The Secret Sadness of Pregnancy with Depression

May 30, 2015 6:06 AM

The myth of the pregnant mother who is high on hormones has had considerable staying power. Something sentimental in us likes the notion that the physical discomfort of pregnancy is outweighed by the thrill of nurturing a new life within your own body...We have not acknowledged how appropriately anxiety-ridden pregnancy is, how traumatic the change in identity that accompanies prospective motherhood can be. (slnyt)

Many mothers experience angst about the persistent admonition to expectant parents that nothing is ever going to be the same. Some imagine this vaunted change as a sentence of doom. Insofar as motherhood is a new language, it is hard to gain fluency before the child has been born. These troubling feelings are common among pregnant women, but for those with antenatal depression, they come to loom large, casting a shadow over all the positive aspects of expectancy. Many women who have endured this kind of depression speak of it in hushed voices.

posted by melissasaurus (27 comments total)

It's nice of the NYT to publish something a bit more even-handed on this topic after previously posting this incredibly biased, mother-blaming embarrassment of an article last fall. That article sent me into such a panicked tailspin that I put off seeking help for my antenatal depression and anxiety for months. I'm pretty unimpressed that it's linked in the sidebar of this article as well.
posted by makonan at 6:48 AM on May 30, 2015 [5 favorites]

This is a thing that concerns me. I'd like to get pregnant and am on antidepressants. My mother had healthy pregnancies but I don't think she was depressed. My "plan" for when I get pregnant is to keep up with antidepressants, exercise, sleep, and therapy, see what happens and hope for the best. One of the things I feel like I have going for me is s good relationship with my GP and I'm trying to build a better relationship with my OBGYN. And I'm trying to lay the groundwork exercise-wise so hopefully I'll be in pretty good health when we start TTC. Other than that, I don't know what I can do.
posted by kat518 at 7:53 AM on May 30, 2015

I've read that megadoses of Omega 3 can help with pregnancy-related depression. Plus it's good for the fetus's brain development.
posted by Jacqueline at 7:57 AM on May 30, 2015

The Center for Women's Mental Health at Massachusetts General Hospital has a website that's a great resource for learning more about treatments and outcomes, very accessible to the layperson.
posted by stowaway at 8:26 AM on May 30, 2015

I had just "normal" mood swings during my first pregnancy (despite it being a miserable pregnancy) and no post-partum depression, so nobody was particularly on the lookout when my second pregnancy made me come completely unglued. By the time I had the baby, I'd be falling down a hole of undertreated pre-natal depression and increasing emotional desperation for around 8 months; unsurprisingly, it rolled into a horrifyingly bad case of post-partum depression. But by then everyone around me was so used to my low mood that it seemed normal (and I was so depressed I could no longer advocate for myself), and it took months before I started getting adequate help, and it almost destroyed my marriage.

And I do remember this bitch nurse at my ob/gyn's office who chided me for not being "excited" that I was having a baby. WTF, woman. STILL MAD.

"We have not acknowledged how appropriately anxiety-ridden pregnancy is, how traumatic the change in identity that accompanies prospective motherhood can be."

My master's thesis was on this topic, specifically on the lack of recognition of pregnancy in Christian religious rituals and the underdevelopment of the theology of pregnancy to actually reflect women's experience of it -- most specifically the anxieties that come with it, and the need for comfort and support.

I had a relative who, knowing I was suffering from pre-natal depression (although nobody knew how bad it was, or that I wasn't getting adequate treatment for the level of severity), made sure to repeatedly, passive-aggressively send me articles about a) the damage my antidepressants were doing to my fetus and b) the damage my anxiety and depression was doing to my fetus. She wonders why I avoid her when she visits. (OMG, just thinking about it is giving me rage-indigestion and making my heart race!)
posted by Eyebrows McGee at 8:56 AM on May 30, 2015 [40 favorites]

Wow, Eyebrows McGee, I'm so sorry you had to go through that with your second pregnancy and taking all that crap from a relative. I literally cannot understand how anyone would think sending scare-tactic articles to a women already stressed out would do any good.

I'm on Zoloft and Wellbutrin for my own depression, and once I finish my degree in a year or so Mr. Pointy Objects and I are thinking of starting a family. The thought of having to go off my meds is terrifying.
posted by sharp pointy objects at 9:46 AM on May 30, 2015

I got pregnant while I was on antidepressants. Every professional I talked to (two OBGYNs, a nurse practitioner, and a maternal-fetal medicine specialist) told me that there was absolutely no reason for me to discontinue them, and that depression posed more risk to the fetus than my medication did. I'm grateful for that, and for me and my kid (so far) it turned out well.
posted by Metroid Baby at 9:46 AM on May 30, 2015 [7 favorites]

I hadn't realized that depression during and after pregnancy was a secret.
posted by Nevin at 9:48 AM on May 30, 2015

Perinatal depression is hell. Luckily, I found UIC's Perinatal Depression project back in 2005 when I was experiencing it. Similar projects can now be found in Iowa, Cleveland, etc.
posted by jeanmari at 10:00 AM on May 30, 2015 [1 favorite]

I hadn't realized that depression during and after pregnancy was a secret.

It is not a secret. It has just been conveniently ignored for centuries so women thought they had to suffer in silence and feel bad about their natural feelings and state.

Now we have more and more women breaking down that stupid barrier and good on them for that.
posted by Alexandra Kitty at 10:07 AM on May 30, 2015 [9 favorites]

sharp pointy objects: "I literally cannot understand how anyone would think sending scare-tactic articles to a women already stressed out would do any good.

Oh, I think she was doing it to do me harm. She cloaks her nastiness in a coat of, "Oh, I'm so WORRIED about you, I saw this article and of course I though of you ... Why are you upset? I'm just trying to HELP!"

I'm on Zoloft and Wellbutrin for my own depression, and once I finish my degree in a year or so Mr. Pointy Objects and I are thinking of starting a family. The thought of having to go off my meds is terrifying."

I was on Wellbutrin for both of mine, and while it clearly wasn't working for the second pregnancy, the first pregnancy went fine. I would suggest a) talking with your ob/gyn in advance about depression and pregnancy, and making sure your ob/gyn is up-to-date on best practices for pregnancy and depression AND aware that you're at risk; b) talking with your psychiatric carer and putting in place a plan for checking in during pregnancy and in the post-natal period, in case your depression escalates and you need to change up your treatment -- being able to check in by phone every couple of weeks would have been really helpful for me, since GOING to a doctor with a new baby can be a bit of a hassle; and c) ensuring people close to you know you're at risk and are alert for when hormonal blues seem to last too long or become too intense and having them prioritize getting you help.

The biggest thing I didn't realize was that not all your pregnancies will go the same way. My first pregnancy was so easy psychologically (though not physically) that I wasn't really watching for pre-natal depression the second time, and neither were my husband or doctors. I was very careful about my psychological care the first time around, knowing I'm prone to depression, but I didn't turn out to need much help. The second time around, I figured I could just wing it and it would be fine. I couldn't and it wasn't! (And some people have miserable pre- or post-natal depression with their first pregnancy, and never again. And for some people it goes the same way every time. You just can't know in advance.)
posted by Eyebrows McGee at 10:25 AM on May 30, 2015 [2 favorites]

Not just depression. Postnatal OCD with intrusive thoughts about your own child must be a special sort of hell. I was having panic attacks having intrusive thoughts about my wife, family and friends and not knowing what was going on. I can't imagine what it would ever be like having those sorts of thoughts about your own child.
posted by Talez at 10:49 AM on May 30, 2015 [1 favorite]

I feel like Eyebrows McGee has a very important point here. A friend of mine had to spend time in the psych ward after her first pregnancy, but she's later had to more babies with no major issues. And is healthy today. Apparently one can't know in advance.
posted by Harald74 at 12:23 PM on May 30, 2015

The article was really well written; thank you for sharing it.

I appreciated that Solomon discussed the risks to the fetus/child(ren) from untreated or undertreated maternal depression and anxiety. So much of the kneejerk anti-medication arguments I see ignore the real risks of leaving mental illness untreated.
posted by jaguar at 12:28 PM on May 30, 2015 [2 favorites]

Pregnancy seems like such a lonely, scary, and difficult time. The article glossed over the bit about being in a non-abusive relationship. I fear that most relationships take an abusive turn at this point. I feel like this myth that the husband will be so great and so supportive and so caring of his pregnant wife is the exception, unless the wife maintains low expectations.

By dressing it up as a happy, great time rather than a frightening time full of anxiety, it's just not helpful. As a non-mother, I have to say, pregnant women need so
much more support than they seem to receive from their partners, their friends & their healthcare providers
through this whole process.

I wish I could say I believed most pregnancies are Norman Rockwell experiences. I just can't.

By the way, there's a service to help pregnant women called Organization of Teratological Specialists. You can call their Mother to Baby line to find out about teratogens. I think their recommendations will be conservative but based on current research. They won't tell you it's cool to have a glass of beer. But it could still be helpful

866-626-6847
posted by discopolo at 1:36 PM on May 30, 2015 [4 favorites]

Also, FDA is changing pregnancy labeling for drugs in July,
posted by discopolo at 1:44 PM on May 30, 2015

By dressing it up as a happy, great time rather than a frightening time full of anxiety, it's just not helpful.

I mean, we don't have to mythologize it as either fantastic or scary and bad, do we? This seems like one of those things that should be talked about in a thoughtful and supportive way without imputing any specific emotional experience as "normal," unless we're saying that it's normal for it to vary considerably from pregnancy to pregnancy and woman to woman.
posted by clockzero at 1:46 PM on May 30, 2015 [9 favorites]

I mean, we don't have to mythologize it as either fantastic or scary and bad, do we? This seems like one of those things that should be talked about in a thoughtful and supportive way without imputing any specific emotional experience as "normal," unless we're saying that it's normal for it to vary considerably from pregnancy to pregnancy and woman to woman.

I think I'd definitely advise women to be cautious, as cautious as they should be in choosing the father of their child and their partner.

I've seen and heard worse stories than the perfectly idyllic ones where fathers are happy and helpful, rather than withdrawn and minimally helpful.

Cultures tend to dress up periods of great transition as celebrations, maybe to distract from the anxiety and the amount of change it brings on. I'm glad women today have forums online to share their experiences and get support, but it's a great time of vulnerability: your partner could suddenly turn into an abusive asshole or just withdraw because "the baby doesn't seem real," you could find yourself judged at every turn, your physical and mental health could be extremely compromised. Other women who have had easy pregnancies might try to make you feel bad, like you're failing physically and mentally.

Many women end up having to mollycoddle and shepard their partners into fatherhood.

My best friend just had her first baby. She's as cool as a cucumber, and I adore her and think she deserves the best in the world. I was surprised to find out that her expectations for her husband are low. It was a planned baby. She's just happy he helps her off the couch.

Honestly, if you're already depressed and anxious, pregnancy seems like an especially lonely and vulnerable time. And I can't imagine not being depressed and scared during pregnancy. Women are most likely to be abused by the fathers of their children, most likely to develop illness, most likely to lose their jobs, most likely to become financially vulnerable etc.

There's no need to pretend it's not a huge undertaking and an especially vulnerable time.

And I'm not saying it's bad. It's just reality. I guess staying realistic is key.
posted by discopolo at 2:06 PM on May 30, 2015 [7 favorites]

And I'm not saying it's bad. It's just reality. I guess staying realistic is key.

Yeah, but there's realistic and then there is presenting the worst-case scenario in the name of You Should Be Warned, and I feel like the second one is not actually that helpful.

I had a miserable pregnancy. I had hyperemesis and was constantly nauseous and vomiting throughout it - constantly, and I really cannot describe in words just how hideous that was - and I had a huge family crisis that exploded just after I got pregnant and dragged on throughout, and then my employers responded to my telling them I was pregnant with "here is your notice of redundancy which will kick in just after your child is born, bye!" and I spent the next six months battling with them about whether I'd get their employee maternity pay package and have a job to go back to.

It was awful, and it felt to me at the time that every other pregnant woman on the internet was living in this Pinterest paradise of "what do you think of our nursery colour scheme?" and "here's a sneak peek at our gender reveal photoshoot!" while I was curled up on the sofa in a haze of nauseous misery. I ended up seeing a counsellor who specialised in perinatal depression, and she was wonderful and helped a ton, but it was miserable nonetheless.

But... I also got all the jokey "haha, wait till the baby's here, you'll never sleep/go out/have fun again!" comments, and I heard people's descriptions of just how hellish it was to deal with a newborn and it was the hardest thing they'd ever been through and nobody tells you how rough it is, mothers need to be warned!

Because I felt so miserable already, I seized on that and believed all that. And it did not make me more prepared - it just made me feel like, dear God, it gets worse than this? There is no way I can cope with worse than this. Life will be hell, and I will be dragging my poor child and husband through it with me... and so on.

So I didn't think "hmmm, here are some unpleasant things I can prepare myself for", I just thought "gaaaah despair". And I'm fairly sure (especially if I hadn't seen the counsellor) that if I had had a tough time postnatally, I wouldn't have sought help - I'd just have accepted any amount of misery as just, oh well, this is what was inevitably going to happen so what can you do.

I don't think women should get a rosy view of pregnancy any more than they should of newborns. Both can be very, very tough. But presenting the worst-case scenario as the most important truth, especially to people who feel vulnerable and miserable in the first place, will just make them more likely to accept misery as the status quo rather than get help for their depression, or take their constantly screaming baby to the doctor, or tell their unsupportive husband to get his act together.
posted by Catseye at 2:56 PM on May 30, 2015 [23 favorites]

By the way, there's a service to help pregnant women called Organization of Teratological Specialists. You can call their Mother to Baby line to find out about teratogens. I think their recommendations will be conservative but based on current research. They won't tell you it's cool to have a glass of beer. But it could still be helpful

866-626-6847

A psychiatrist I work with regularly refers pregnant clients to that line (and has said she's called it herself), and I'm happy that it exists.
posted by jaguar at 7:52 PM on May 30, 2015 [1 favorite]

clockzero: "I mean, we don't have to mythologize it as either fantastic or scary and bad, do we?"

In my thesis, the themes I identified in the Bible were (self quotes):

1) Releasing Control, "offering oneself up wholly to an act of creation that is difficult to understand, and knowing oneself both responsible for the life growing within but in many ways unable to do anything conscious or deliberate to protect or nurture it"

2) Hopeful Waiting, "Pregnancy brings us out of the everyday chronos of the world and into the kairos of God’s time, where we have no control. It is a hopeful waiting where we know little about the outcome – traditionally, not even the gender of the baby – but it is joyful, even though we can only “see through the glass darkly.” Pregnancy and birth gives us a glimpse of what it is like to wait for the new creation and see it at last realized – exactly what we expected, and nothing like it at all."

3) Pain and Fear, "Outcomes are uncertain; illness and death are all-too-real possibilities, for both the mother and the child."

4) Paretnership in Creation, "The only way God has provided for new human life to come into being is through a nine-month gestational period in a woman’s uterus; even Jesus spent his nine months in the uterus. Human life requires pregnancy; each pregnancy is a crucial participation in the act of creation, a partnership with God."

I also noted:

"From the first stories of Eve giving birth to Cain and Abel, to the stories of the matriarchs, the Bible begins with stories of pregnancy and birth, often much-desired, sometimes long-delayed. The story of Mary’s pregnancy is foundational to the New Testament; Hannah’s pregnancy with Samuel is crucial to setting up that narrative and understanding Samuel’s life. Elizabeth’s pregnancy with John the Baptist is similarly important, and the wife of Manoah, Samson’s mother, helped make Samson into the man he became, for good or ill, by her actions during her pregnancy. Tamar’s pregnancy by Judah turns the course of her life. These are just a few of the many stories of pregnancy and childbirth in the Bible. Elsewhere in the Bible, God is referred to in terms of pregnancy and childbearing: in Isaiah 46:3, God is spoken of as carrying Israel in God’s womb; in Isaiah 42:14, God is a woman in the pangs of labor; several times in the Psalms (e.g., 22:9, 71:6), God is a midwife bringing forth the infant. God is also spoken of in a variety of mother metaphors, from a woman suckling an infant (Hosea 11) to a mother hen gathering her chicks (Luke 13:34). There is no dearth of Biblical resources for contemplating pregnancy, both as an experience women share with other women and as an experience women share with God."

I wrote my thesis before I had kids; reflecting on it after having actually been pregnant, I might have also included a theme about being SUPER MAMMALIAN and EXTREMELY AND UNAVOIDABLY PHYSICAL. I note some of this in quotes I give from various sources writing about pregnancy from a Christian perspective, but I think having been through pregnancy I'd probably separate that out because Oh. My. God. So. Much. Mammal. I was TOTALLY unprepared for how mammalian it was.

PS I was kinda douchey when I wrote my thesis and I definitely knew a lot more then than I know now. :P
posted by Eyebrows McGee at 7:55 PM on May 30, 2015 [8 favorites]

That's funny -- there was a brief moment when I considered having children, and it was after an Episcopalian service in which the priest (a friend of mine) really emphasized Mary's choice in the matter. He talked about the Annunciation and how Mary could have said "No," how that was a reasonable choice, especially given the whole supernatural thing, and how Mary was allowed to determine whether she wanted to move forward with it, given the obvious ambivalence created by an angel arriving to tell you God wants you to have his baby. It was the first time I really heard a message that embraced a potential mother's ambivalence.
posted by jaguar at 8:59 PM on May 30, 2015 [4 favorites]

And "terrible depression" included insane amounts of rage. I really can't imagine trying to be around kids while raging like I was when I was pregnant.

Yeah, I want another and this scares me. I was a labile mess when I was pregnant, going from superduper loving to a screaming, crying rage bucket. Not to mention the fact that I was anemic during pregnancy, tired to the point of being unable to stay awake through movies.

I hated being pregnant. I hated the long list of physical symptoms and the feeling that my body was so far out of my own control. I hated how it made me dull and fuzzy, at best, and angry and weepy, at worst.

On the other hand, I had a really intensely good postpartum period. Prolactin was a hell of a drug for me, or maybe it was just low estrogen. I was more easy-going than I ever have been at any time in my life, to the point where I'm actually excited for menopause.

Hormones are powerful.
posted by PhoBWanKenobi at 10:03 AM on May 31, 2015

Thanks for posting. I love kids and often imagined myself having a lot of them, but I had terrible depression while pregnant (and while on any kind of progesterone birth control) so the idea of having more children is really fraught for me.

Just yesterday I was trying to explain, not very well, to some friends why I thought I could never have another baby because of the terrible time I had with the first one (a perfect storm of body horror, traumatic birth, and untreated post-partum depression). When I started talking about my birth experience I got goose bumps, and then had to change the subject because I knew that if I continued I was going to cry. And not in a good way. He's almost two years old and I'm still not over it. I'm very glad to hear that there are other women who feel the same way.
posted by lollymccatburglar at 2:43 AM on June 1, 2015 [2 favorites]

Nice, but ECT gets unnecessarily dissed in that article: "may provoke uterine contractions". Well, so can dehydration. The 1994 Miller paper usually used for reference for ECT outcomes in pregnancy found a rate of 0.6% for post-ECT contractions, and these were "self-limited". For pregnant women or anyone else concerned about drug interactions, ECT is basically one of the lowest risk choices.
posted by meehawl at 3:13 PM on June 1, 2015

Also:
Antidepressant Use Late in Pregnancy and Risk of Persistent Pulmonary Hypertension of the Newborn

Evidence from this large study of publicly insured pregnant women may be consistent with a potential increased risk of PPHN associated with maternal use of SSRIs in late pregnancy. However, the absolute risk was small, and the risk increase appears more modest than suggested in previous studies.

posted by meehawl at 8:56 PM on June 2, 2015

Andrew Solomon, the author of the article/book, was on Fresh Air today. I didn't hear the whole thing, but the parts I did hear were mostly great -- the not-so-great thing was when Terry Gross did a gross (sorry) intrusive bit near the end where she started asking for a lot of details about the suicide of Solomon's college roommate -- but he talks a bit about his own depression, too, which I found interesting. (I also hadn't realized he wrote the New Yorker piece about Adam Lanza. I plan to seek out his full-length books; he seems like a really nuanced writer about mental illness.)
posted by jaguar at 9:38 PM on June 4, 2015