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I should be happy:

Pregnancy is often a time of joyful anticipation; for many women, being pregnant and starting or
expanding their family is something they have planned and longed for. Unfortunately, for some
women, pregnancy turns out to be a very challenging time. Whereas depression after childbirth has
been well-documented and discussed in both clinical writings and the media, there has been little
awareness of depression during pregnancy, which, up until recently, was considered a protective
time for women. Recent research indicates that about half the women who experience postpartum
depression have had significant symptoms during pregnancy. Between 10-15% of pregnant women
develop serious depression while some struggle with anxiety, panic, obsessive-compulsive disorder,
bi-polar disorder and post-traumatic stress disorder. Unfortunately, only a small percentage of
women get diagnosed and treated during pregnancy. Most of pregnant women who struggle with
symptoms of depression and anxiety are not detected by their health care provider and do not
receive appropriate treatment. Others, who are diagnosed, are often ill-informed about their options
for treatment.
Why do some women get depressed during pregnancy?
The exact causes of depression and anxiety during pregnancy are not known, but many experts
believe that some women are sensitive to the hormonal fluctuation that come with pregnancy and
postpartum. Although we are not sure about the direct causes of depression and other mental health
challenges during pregnancy, the following risk factors have been linked to depression and/or
anxiety during pregnancy:
Previous history of depression or another mental disorder Mental health issues in the immediate family Significant physical or medical problems
Why do health care professionals often fail to diagnose pregnant women with depression?

Symptoms of depression and some anxiety symptoms are similar to common complaints during
pregnancy. For example, sleep disturbances, changes in appetite, mood fluctuation, lack of energy
and worries are common in both. Many women who complain about such symptoms are being
dismissed by well-meaning but ill-informed health care professionals. The problem is that, once a
woman has complained to a professional about symptoms of depression and/or anxiety and has been
dismissed, she is highly unlikely to complain about these symptoms again, which explains why
many pregnant women who struggle with these disorders do not receive treatment. Untreated
depression is likely to get worse with time and can have dire consequences for both mother and
baby; untreated depression may result in a myriad of complications, such as: miscarriage, premature
birth, low birth weight, low Apgar scores at birth, self-neglect of the mother that may adversely
affect the baby’s health, poor bonding and self-harm. Not treating depression during pregnancy is
not an option. There are many options when it comes to the type of treatment.
What are the treatment options available for pregnant women who suffer from depression,
anxiety and other disorders?

Many women who get diagnosed with depression or anxiety during pregnancy are being prescribed
anti-depressant medication, such as Prozac, Paxil, Wellbutrin, etc. When women question
medication or are reluctant to take medication in fear that it may harm their baby they are often told
that the risk of not treating the depression outweighs the risk of the medication. Indeed, not treating
the depression would be very risky. However, to tell a woman that medication is the only way to
treat depression or anxiety is misleading. While anti-depressants may be warranted and helpful in
severe cases, it is hardly justified that they should be prescribed as the first line of treatment,
especially in mild to moderate cases. Women should be made aware that there are several other
highly effective treatment options for mood and anxiety disorders in pregnancy. Among these are:
None of the above mentioned treatment options has any known side effects. Pregnant women who suffer from mood and/or anxiety disorders need to be well-informed of ALL of their treatment options and be encouraged to always seek treatment from registered health care professionals. Written by Dr. Michal Regev, Registered Psychologist & Marriage and Family Therapist, Vancouver, B.C


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