Depression can be early-warning signal: Pre-partum anxiety


When Dr. Suzanne Killinger- Johnson threw herself and her baby in front of a Toronto subway train last year, Canadians were suddenly talking about postpartum depression, a form of depression that hits one in 10 women after they give birth. The discussion began anew in June with the drowning of five children at the hand of their mother, Andrea Yates, in Texas.

However, a study published in the August issue of The British Medical Journal claims depression during pregnancy is more common than depression after birth. Following 9,000 pregnant women in Avon, researchers at the University of Bristol discovered 11.8% of the women experienced depression at eight weeks and 13.5% experienced depression at 32 weeks.

Dr. Jonathan Evans, lead author, said physicians need to be on the lookout for pre-partum feelings of anxiety, guilt and hopelessness, especially since the mothers' emotional and mental state could affect the baby. Adrienne Einarson, assistant director of the Motherisk Help-line and Counselling Service at the Hospital for Sick Children in Toronto, read the study, and agrees.

"How can somebody who is severely depressed bond with her baby and do all the things a mom is supposed to do? You don't have to be a scientist to figure that out," she says.

True depression during pregnancy is not simply feeling blue. Some depressed women describe feelings of crippling doubt, confusion, anxiety, insecurity and unshakable sadness and hopelessness. To make matters worse, many feel they have to put on a brave face around friends and family. They feel ashamed for feeling sad in the first place.

"Women feel they should be happy," says Karen Taylor, a registered nurse and perinatal education co-ordinator who runs the Out of the Blues program in Winnipeg with Doreen Fleisher, a social worker. The program is for women suffering post-partum depression.

From a small study of their own, Ms. Taylor says they see a link between pre-partum and post-partum depression. Of the women they helped during the first 18 months of the program, 79% of their post- partum sufferers had signs of depression and anxiety during pregnancy. However, Ms. Taylor cautions some symptoms of depression mirror harmless pregnancy-related symptoms. Sleeplessness, feeling unorganized and lacking concentration are a few examples.

"All of those things that we pick out as signs of depression, a lot of new mothers feel that way and are not depressed," she says.

So what causes true depression during pregnancy? Dr. Vyta Senikas, associate professor of obstetrics and gynecology at McGill University in Montreal, delivers 200 to 250 babies a year in the city's Royal Victoria Hospital and has talked to numerous mothers- to-be.

"Most of us tend to think of the context of pregnancy within a family unit; something that is planned, anticipated and looked forward to," she says.

Yet if a pregnancy is unplanned, or the women has little support at home, hopelessness can set in.

Stress over work is another factor. Dr. Senikas says not all bosses are supportive, understanding or helpful during their employees' pregnancies. If that superior is a woman -- especially if she had a relatively easy pregnancy herself -- the pregnant employee's feelings of guilt and shame can be even more severe.

"I hate to tell you this, but we women don't do ourselves a favour sometimes -- and the worst stories I hear are about women employers," she says. "You can't compare your pregnancy to somebody else's. Everybody is different."

Finally, some women simply have a "glass half empty" personality. Usually these women have battled depressive episodes before the pregnancy and becoming pregnant changes nothing.

What is unusual, says Dr. Senikas, are women who have never felt depressed before, are happy about becoming pregnant and suddenly take a nose-dive into deep depression.

"A true depression coming on, and a pure result being the pregnancy -- while everything else is hunky-dory -- that's very rare," she says.

There are a number of ways to treat pre-partum depression, from calling help lines to joining therapy groups or even one-on-one counseling with a psychologist or psychiatrist. Many medications can even be taken safely under the guidance of a physician.

Motherisk's Ms. Einarson has conducted numerous studies on how prescription drugs affect pregnancy and she says physicians and the public have to become more open-minded about the pervasive feeling that pregnancy and medications do not mix.

"Pregnant women should not take any medications at all? That sounds pretty good unless you have a disease, including depression, that has to be treated. People don't think about that," she says.

If a pregnant woman still wants to discontinue taking an anti- depressant such as Prozac, she says to avoid stopping cold turkey because the withdrawal symptoms can be worse than the depression itself.

She knows of what she speaks. After following 36 women who called Motherisk saying they had suddenly stopped taking their anti- depressants, Ms. Einarson reports that 11 became suicidal, four were hospitalized and one woman even started drinking to combat the effects of withdrawal.

"This was not a good thing," she says.

Detecting depression early and treating it can mean the difference between having a comfortable pregnancy and one that zaps the life and energy right out of the woman. Add sleepless nights and a crying baby after delivery and it is easy to see why some women who experience pre-partum depression think ahead and call the Out of the Blues program to ask for help before the baby is born.

"Depression is so treatable and people get better. The more that the message is out there, the more that women are seeking help sooner," Ms. Taylor says