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Prenatal Depression

Pregnancy is supposed to be this happy, crazy, wonderful, exciting thing – and for many moms-to-be, it is. Barring the back pain, mood swings and hypersensitive gag reflex, the process of growing a tiny human life inside you is magical. Right? 
Not for you. Instead, you’re worried and anxious and wondering where that pre-pregnancy person you used to be has disappeared to. Your friends are giddier about your latest sonogram than you are. You’re sick of baby names. And if you see one more selfie of your friend’s bulging belly (“Week 22!!!! #babybump #sohappy”), you’re going to throw up – and the morning sickness isn’t helping. You just don’t feel it.  
But you do feel so, so guilty
Postpartum depression has an acronym (PPD). It’s something most moms are aware of and acknowledge, and, although it’s a terrible reality, it’s a reality you can label and blame for the blues you’re feeling after the baby arrives. 
Prenatal depression, on the other hand, is much less talked-about, even though it affects about as many women as PPD, says Ann Dunnewold, Ph.D., a licensed psychologist with an independent practice in Dallas. The co-author of Life Will Never Be the Same: The Real Mom’s Postpartum Survival Guide believes prenatal depression is under-diagnosed for two primary reasons. “A lot of the symptoms of depression, like being tired and not having energy, are very similar to symptoms of pregnancy,” she says. In addition, women who do realize something else is going on are often too embarrassed to admit it.   
“You have to pretend that you’re OK,” explains Dawn Hallman, executive director of the Dallas Association for Parent Education (DAPE). “You have to smile and be excited about shopping for diapers. And then you feel guilty.” The media says you should be glowing à la Kate Middleton, and you see other moms-to-be beaming about their baby bumps; the message is, if you’re not happy, you’re obviously doing it wrong. 
False. It’s not your fault, though admittedly that can be tough to believe when you’re in the throes of depression. The causes of prenatal depression vary from woman to woman, but the most common factors are hormones (because you are pregnant, after all); major life changes, like buying a bigger house or coming to terms with how your family dynamic will shift with one more on board; unrelated events like the death of a loved one; a history of PPD, depression or anxiety; and undiagnosed depression or anxiety apart from pregnancy. 
Most important, “‘I’m a bad person’ is not on the list,” emphasizes Dunnewold. “It’s not a character flaw.” 
Sheila McComas experienced the perfect storm of major life changes, riotous hormones and a history of PPD when she became pregnant with her fourth child. “I was devastated. I was scared to death,” she says. The Garland mom of five had trouble eating and sleeping, and many days she didn’t have the energy to get out of bed. But most alarming was her lack of relationship with the child growing inside her. “I didn’t feel like I had a connection with the baby,” she admits. “I would call the baby ‘it,’ and we knew it was a girl.” 
McComas’ symptoms were typical of prenatal depression: lethargy, insomnia, irritability and never-ending worry. Dunnewold says the latter is the telltale sign that sets prenatal depression apart from plain old pregnancy. “‘Am I going to be a good mom?’ That’s probably the hallmark of it.” Though many moms toss and turn over this question, those suffering from prenatal depression can’t get away from it. The anxiety becomes a constant companion, just like the unborn child they’re worrying about. And because such stress can negatively affect the baby in the womb, they worry that their worry is harming the child, and so on, and on, and on. 
“It’s those maternal feelings of guilt,” McComas says. “I’m not a good enough mother. I don’t know what I’m doing. I just want to give up.” 
Postpartum depression shares these symptoms, but prenatal depression is “a different kind of hard” than PPD, Hallman says. “You can’t stop being pregnant. With a new baby, you can say to somebody, ‘Please take this baby – I need the afternoon off.’ When you’re pregnant, you’re pregnant all the time.” 
But that doesn’t mean you have to wade through the blues by yourself. Hallman recommends a visit to your midwife or obstetrician as the first step to dealing with depression. Be prepared for a range of receptions. Some healthcare practitioners don’t recognize prenatal depression and will brush you off, while others may prescribe medication without exploring alternative treatment options. Though some antidepressants are thought to be OK during pregnancy, your doctor should weigh the risks and benefits before prescribing. Besides, “medication isn’t the only answer,” Dunnewold says. “It’s a very powerful answer, but it doesn’t have to be the first line of defense.” She explains that exercise, therapy and meditation can work in place of medication or alongside it to boost the effects. 
Your doctor or midwife should send you to a therapist or a psychologist, and Hallman also suggests that you ask about support groups, help lines and online forums. The bottom line: talk about your depression with someone else instead of bottling up the guilt. Moms who’ve been there, done that can provide tips and encouragement, and your partner can support you better if he knows what you’re dealing with (and chances are, he’s already sensed something’s off). 
Now that McComas has weathered the storm, she acts as a listening ear for other moms facing prenatal depression and PPD, primarily by talking to them on the phone as a volunteer for DAPE. Some women she’s never even met in person, but she’s still able to encourage them one conversation at a time. “Sometimes it’s one step forward and two steps back,” she admits. The road to recovery is long, sometimes longer than the pregnancy itself, though your depression may vanish as soon as you lay eyes on your new little bundle. McComas wasn’t so lucky – her depression lingered as PPD – but she’s confident moms can overcome the struggle just like she did: with help. “It is very scary. And it is embarrassing. But it does get better.”

Published March 2014