Updated January 20, 2016 (article by Aviva Romm MD)

You’re full of new life! Overjoyed, right?

Actually, if you’re among the 1 in 10 – or even more – pregnant women who struggle with the symptoms of depression, then you might not be feeling overjoyed at all. While you may be happy to be pregnant, this may be overshadowed by cloudy feelings…

I know it can be really tough to admit we’re depressed when everyone else thinks we should be ecstatic. Many women have told me they fear they will be judged by others as “bad moms” for admitting they feel miserable.  And it can be terrifying to imagine taking care of a baby when you feel you can barely get a smile on for the day.

You may also feel very alone with your concerns.

Your midwife or doctor, and even your friends and family, might not recognize that you’re depressed. Your symptoms may be mistaken as simply normal changes of pregnancy due to hormonal shifts and other physiologic changes. After all, fatigue, changes in eating habits, sleep problems, general aches and pains, changes in mood, irritability, and tearfulness – all of these are normal during pregnancy, right?

The answer is sometimes, but not always. When mild and infrequent, these symptoms may be normal, but they are also classic signs of depression! 

Why Do I Feel So Blue? Causes of Pregnancy Depression

The root causes of depression are often complex – but they can be tackled! 

As you can see from the diagram below, depression has many possible causes and sometimes even more than one. These can include:

• Medical problems (for example, hypothyroidism, severe nausea and vomiting in pregnancy, or a pregnancy-related medical problem)
• A previously complicated pregnancy or pregnancy loss
• Nutritional deficiencies (protein, omega-3 fats, iron, vitamin D, to name a few)
• Fatigue from poor sleep
• Blood sugar problems, including both hypoglycemia and elevated blood sugar
• Lack of support or relationship problems
• Family history of depression
• Inadequate or ineffective coping skills
• Stressful life problems (money, living situation, job stress)
• Unhappiness or ambivalence about being pregnant
• Food sensitivities  or  gut dysbiosis (unhealthy changes in the gut flora or microbiome)
• Lack of exercise/movement
• Lack of sunlight or time in nature
• Environmental toxins, for example, heavy metal toxicity, usually from eating too much high mercury fish such as tuna, or hormone mimicking chemicals such as plastics from food packaging and water bottles, to name a few sources

Does Depression Pose Increased Risks to My Baby?

Untreated, severe depression can increase some risks to you and your baby – that’s why it’s so important to promptly get the support and the treatments that work best for you.

Even moderate depression can impair your quality of life.

Problems can arise because when we’re depressed, we don’t tend to take optimal care of ourselves. If this happens during pregnancy women are more likely to:

• Skimp on nutrition
• Not gain enough weight
• Have sleep problems
• Skip prenatal visits
• Use harmful substances (i.e., tobacco, alcohol, or drugs)

This can increase the risk of premature birth, having a low birth weight baby, medical problems in the pregnancy, and problems at birth.

Increasing numbers of studies are also showing that depression, stress, and anxiety in the pregnant mom influences and alters the expression of the baby’s genes, increasing the child’s lifetime risk of mental health problems.

Prenatal depression also increases the risk of postpartum depression, which, if untreated, can lead to developmental, behavioral, and mental health problems in the baby, as well as problems that arise from neglect if mom is unable to fully care for the baby.

On top of it, all of this can also have an impact on your self-esteem and confidence as a new mom, and this can also negatively affect your parenting.

But not to worry – there is help!

Should I Take an Antidepressant?

Whether to take an antidepressant is a complex and often tough decision. The evidence on the safety of these medications in pregnancy does show some risk of potential birth defects, and also withdrawal symptoms in baby after birth. You have to weight the potential benefit to you and the baby against medical risks of  taking antidepressants in pregnancy. I address this thoroughly in Depression in Pregnancy: Should You Take Medications?.

For mild to moderate depression, natural approaches can be tried first, and are often all that is needed, but women should also consider being under the care of a midwife or obstetrician and a mental health provider simultaneously.

Women with moderate to severe depression, in addition to trying these 10 tips, should be under the care of a physician who specializes in prenatal depression. Medications are an option that should be considered in severe cases, or in moderate-severe cases where your health is at risk because you aren’t able to take care of yourself; but in moderate-severe cases one can often try natural treatment for a few weeks first .

 

  

“The new medicine for women” as I call my whole women approach to Functional Medicine, includes the best combination of available strategies for individual women, used with wisdom and common sense.

 

So What Can I Do? 10 Strategies for Beating Depression Naturally

Here are 10 pregnancy-safe, positive steps you can take toward optimizing your mood and your wellness.

1. Get Real About How You Feel

The first step toward feeling better is to get real about how you feel. If you’re not happy, if you’re feeling sad, or worse than this – feeling desperate – don’t pretend otherwise. The consequences of ignoring depression in pregnancy are serious for you and baby. Admit how you’re feeling to yourself, let your partner, a close relative, or BFF know, tell your care provider and get the ball rolling on feeling better. You’re not alone, there is help, and you deserve wellness!

2. Get a Medical AOK
A number of medical conditions, including thyroid problems, diabetes, hypoglycemia, and anemia can cause symptoms of depression. Have your doctor or midwife run some simple blood tests to check for these and start appropriate treatment as necessary.

Many women who experienced severe nausea and vomiting in pregnancy also report depression – sometimes just because they felt so awful and thought it would never end, other times likely because underlying nutritional issues led to or resulted from the vomiting. Get with your midwife, doctor, or a functional medicine physician who specializes in prenatal care to help you get your nutrition on track.

3. Seek Support, Stay Connected, and Pay for Help if Needed
This is not a time to be shy asking your partner, other adult family members, your BFF, or other moms you know for support, particularly if you already have young children and are experiencing depression. If you are single or if everyone else is too busy to help when you need it, hire some extra help – whether for getting shopping and chores done, or taking care of the house or older kids. This will give you time to take care of yourself – and it’s so important!

Find a therapist. Cognitive Behavioral Therapy is one form of therapy that is especially helpful in developing coping skills for depression, and changing old, ineffective thinking patterns into new and successful skills for coping with challenging emotions, behaviors, and thoughts.

Get educated and clear out the fears. Interestingly, a recent study showed that fear of birth is associated with the later development of postpartum depression. While this association has not been studied in pregnancy, it does make sense that unresolved fears and worries can lead to prenatal depression. I once had a patient who was terrified that, because she’d had an abortion as a young adult some 15 years earlier, she would be “punished by God in this pregnancy,” and that her baby would be born deformed. This fear was even playing out in her dreams, causing her to be fatigued on top of the worry! When I was able to elicit the story and her fears, we were able to do some emotional healing around the issue and she once again had peace of mind and peaceful sleep.

4. Optimize your Diet

Gluten and dairy, while we might crave them like crazy during pregnancy, can cause mood problems in those who are sensitive. A trial of gluten and dairy free for a month, even, might shed light on whether these are not optimal for you. If symptoms improve, stay clear of them; if you don’t notice a difference, it might not have been a long enough trial, or you might not be intolerant of these substances. If you do go dairy free, make sure to get calcium from other sources.

Hypoglycemia is common during pregnancy, often made worse by nausea in the first trimester. It is important to eat high quality foods, especially a protein source (nuts, nut butters, meat, fish, or poultry, hummus or something with beans or legumes, or a protein shake, for example) and good quality fats (avocado and nut butters, for example) every few hours, and never skip meals. You do not have to eat larger quantities, but keeping your blood sugar steady is especially important if you struggle with mood swings or depression. High blood sugar over time leads to gestational diabetes, but can also lead to generalized inflammation in the body, and the chemicals produced during an inflammatory response also depress the mood. So make sure to avoid simple carbs (white flour products, white rice, pasta) and sugar, and emphasize a pregnancy-smart way of eating.

Also, make sure that you are getting all of the nutrients you need. Iron deficiency anemia, low vitamin D, low vitamin B12, can all increase depression in pregnancy, and are easily to supplement. Talk with your midwife or doctor about testing.

5. Get a Move On: Yoga and Exercise Really Help!
30 minutes per day of exercise has been shown to prevent and help with depression in pregnancy. One 12-week study done at the University of Michigan, found that group yoga classes in pregnancy substantially reduced depression, increased mindfulness, and improved mother-child bonding after the birth!

6. See The Light
Bright light therapy can be helpful in brightening your mood. The usual dose is up to 10,000 lx for 30–60 min/day using a light box. One side effect is a slightly “hyper” mood – use for a shorter duration or every other day if you experience this. Even just sitting with your face toward a sunny window for 30 minutes each morning has been shown to improve mood.

7. Sleep Well … and Embrace the “Cat Nap” 
We don’t need to be rocket scientists to know that lack of sleep increases depression and irritability, makes us grab for quick sugary foods that later lead to a blood sugar crash, and generally rocks our boat. It also increases inflammation so our health takes some hits when sleep is poor. Since pregnancy naturally makes it harder to sleep due to our growing belly size and frequent need to pee in the night, taking cat naps in the day rather than pushing through or grabbing for sweets or caffeine is the healthy way to catch up on rest and nip depression in the bud.

8. Spend Some Time in Nature
It’s so easy to spend most of our time indoors and to forget how uplifting even a little bit of fresh air and sunshine can be. But getting even 15 minutes of fresh air each day can help us overcome the nature deficit disorder most of us suffer from, and with it, brighten our moods. Consider a brisk walk for the double benefit of fresh air and exercise for a better mood and even better sleep, or find a sunny spot for a quick mediation to brighten your day!

9. Use these Pregnancy-Safe Herbs and Supplements to Reduce Inflammation and Support Your Brain and Nervous System

• Omega-3 fatty acids: There is good evidence to show that many pregnant women are deficient in omega-3 fatty acids, and when maternal intake is low, so is the mom’s DHA level which can affects mood. Fish oil capsules (I recommend Nordic Naturals prenatal fish oil products) can be trusted to be mercury-free, and vegetarians can use a product such as Omega Twin by Barleans. I recommend discontinuing use 2 weeks prior to the due date because of a small but possible increased risk of bleeding while supplementing. Though this is likely overly cautious, and most evidence suggests no risk, many herbalists have reported observing bruising in clients taking 2 g or more/day. If you do discontinue it, simply resume a few days after birth to help prevent postpartum depression.

• Sam-E: A natural substance important for methylation, a process involved in making chemicals called neurotransmitters, which control mood, Sam-E has been well-studied and found to be safe in pregnancy. It should not be used in women with bipolar depression. A typical dose is 400 mg/day, but up to 800 mg (400 twice daily) may be needed for an optimal therapeutic effect. Rarely, it has been reported to cause mild gastrointestinal symptoms, sweating, dizziness, and anxiety.

• Folate: Important for preventing neural tube defects in our babies, folate is also important for a healthy nervous system. Taking folate does not in itself seem to improve prenatal depression, but it does appear that women who have adequate folate intake respond better to treatment with antidepressant medications. It may also have protective effects against autism in our babies. I recommend 800 mcg – 2 mg of methylfolate daily, ideally starting 3 month prior to pregnancy, or at any point that you realize are pregnant.

• St. John’s Wort: While the data is limited, and more studies are needed, especially given uncertainty over the safety of conventional antidepressant medications in pregnancy, studies on the effect of prenatal consumption of St. John’s wort on pregnancy in mice and rats were generally associated with normal gestation and offspring development. A limited number of human case reports indicated healthy pregnancies and infants when St. John’s wort was used prenatally. A standard adult dose is 300 mg 2-3 times/day, of a product standardized to 0.3% hypericin.

• Probiotics: Increasing evidence suggests that disrupted flora can contribute to a disrupted mood, including depression and anxiety. Studies have shown that eating live active cultures such as found in yogurt can improve women’s moods! I extend this to fermented foods in general, such as sauerkraut, kimchee, and miso.  A good probiotic can also do the trick!

Check with your midwife or doctor before using if you are already on a medication or if you have any medical problems related to pregnancy).

10. Call on a Pregnancy Natural Medicine Expert
If after a couple of weeks of incorporating a combination of the above strategies you’re not noticing any improvements, this is a good time to consult with a medical provider who specializes specifically in the functional medicine, naturopathic, integrative, or mental health care of pregnant women. While self-care is the cornerstone of health, greater health challenges can be best addressed with a supportive, knowledgeable team.

Now it’s your turn to share! If you suffered from depression in a past pregnancy, what helped you to cope or heal? What do you wish someone had told you while you were pregnant that you can share as inspiration for other women?

Want to learn more about natural care for yourself during your pregnancy and beyond? You’ll love the down-to-earth nature of The Natural Pregnancy Book, and for after baby – Natural Health After Birth. They also make great gifts for other pregnant women in your life!

With love and compassion,

Aviva

References

Benard, A. et al. The risk of major cardiac malformations associated with paroxetine use during the first trimester of pregnancy: A systematic review and meta-analysis. British Journal of Clinical Pharmacology.doi: 10.1111/bcp.12849.

Freeman, MP. (2009). Complementary and alternative medicine for perinatal depression. Journal of Affective Disorders, 112: 1–10.

Hogg K, Price EM, et al. (2012). Prenatal and perinatal environmental influences on the human fetal and placental epigenome. Clin Pharmacol Ther, 92(6):716-26.

Misri, S and S Lusskin. (2013). Depression in pregnant women: Management. http://www.uptodate.com/contents/depression-in-pregnant-women-management?source=see_link

Muzik, M et al. (2012). Mindfulness yoga during pregnancy for psychiatrically at-risk women: Preliminary results from a pilot feasibility study. Complementary Therapies in Clinical Practice, 18:235-240.

Romm, A. (2014) Uncovering and Treating Depression during Pregnancy. Alternative and Complementary Therapies. In Press.