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Pregnancy: Feel Sad When You Should Be Happy?

WebMD Health News

Aug. 3, 2001 -- The recent murder of five Houston children by their mother has focused media attention on psychiatric illness, including depression, which may strike a mother soon after her children are born.

But people know less and talk less about depression during pregnancy -- that period that's supposed to be the "happiest time of a woman's life."

Now, a large study of pregnant women has found that depression is liable to be even more common during pregnancy than afterward -- and just as severe.

"Symptoms of depression are actually quite common during pregnancy," author Jonathan Evans, MBChB, tells WebMD. "We didn't find it to be more common after childbirth or any different in severity."

The findings are important because experts say not enough pregnant women are screened for depression, and many who are depressed are not treated. The decision to use antidepressant medications during pregnancy should be made on an individual basis between a mother and her doctor, says Evans, a consultant in the division of psychiatry at the University of Bristol, in England.

Some forms of psychotherapy, or talking therapy, may also help relieve symptoms of depression in mothers-to-be, he says.

"What we don't know about are the harmful effects of untreated depression on the fetus," he tells WebMD.

In the study, 9,028 pregnant women in Avon, England, completed questionnaires about symptoms of depression at four periods during and after pregnancy: 18 weeks pregnant, 32 weeks pregnant, eight weeks after delivery, and eight months after delivery.

There was no difference in depression scores during pregnancy or after childbirth, but scores were higher at 32 weeks of pregnancy than they were at eight months after delivery. More mothers had scores on the questionnaires that would qualify them for a diagnosis of depression between 18 and 32 weeks of pregnancy than between eight weeks and eight months after delivery, according to the report.

"Being pregnant doesn't always make you happy," says psychiatrist and obstetrician-gynecologist Nada Stotland, MD, who reviewed the report. "It can be cruel for a depressed pregnant woman to tell herself she is supposed to be happy, instead of paying attention to the depression and doing something about it."

"Not only is it a miserable disease at a time that might be happy, depression almost certainly will effect eating, sleeping, exercise, and other activities important to the developing fetus," says Stotland, professor of psychiatry and obstetrics-gynecology at Rush Medical College, in Chicago.

Stotland says women who are being treated for depression often stop taking medication unnecessarily when they become pregnant, or are advised to stop taking it by their doctor.

"If the depression is mild or moderate, it can probably be treated with psychotherapy," she says. "If it is more severe she should think about taking medications. Ultimately, it is the woman's decision, but it is very helpful for her involve other people she thinks are important."

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