foods can help.

Like infertility, mental illness is varied and widespread.  If I may simplify, women reading this post may fall into three categories.  The first two are women who have had mental illness and then developed infertility; and women sought treatment for depression during infertility and are now considering wether to continue medication.  There’s a third group I especially want to reach out to, and you know who you are.  You’ve been depressed and anxious for months or years, maybe because of your infertility, or perhaps for other reasons.  You never sought treatment because the pregnancy was the light at the end of the tunnel.  You’ve spent the bulk of your recent life in a “I’ll be happy when…” limbo.  And now “when” is here, and the clouds didn’t part.  Please don’t keep waiting for tomorrow, and seek help.  There are many health care professionals who can help you with or without medication.  You may want to try some of the lifestyle measures I’ve mentioned or possibly some other alternative treatment like acupuncture. It may mean letting those who love you know where you’re at and asking for help.  I encourage you to do all three;  even if you’re dead set against medication, a professional can help navigate you through treatment choices and give you other great tools to use.

If you’re not sure, please find out.  A simple thing is to use a depression screening tool:  http://www.beyondblue.org.au/resources/for-me/pregnancy-and-early-parenthood/edinburgh-postnatal-depression-scale.  Massachusetts General Hospital has a great website with resources for women with mental health issues:  http://womensmentalhealth.org.  Help may look different to everyone, but everyone should get help.  You worked tirelessly to get to this point, and you deserve it!

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