One of the most common expectations of a newly pregnant woman is that she will exude joy in anticipation of her new baby. When she learns the news that she is pregnant, an expectant mother seldom imagines she might also have to deal with suffering from depression.

Pregnancy and depression
The medical literature suggests that as many as one in 10 pregnant women suffer from depression during their pregnancy. Statistics Canada reported 386,013 births in Canada between July 1, 2010 and June 30, 2011, which suggests that approximately 38,600 Canadian women suffer from depression while pregnant each year.

Dr. Sarah McDonald, an associate professor in the Department of Obstetrics and Gynecology at McMaster University, wants expectant moms who find themselves in this position to know that they are not alone. "If a woman looks around the waiting room in her doctor or midwife's office, she'll likely be sitting with other women struggling with same issue," explains McDonald.

Symptoms of depression, signs of pregnancy
What should you do if you think you might be suffering from depression during your pregnancy? First off, pay attention to your mood. Some of the symptoms of depression can be very similar to the effects of pregnancy, such as experiencing fatigue, difficulty sleeping and changes in appetite or weight. According to McDonald, the "hallmark of depression is a depressed mood or the lack of ability to find pleasure or joy in activities."

All pregnant women will likely experience physical discomfort at some point during the nine-month period. For instance, "a pregnant woman in the third trimester will almost always note fatigue," explains McDonald. As a result, acknowledging that you may be suffering from depression comes down to differentiating between a depressed mood and simply uncomfortable physical symptoms of your pregnancy.

New medical research on pregnancy and depression
Of course, making it through your pregnancy healthy and strong has positive effects for both you and your baby. New research published in the American Journal of Obstetrics and Gynecology found that women who presented as depressed (as evaluated by the Edinburgh Postnatal Depression Scale) had a greater chance of delivering their baby prematurely (where premature means a less than 37-week gestation period).

McDonald explains the study to me, noting that while the increase in risk for depressed women who were delivering prematurely was small – babies were born early to 13.9 per cent of depressed women compared to 10.3 per cent of women who were not depressed – an increase was present. Any pregnant woman who is experiencing symptoms of premature labour, such as regular contractions, menstrual-like cramping or new lower back pain, should seek care, as prematurely born babies can suffer from a variety of health issues, including "increased risks of breathing and feeding problems, infection, sight, hearing or cognitive impairments," notes McDonald.
What to do if you think you are depressed
The Public Health Agency of Canada has comprehensive online materials that outline the symptoms of depression in pregnancy and offer suggestions for self-care and finding outside help if necessary. McDonald reminds women that they are not alone and that should seek help by talking to their family doctor, midwife or obstetrician if they think they might be depressed. One of the biggest problems for depressed people in general is finding a path past the social stigma that is still associated with mental health diagnoses.

"Sometimes there can still be shame associated with a psychiatric diagnosis," explains McDonald. This shame can be compounded for women who are depressed while pregnant, since our cultural narrative often describes this time as one of the happiest in a woman's life.

Treatment options for depression during pregnancy
There is plenty of hope if you learn you are depressed while pregnant. Depression can be improved with treatments that do not necessarily involve medication (though some do).

McDonald suggests cognitive behavioural therapy, group therapy or other forms of counselling as often effective methods of managing and decreasing symptoms of depression. Furthermore, there is "enormous potential in group support, especially for mild cases," she notes.

On its website, the Public Health Agency of Canada suggests that maintaining proper nutrition, getting regular exercise, maintaining a regular sleep-wake pattern and using stress-management techniques such as yoga and relaxation can greatly stabilize mild depressive symptoms.

Some issues cannot be managed on your own, however, and this is where a family doctor, therapist or psychiatrist comes in. Many expectant mothers are worried about taking any medication while they are pregnant, but in cases of severe depression medication may be warranted. Selective serotonin reuptake inhibitors have comparatively fewer side effects than some other anti-depressants, says McDonald. While there is a "small increased risk to the baby after birth (concerning neonatal withdrawal)," she explains, "if the pregnant mom needs medication, the benefits of treatment far outweigh the risks."

If you are depressed during your pregnancy, remember that there are effective treatments available to you and that you are not alone. "Depression is a recognized illness," McDonald notes, and you have the right to appropriate treatment, support and care.