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Anxiety + depression in pregnancy: What you need to know

06/06/2018

The pregnancy process is enough to make any woman worry. And while it is extremely common to experience some degree of uncertainty, those who suffer from clinical conditions like depression and anxiety may be putting themselves, as well as their baby, at serious risk if left untreated.

"I discuss with my patients that what we see on television about how pregnancy is supposed to be best time of your life - is not always correct,” said Dr. Andrea Zuckerman, Chief of Pediatric and Adolescent Gynecology at Tufts Medical Center. But that's not always the case for a lot of women.

In reality, one in seven pregnant women and new mothers suffer from depression and/or anxiety. But mood disorders can be tricky to diagnose because some of the symptoms can overlap with pregnancy. 

Symptoms of clinical depression include:

  • Being in a depressed mood most of the time for at least two weeks
  • No longer enjoying the things you used to enjoy
  • Decreased interest in the world around you and feeling hopeless
  • Guilt and sense of worthlessness
  • Low energy poor concentration, and appetite changes
  • Thoughts of suicide

Symptoms of generalized anxiety disorder include:

  • Excessive worry that's difficult to control
  • Irritability and feeling restless inside
  • Tension/muscle aches
  • Disrupted sleep patterns and fatigue
  • Poor concentration

Pinpointing who needs help traditionally has been a challenge, because in years past, it was taboo to talk about the topic. But now, it is routine for doctors at Tufts MC to encourage mental health screening for women at specific points before, during, and after pregnancy.

"We've always screened for diabetes in pregnant women,” said Dr. Margaret Sullivan, OB/GYN at Tufts Medical Center. “But the incidence of depression is twice that.”

If patients show signs of depression and/or anxiety, and red flags are raised, Tufts MC doctors now have access to a state-run program called the Massachusetts Child Psychiatry Access Program (MCPAP for Moms) that ensures women receive the proper care in a timely fashion.

The initiative provides OB/GYN’s and primary care doctors with a direct connection to psychiatric providers who can offer treatment. 

“What makes this program unique is the fact that these mental health providers specialize in pregnancy and postpartum health. If I have a patient that screens positive for a mental health condition, I can immediately call MCPAP and they help me find a counselor or psychiatrist within hours who can provide the help she needs,” said Dr. Zuckerman

“The program has helped us, as obstetricians, be more proactive,” added Dr. Sullivan. “As I say to my patients‘if you’re not healthy, you’re not going to have a healthy baby, so we need to take care of you first.’”

Depression and anxiety are treatable, and doctors say the quicker patients receive treatment, the better the outcome. 

“It is always a good idea to consider a pre-conceptual consult when you have a preexisting history of depression or anxiety to ensure the current treatment regimen is safe entering a pregnancy,” advised Dr. Sullivan.

There are misconceptions that still exist, however, particularly when it comes to the safety of taking medication while pregnant. But doctors say medication is generally safe, and the consequences of not taking it may be severe in some women.

“Studies show that untreated depression can be more detrimental to patients and have more consequences to pregnancy than taking medication,” said Dr. Zuckerman.

While there are some drugs that may not be as beneficial in pregnancy, doctors say there are many options from which to choose.

“We always want pregnant patients to be on the lowest dose of any medication, because some drugs, like selective serotonin reuptake inhibitors (SSRIs), do have risks,” said Dr. Sullivan. When patients don’t want to take any medication, I say to them ‘if I told you that you had diabetes, would you take insulin?’ Their answer is usually yes. And then I ask them, ‘depression is also a disease, so why wouldn’t you take medication to treat it?’”

Overcoming the social stigma of seeking mental health treatment may be difficult for some women, but necessary in order to have a healthy outcome.

“Depression and anxiety are medical conditions that patients did not bring upon themselves,” explained Dr. Sullivan. “It’s not your fault, you’re not weak, you can’t just snap out of it. But we can help. We can screen and treat you and make sure you have a healthy pregnancy.”