ANXIETY & DEPRESSION IN PREGNANCY
By Susan Almquist, MD, FACOG of Wendover OBGYN
Many women struggle with symptoms of anxiety and depression, and both are diagnosed more commonly in women than in men. Often, the diagnosis occurs during childbearing years and is therefore not surprising that women have symptoms of anxiety, depression, or both during pregnancy. Some women enter pregnancy having been diagnosed with anxiety or depression before pregnancy, but many women begin to have symptoms during pregnancy or within the first six weeks after delivery. More than 1 in 10 women experience anxiety or depression during pregnancy or in the postpartum period. Undiagnosed anxiety and depression can place both mom and baby at risk – including the risk of preterm delivery, poor fetal growth, and even complications for the baby after delivery. For those women diagnosed with anxiety or depression before pregnancy, it is important to be closely followed as some women experience a relapse or worsening symptoms during pregnancy.
Symptoms of anxiety can include excessive worry, intrusive thoughts, feeling overwhelmed, and difficulty sleeping. Symptoms of depression may include crying, lack of interest in activities, sleeping a lot, and fatigue. Some women may also experience weight loss/weight gain or irritable mood. For many women, it is difficult to identify the symptoms of anxiety or depression from the common issues associated with pregnancy or the postpartum period. Therefore the diagnosis of anxiety or depression may be missed. It is essential for any patient that is experiencing any of these symptoms to speak with their medical provider so that they can be cared for in the best way possible.
Treatment for anxiety and depression is often with a multidisciplinary approach which may include an obstetrics provider, therapist, and sometimes a psychiatrist. Treatment will vary from person to person, depending on the type and severity of a patient’s symptoms. Treatment can include therapy/counseling, medicine, or both.
Choosing a medication in pregnancy is an essential discussion for the patient and medical provider. It is important not only to look at the risk of medication to the fetus but also the risks to the patient and pregnancy if not treated (worsening symptoms, preterm delivery, and poor fetal growth). There are options for medications that can be used safely both during pregnancy and breastfeeding to treat depression and anxiety. Your medical provider can discuss the best treatment options for you.
Pregnancy and the postpartum period are unique experiences in a women’s life, and introduce unique stressors. There are normal anxieties that women can have throughout their pregnancy (worrying about the delivery, breastfeeding, taking care of a newborn). It can be challenging for a patient to understand when normal anxiety is no longer healthy. Women need to have open communication with their provider to relay the symptoms that she is experiencing. Having this dialogue will help in determining if these symptoms are more than “just being pregnant.” Sometimes family members can also help identify changes in a patient that can assist with the appropriate diagnosis. There are excellent treatment options available if a patient does experience symptoms of anxiety or depression in pregnancy. More importantly, the patient should realize that she is not alone in addressing