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TORONTO (CP) - While some women go through pregnancy in blissful anticipation, viewing an expanding waistline and dessert without guilt as a passage into motherhood, others battle fear, sadness and confusion.
Highly publicized, tragic cases of women killing themselves or their children have put the spotlight on postpartum depression, but the long-held belief that a surge of hormones keeps women happy during pregnancy has meant that prenatal depression is largely overlooked.
"Pregnancy is not a time when all women will be happy all the time," said Dr. Shaila Kulkarni Misri, author of Pregnancy Blues (Random House of Canada).
Fluctuations of mood, crying spells, changes in sleep patterns, changes in appetite and a general feeling of tiredness or malaise can affect women in their first trimester, said Misri. And those symptoms aren't completely separate from what people experience when they suffer from depression.
"The difference here is the intensity and duration," said Misri, director of reproductive mental health at both St. Paul's Hospital and B.C. Women's Hospital and Health Centre in Vancouver. "If (those symptoms) continue day after day for more than two weeks, then this person has met the diagnostic criteria for major depressive illness."
When women become pregnant, most know to omit alcohol, cigarettes and caffeine, and often those on antidepressants stop taking the drugs because of some data suggesting risks.
For Diane Sandor, 35, "going off (antidepressants) wasn't an option." When she and her husband decided to have children, Sandor met with her doctor. They discussed the risks of taking medication while she was pregnant and they decided to continue treatment with Prozac.
"There was still depression, but it was manageable. If I hadn't been on the meds it wouldn't have been manageable."
"I was actually quite worried ... 'Oh I'm taking something. What am I doing to my baby?' You don't even want to have a cup of coffee because you are worried about what the caffeine could do to the baby," she said from her home in Coquitlam, B.C.
But as it turned out, her 11-week-old Atticus is a very happy, healthy baby. She jokes that all the antidepressants made him a very happy boy.
Sandor's experience isn't an isolated case. New studies cast a different light on the use of antidepressants during pregnancy.
A study published in a recent issue of the Journal of the American Medical Association found that women who were being treated for depression and stopped taking their medication during pregnancy were at a five times greater risk for recurrence of depression than were women who continued taking their medication throughout their pregnancies.
"Clinical lore has held for decades that pregnancy protected women from mood disorders," Dr. Lee Cohen, associate professor of psychiatry at Harvard Medical School, said in a statement.
Cohen, director of the Perinatal and Reproductive Clinical Research Program at Massachusetts General Hospital who led the investigation, said the study was borne from that belief and what doctors were seeing in their patients.
The study looked at 201 pregnant women between 1999 and 2003, who were treated at centres which focused on the care of psychiatric illness during pregnancy.
In an analysis in February's Canadian Medical Association Journal, Dr. Donna Stewart outlines that the "depressed pregnant woman is less likely than others to eat and sleep well, seek prenatal care or adhere to medical recommendations."
Her analysis of World Health Organization numbers indicates that suicide was one of the three leading causes of maternal deaths overall (this includes deaths within one year of delivery).
"Depression rates are slightly elevated by third trimester and continue to be so for the first year after giving birth. The strongest predictors of postpartum depression are depression or anxiety in pregnancy, a history of depression in the woman or her close relatives or low social support. Although suicide is a rare event, it unfortunately does occur in pregnancy and postpartum," Stewart, professor and chair of the Women's Health University Health Network at the University of Toronto, wrote in an e-mail interview.
Beyond the mother-to-be battling depression, Misri points out that when depression goes untreated, it affects the unborn child.
Her book outlines studies that have shown prenatal stress leads to delayed development in motor skills, impaired cognitive learning, attention deficit, maladaptive social and sexual behaviours and increased anxiety in the newborn.
But there are studies showing some risk to babies of mothers taking antidepressants as well. For instance, a study published in February in the New England Journal of Medicine linked the use of Prozac and other similar antidepressants during the second half of pregnancy to a life-threatening lung problem in newborns, known as persistent pulmonary hypertension.
"Here is the bottom line: There is nothing that is (100 per cent) safe," Misri said. "I'm not fond of giving medication ... It's still an evolving field. We need to study more, but at the present time if the risk of non-treatment is more than the risk of treatment, then you have to go ahead and give (antidepressants)."
© The Canadian Press, 2006
