Q&A: depression during pregnancy

Jodi writes:

"This will be short and sweet. This is my first pregnancy and I am almost three months along. I am very excited and feel lucky because I got pregnant the first time I ever went without protection (thank god I was a responsible teen). I am 33 and as my ob/gyn said "On the senior citizen side of birthing"  (hell of a bedside manner I know ). Anyway here is my thing I have been feeling DOWNRIGHT DEPRESSED for a few weeks. I am usually outgoing and love to have fun but I just feel sad and kind of remorseful that I have not done more of the things I set out to do. Did you ever experience this? It is making me feel very guilty."

33? Is old?

Bwahahahahahahahahahahahahahahahahahahahaha. Hahahahaha. Ha.

Excuse me while I wipe the tears from my eyes.

I think your OB must have had extremely limited experience if s/he thinks 33 is "on the senior side" of first-time pregnancy. Even the technical definition of  "older" first-time mother doesn't start until 35. I had my first baby at 29 and I've always been The Kid with other moms of children my son's age. (Now that the kids are around 4, all the other moms at my son's school seem to be in the 38-45 age range.)  I know a ton of women who didn't have a first baby until age 38 or 39 (note that I'm not saying that it's advisable to wait until that age specifically, or that you'll have an easy time conceiving then, just that I know plenty of people who had first babies then).

All this is to say that 33 sounds positively early to have a first baby to me. Your OB's comment is uninformed and a wee bit insulting.

But about the depression. Did I ever experience this?

YES.

I spent the first trimester of my first pregnancy in a serious, almost debilitating depression. I had just started building a little teeny career in something I liked better than my old "career." All of a sudden I was pregnant (with a baby we'd been trying to conceive, but somehow didn't think would come so soon) and felt like I had nothing to show for my life, which would now, of course, be over, because you can't do anything with a baby.

I dragged through the days, too exhausted from the pregnancy and too heartsick from the depression to do more than two things each day (and sometimes one of them was take a shower). I started having panic attacks. When I went in to a prenatal visit the midwife could tell I was not doing well and she basically twisted my arm to see the therapist that worked with women at the birth center.

What the therapist told me was this: There are extremely powerful hormones surging through your body when you're pregnant. Different women react to them in different ways. Many women become depressed under the influence of these hormones. The only thing to be done about it is go through the motions of living day by day as best you can. Getting up in the morning is a victory.

What I know is that the depression may change or lessen or disappear by the end of the pregnancy, or it may not. I felt a little better in the second trimester (until the World Trade Center was attacked a few miles from my apartment), and then the depression came back slightly in the third trimester. Since I have had depression in my "normal" (non-pregnant and non-lactating) life, I knew I was at a higher risk for post-partum depression, but I never developed it (I made a hard-core plan to prevent it and it worked).

There's a website called Pregnancy and Depression that has collected all the available research studies about depression in pregnancy (it also has some info about treating depression while breastfeeding and during mothering, and some info about bipolar disorder). Most of the studies are evaluating the risks to babies of exposure to antidepressants while in utero, but I thought this study was interesting and kind of sad. The conclusion is "Rates of depression, especially during the second and third trimesters of pregnancy, are substantial. Clinical and economic studies to estimate maternal and fetal consequences are needed."

I can tell you what I think the maternal and fetal consequences of prenatal depression are. I think those of us who are depressed during pregnancy doubt ourselves. I think we feel guilty that we're not glowing, happy little earth mothers, basking in the miracle of human repoduction and our own fecundity. I think we feel cheated out of enjoying something our culture tells us is the pinnacle of human experience, and terrified that we won't enjoy being mothers. I think we're afraid that there's something inherently wrong with us that means we won't be good, or even adequate, mothers to our children. I think we think that if we're so depressed during pregnancy we don't deserve to have children. I think that's why no one talks about prenatal depression.

But it's real. It exists. It's caused by hormones and the enormous changes we're going through in our views of ourselves and in our relationships. It doesn't have anything to do with how much we'll love or enjoy our children, and it certainly doesn't mean we won't be damn good mothers. It does not have to mean that we'll get PPD. It just means that we're not the happy preggos in the magazines. But that's OK. We'll keep on getting up every morning, and we'll waddle through our days until delivery, and then when the baby is crying at 3 in the morning we can think "At least I'm not still pregnant."

So, Jodi, don't feel guilty. You're going through a ton of changes and you have enough hormones to kill an elephant racing through your system. If you end up coccooning yourself your friends will understand. And life's not over when you become a parent. You can't do much of anything for the first year or two, but then you'll get your groove back, only with renewed efficiency and a BTDT kind of fearlessness (that undoubtedly comes from knowing rightly that once a small person has puked into your mouth there's really nothing left to be afraid of).

If you're not already supplementing with flax seed oil, consider starting now--it can't hurt. But try to cut yourself a break, and know that better things are coming for you soon.

Comments

[Jen (yup, another one)]

Can you please share the "hard-core plan to prevent" PPD? I have been off anti-depressant/anti-anxiety meds throughout this pregnancy very much by choice, but it's definitely affected my motivation, mood, and ability to cope with stress. I want to stay off them while nursing but my shrink mumbles dire things about the likelihood of PPD (although she is willing to go along with my no meds unless proven necessary approach). I'd love more concrete ideas about anything I can do to fend off PPD.

(You know I am already on the flax seed oil & chocolate plan!)

[Moxie]

I could probably write a book about it. I'll write the main points over the weekend and post them next week for you.

[AmyinMotown]

Thank you for this post, Moxie, and Jodi. The one thing that's reallly stopping me from being good and ready to try to get pregnant again is that I kind of lost my shit in different ways. I wrote about it on my blog at the time and you made a very nice comment, Moxie. I am not sure if knowing it was all okay eventually will make it easier if I can get pregnant a second time. But thanks to you both for adressing this issue.

[Wood]

Wow, Moxie.

I'm going to tell every pregnant woman I ever encounter to read this.

[Jody]

Best wishes with your pregnancy, Jodi. I struggled with unidentified depression until after delivery and wish now that I had articulated my problems for myself much earlier.

And, well -- I'm trying to be polite here -- please believe that many folks were responsible teens (sexually and otherwise) and were not able to get pregnant the first month they or their partners went off the pill. Or the twenty-eighth. Infertility cannot be attributed to prior sexual behavior. Thanks.

[parodie]

Jody, I wonder if you misinterpreted Jodi's comment? I understood her comment to mean that she's glad she was responsible as a teen because she got pregnant so easily, and therefore that not being responsble as a teen would have led to "problems" such as dealing with pregnancy.
I didn't read that as a responsible teen -> easy conception.

[mary]

The old thing? Kind of depends where you live. Back when I lived in California, all the moms were in their 30s. Now that I've moved to the midwest, I see people my age (31.5) with 4 kids. So I guess I'm getting on towards elderly here, myself. :P

And Parodie, I was going to say exactly what you said about Jodi's "responsible teen" thing.

[Jody]

Well. Yes, that does make more sense as an interpretation of Jodi's comment about responsibility. I suppose it says something rather sad about me, that I read the comment three times, angsting over how to respond, and never saw it as anything other than a comment about fertility. Five years out, and my infertility-over-sensitivity is still showing up in weird places. (You'd be amazed how many people imply that only sexually promiscious women have trouble conceiving, what with all the undiagnosed STDs they surely must have endured.)

I'm sorry I misinterpreted the comment.

[Linda B]

Moxie,

This is excellent.

I'm towards the end of the first trimester with my second pregnancy and all I can say is that this was me last time, and a bit of me this time, too.

This statement "I think we feel guilty that we're not glowing, happy little earth mothers, basking in the miracle of human repoduction and our own fecundity. I think we feel cheated out of enjoying something our culture tells us is the pinnacle of human experience, and terrified that we won't enjoy being mothers" is so right on I want to print it out and have it matted to be hung on my wall. I had mixed emotions about how I was supposed to feel during my first pregnancy and struggled with balancing my emotions. Society sets a certain expectation of how an expectant mother is supposed to act, without factoring in sometimes shocking physical and mental changes that come with pregnancy and parenthood. I swear, those happy and blissful statements were written by a man!

With both pregnancies, I have experienced the strong desire to hole myself away from society and just be left alone. Also, can I tell you how moody I've been? Let's just say I feel very sorry for my husband.

It's very reassuring to know that this is normal and that other people experience the same thing.

I hope people know it is ok to feel and even normal this way. I think (for me, at least) things seem to get better when the nausea and fatigue dissipate. I've had many days where I've broken down crying on my way home because I've felt so tired and worn out from my everyday responsibilities. Somedays, it's just too much to handle. But (somehow!) I got through it and I know I will be ok this time, too.

Hang in there, Jodi.

Moxie, I have problems taking large pills and I've heard that flax seed pills can kind of "come up" on you after you take them and leave a nasty aftertaste. Does the oil have the same effect and if so, what is the easiest way to get that stuff down? I tried mixing a tbls full into my yogurt and I could barely choke it down.

[Moxie]

Linda B, my mom takes flax seed oil to keep her mild arthritis at bay, and she drizzles it on her toast like butter in the morning. I think you could also freeze the pills and take them right before you go to bed and that might help, too.

I also experienced symptoms of depression with my second pregnancy, but that time I realized it was all physical, induced by the pregnancy, and just tried to sort of ride above them, if that makes any sense. I didn't feel great, but at least I wasn't thinking I was depressed for any reason that I could do anything about.

I also holed up and had limited contact with people IRL while I was pregnant, both times.

Anyone else? Why don't we talk about this the same way we talk about herorrhoids?

[Linda B]

If only flax seed tasted like butter. Then I'd have NO problem getting it down ;)

Thanks Moxie.

[Katie]

I have mixed my tablespoon of flax seed oil with a glass of orange juice and it goes down much easier.

[jodi]

I was the original person to post about depression and want to emphasize that I was not insinuating that sexual behavior has an correlation to infertility. In fact I explained that part of my guilt over my depression came from the fact that I had the good fortune to become pregnant easily when many of my friends have experienced difficulty. The other part is that I am sarcastic as hell and that doesn't always e-deliver smoothly. Moxie you had better be in advertising or marketing if you write this well as a hobby it is truly unfair.

[heather]

Hi Moxie, I'm looking forward to your upcoming post about your 'hardcore plan' to prevent PPD.
I'm 5 months along, and quite frankly shitting my pants about the risk of PPD... I have lived with not-too-harsh depression for 3 years now, and my doctor and I agreed it'd be best for me to stay on the low-dosage, low-risk antidepressants rather than go through what I know to be very unhealthy depressive episodes without the meds.

The studies I've looked over tend to be both yes-correlation and no-correlation as to depression before pregnancy and PPD, or depression during pregnancy and PPD. So they don't help me at all.

I have read up on PPD (drawn to what scares us, eh?) and am in the process of educating those around me to help in the event that.

Er.. I'm blathering on here, but you *did* ask if anyone else had anything to say ;) Fortunately, I have nothing to contribute about the hemmorhoid discussion!

Keep up the good work :)