TV commercial: Young woman, obviously pregnant, gazes out the window with a dreamy expression. In the background, a brand-new crib, whimsical prints on the wall, and—don’t miss it!—the product being pushed. The spot exudes a blend of contentment, joy, and anticipation. Many pregnant women feel just that way, at least some of the time. But what if they don’t? What if their emotional tone is more like a toxic blend of sadness, worry, guilt, and fear? Not so unusual, unfortunately. Too often these negative feelings are multiplied by mom’s fantasy that there must be something badly wrong with her—and that it’s her fault.
BEFORE AND AFTER BIRTH
Everyone knows about post-partum depression—PPD—and its milder form, the “baby blues.” Unsettled feelings and mood swings during the first week or two after giving birth don’t afflict everyone, certainly not to the same degree. And it can happen anytime during the first year after the birth. To dismiss it by saying that “it’s just hormones,” and will quickly pass, is unhelpful and risky for both mother and baby. Fortunately, as a rule, PPD does pass quickly. (In an upcoming post, we’ll describe steps to take when PPD lingers.)
Mood problems during pregnancy, or gestational depression—our focus here—has received much less attention. As many as one in eight women have to deal with clinically severe depression while they are pregnant. Many more experience periods of feeling sad, helpless, or deeply tired. This mental state has potentially serious consequences for both the mother and her developing baby. Yet too often gestational depression goes undiagnosed and untreated. Instead, the family—and even many doctors—dismiss it as a typical and temporary consequence of pregnancy.
THE RISKS OF GESTATIONAL DEPRESSION
The effects of gestational depression go well beyond its emotional cost. If you are coping with depressed feelings, you’re likely to lack the energy and desire to give yourself the attention you need. You may neglect your diet and deprive yourself of vital nutrition at a time when nutritional needs are greater and more critical. You may drink, smoke, or use illicit drugs in an effort to numb your feelings … and then feel guilty because you know these substances are harming both you and your baby. You may feel so down, so hopeless, that you can’t drag yourself to your medical appointments. Even if you do see the doctor, you may forget to follow instructions.
The consequences of gestational depression spill over to the baby’s birth. There is a clear link to premature birth and lower birth weight—both risk factors for the baby’s health. Depressed mothers are more likely to need surgical help during delivery. Their babies are more likely to wind up in neonatal intensive care, instead of quickly going home and receiving family attention and love. These newborns have reduced muscle tone and higher levels of stress hormones in their bloodstream, a bad start to a healthy life.
IS THERE SAFE AND EFFECTIVE TREATMENT?
What can we do to eliminate gestational depression and remove the risks? Psychotherapy and antidepressant drugs are the standards, but both present problems. Most women with gestational depression don’t have ready access to psychotherapy, especially if they lack mental health insurance coverage or live outside major urban areas. Even when psychotherapy is available, practical and emotional difficulties make these moms likely to drop out of treatment before it can succeed.
Antidepressants can be found as close as the nearest drugstore, but many pregnant women—and many doctors—hesitate to use them. Antidepressants cross the placenta, bathing the baby’s developing nervous system. Is this harmful? No one knows for sure. We still lack well-designed studies that offer firm answers. Antidepressants may pose risks for the baby, but untreated depression in the mother also poses risks for the baby. Weighing the risks and benefits is vexing, problematic, and nerve-wracking. Fortunately, new research shows that antidepressants are not the only choice for biological treatment of the disorder.
HERE COMES THE LIGHT…
Light therapy has been proven to be a safe, effective treatment for both seasonal and nonseasonal depression. Can a woman who is pregnant safely use it, and will it help? According to a five-year clinical trial in Switzerland published in 2011, yes and yes. After five weeks of treatment, 83% of the women who received bright light therapy showed major improvement, as compared to 46% of those who used a placebo light box. Light therapy should be a prominent treatment option for pregnant women who are suffering from depression or mood problems. It is simple, inexpensive, and biologically based. Side effects are infrequent and minimal, there is no known risk to the unborn child, and neither mother nor baby is exposed to powerful, potentially harmful drugs. You can explore the details in Chapter 11 of Chronotherapy.
Michael and Ian are co-authors of the 2013 Penguin paperback, Reset Your Inner Clock. They invite you to follow them on Twitter for news updates, opinions, and challenging Q-and-A’s. If you want to stay on top of body-clock matters, light therapy, and more — and take advantage of confidential, online self-assessments of inner clock time, depression, and seasonality — you should become part of the nonprofit Center for Environmental Therapeutics community. Email PTuser@cet.org so we can stay in contact.