Most women feel that they should be glowing with happiness while carrying. So, developing symptoms of depression often make them feel guilty, thinking they do not love their child as much as they should. But the truth is, many women suffer from depression due to the body changes occurring during this period . However, one can easily deal with the symptoms by talking to their health care provider and taking certain precautionary measures.
Can pregnancy cause depression?
Pregnancy hormones were earlier believed to provide protection from depression as pregnant women often have a feeling of emotional wellbeing . But lately, experts believe that the rapidly increasing estrogen and progesterone levels can contribute to signs of depression by disrupting the brain chemistry . Depression can occur anytime during the first, second and third trimester.
Is depression common during pregnancy?
Around 10% to 15% women develop prenatal depression, making it almost as common as postnatal depression (PPD) .
What are the risk factors for depression while pregnant?
- A history of depression or PPD in a previous pregnancy 
- Family history of depression
- Conceiving at a young age (prenatal depression is more prevalent among teenage mothers)
- Relationship problems with partner 
- Financial difficulties or having a stressful jobs
- Having to take care of other children while pregnant (the more children you have the more likely you are to get depressed during pregnancy) 
- Carrying twins 
- Having experienced difficulty conceiving or a miscarriage or stillbirth in a previous pregnancy (worrying about your baby’s safety) 
- Being a victim of domestic violence or abuse
- History of serious complications or a traumatic birth in a previous pregnancy 
- Unplanned pregnancy 
What are the signs and symptoms of depression during pregnancy?
- Feeling sad and miserable almost all the time 
- Losing interest in activities that you used to enjoy
- Fatigue and lethargy 
- Insomnia (no sleep) or hypersomnia (excessive sleepiness)
- Difficulty concentrating 
- Changes in appetite
- Feeling angry and irritable
- Sense of worthlessness
- Crying for no reason 
- Thoughts of suicide or hurting yourself 
How to prevent depression in pregnancy?
- Spend lots of time with your partner as it is vital for you to feel his support during this time 
- Maintain a regular sleep-wake routine 
- Follow a healthy diet
- Avoid working too much to prepare for the baby’s arrival
- Do some light exercise (walking, swimming) or practice prenatal yoga  and other relaxing techniques to reduce stress
- Talk to your friends and family members regarding your worries and fears about becoming a mother 
- Keep yourself happy; go out with your friends for dinner or a movie
- Avoid alcohol as it is a depressant
Risks of Depression during Pregnancy
Women suffering from depression are more prone to postpartum depression as well as various pregnancy complications as they are more at risk of:
- Poor prenatal care
- Poor diet
- Drug abuse or drinking alcohol 
- Poor weight gain
- Extreme high pressure in pregnancy (preeclampsia)
Those with major depression are even at risk of committing suicide .
Does depression during pregnancy affect the baby?
Effects on the baby may include:
- Low birth weight 
- Developmental problems
- Difficulty concentrating while growing up
- Suffering from Depression (especially as teenagers or young adults) 
Diagnosing Depression during Pregnancy
Having three or more of the above signs continuously for over 2 weeks may indicate clinical depression . It is recommended to talk to your doctor if you suspect possible depression. Your doctor may ask a few questions regarding any history of depression while also ordering some tests to rule out any physical condition that might lead to mental symptoms.
Depression during Pregnancy Treatment Recommendations
Counseling, cognitive behavioral therapy and problem solving therapy are commonly used to fight depression . Psychological treatment options used for managing postpartum depression (depression after pregnancy) are useful for dealing with depression and anxiety in pregnant women as well. Forums and support groups for antenatal and postnatal depression can also help you overcome the symptoms.
Your doctor may prescribe antidepressants for severe depression during pregnancy if their benefits overcome the potential risks . Certain anti-depressive medicines have been proved safe for short-term use in pregnant women, including:
- Selective serotonin reuptake inhibitors or SSRIs: fluoxetine (Prozac), sertraline (Zoloft), citalopram (Celexa) and paroxetine (Paxil) 
- Tricyclic antidepressants or TCAs: Amitriptyline (Elavil), nortriptyline (Pamelor)  and imipramine (Tofranil)
Another drug named Bupropion (Wellbutrin, Budeprion, Prexaton) is sometimes used for fighting depression as well as smoking cessation .
Alternative Treatments for Dealing with Depression during Pregnancy
- Acupuncture: Chinese healing method that involves inserting tiny needles into certain points of the body, believed to influence your mood
- Light Therapy: Involves exposing the patients to artificial sunlight for relieving depression 
Herbal depression remedies like St. John’s wort are not recommended in pregnancy without expert consultation. There is a lack of adequate research regarding the safety of such remedies and their potential effects on the fetus .
Is it safe to use antidepressants during pregnancy?
Not all antidepressants are recommended for pregnant women as certain drugs (venlafaxine) may increase the chances of miscarriage or stillbirth . Recent studies show antidepressant use in pregnancy to be associated with premature delivery. However, scientists are still researching the contribution of other risk factors like maternal obesity, socioeconomic stress and depression .
Using SSRIs during the third trimester is believed to increase the risk of preeclampsia in the mother as well as pulmonary hypertension, autism  and certain birth defects in the baby . It is also associated with certain symptoms in the newborn, including poor feeding, irritability and sleep disturbances that may last up to a week.
TCAs are considered safer than many newer antidepressant drugs, but their fatal toxicity index is higher than that of SSRIs .
Depression during Pregnancy Incidence Statistics
Depression is quite common in pregnancy with 14% to 23% pregnant women experiencing the symptoms .
Depression ICD-9 and ICD-10 Codes
The ICD-9 codes used for indicating depression are 296.2, 296.3  while its ICD-10 codes are F32, F33 .
Depression during Pregnancy Support Group
American Pregnancy Association
1425 Greenway Drive,
Suite 440 Irving,
- http://apps.who.int/classifications/icd10/browse/2010/en#/F32 [/ref]