In May when I found out I was pregnant, I was absolutely ecstatic. But by June something in me had come undone. Within days, I’d gone from happy to utterly hopeless. All of a sudden, brushing my hair, changing out of pajamas, or seeing people felt like a huge task. I spent most of the day in bed, my mind blank. The few thoughts that did sneak in were dark, frantic, and anxious.
Initially, when the women in my life who had been pregnant before told me that my low mood, fatigue, and near-constant stream of tears were par for the course in the first trimester, I believed them. Still, there was a hollowness inside me that just didn’t feel right. It was as if my emotions were flatlining.
The emptiness was bad enough, but what truly terrified me was that I’d gone from caring deeply for the rapidly blossoming being inside of me to thinking thoughts I was too ashamed to say out loud. One day I locked myself in the bathroom and dialed the National Suicide Prevention Hotline.
I hung up before the line connected, the very act of dialing shaking something inside of me. It was a turning point: Whatever was causing the hole inside of me wasn’t just a fleeting case of pregnancy blues. I knew I was in trouble.
I told my partner and my family how I had been feeling, and within days of calling the suicide hotline, I was booked in to see an obstetrician who told me I had prenatal depression. I felt some relief to know there was a name to what I felt—that it wasn’t my fault—but mostly I was confused. I had heard plenty of stories of women battling anxiety or depression after giving birth but had never heard of it happening during pregnancy.
Ironically, my diagnosis gave me more hope than I’d felt in weeks: I hadn’t done anything wrong nor was I necessarily doomed to be an unfit mother. I could get help.
Prenatal depression (also known as antenatal depression) is a type of clinical depression that affects women during their pregnancy. According to the American College of Obstetricians and Gynecologists, somewhere between 14 and 23% of women will struggle with symptoms of depression during pregnancy.
Some of the common symptoms associated with prenatal depression include persistent sadness, difficulty concentrating, sleeping too little or too much, anxiety, feelings of guilt or worthlessness, a loss of interest in activities that you usually enjoy, and recurring thoughts of death, suicide, or hopelessness. Because a lot of these symptoms are chalked up to hormonal imbalances associated with pregnancy, prenatal depression frequently goes undetected or undiagnosed.
Because I had previously experienced a depressive episode and because I had recently felt low enough to call the suicide hotline, my obstetrician felt my depression was on the more severe end on the scale. She referred me to a perinatal psychiatrist (someone who specializes in prenatal and postpartum depression) and gave me the option to start an antidepressant.
The decision to start antidepressants during my pregnancy was deeply complicated.
Our society has a rigid ideal of what pregnancy should look and feel like. In what has been dubbed the Goddess Myth, we are repeatedly told that not only should our skin glow and our hair shine but that breast is best and that we should only want a vaginal delivery. Mommy bloggers and well-meaning neighbors are there to remind us that for the next nine months our bodies are sacred temples. We give up coffee, sushi, and alcohol. Switch to organic foods. Scour the ingredient list of any new skin care product. How, in the midst of all this, does a pregnant woman willingly start taking a drug?
Research on the subject has historically produced some scary findings. Selective serotonin reuptake inhibitors (SSRIs), the type of drug typically used to treat depression, have been associated with an increased risk of certain birth defects. But many of these older studies compared pregnant depressed women who are taking antidepressants to pregnant women with no history of depression, which is “like comparing apples and oranges,” says Pooja Lakshmin, M.D., a perinatal psychiatrist and clinical assistant professor at the George Washington School of Medicine.
But newer studies are more nuanced, finally comparing results using the right control group—pregnant women with depression who take antidepressants versus pregnant women dealing with untreated prenatal depression. In 2015 the Centers for Disease Control and Prevention did a critical review of past studies and added new research. They found that while some antidepressants can increase the risk of birth defects, the overall risk is “very low.”
On top of that, recent research has found that not treating depression during pregnancy can also be harmful. “People are so worried about harming the baby with meds. But if you have prenatal depression and you don’t treat it, you can still cause harm,” says Lakshmin. “Either decision comes with a risk.”
Untreated prenatal depression actually mirrors some of the same risks previously thought to be associated with taking meds for depression, such as preeclampsia, low birth weight, and preterm delivery. Additionally, untreated prenatal depression can limit a woman’s ability to self-care, eat well, and keep up with doctor visits—all things that studies show to be disruptive to maternal bonding and potentially harmful to the baby for years to come. “Women with prenatal depression are at risk for future depressive episodes, and a lot of research shows that their parenting skills are negatively impacted,” says Darius Tandon, Ph.D., a psychologist and principal investigator for multiple Mothers and Babies projects, an evidence-based program that aims to prevent postpartum depression. “There is evidence of negative outcomes not only in the first year of life but persisting into toddlers and school-going age or even into adolescence.”
The Stigma of Being a Medicated Mom
The good news is that prenatal depression is very much treatable. The bad news is that many women forgo treatment because they can’t get past the stigma of seeking help.
Even after learning about the risks of going unmedicated, it still took me a few days to fully accept that I was very much clinically depressed and very much in need of treatment. The stigma surrounding antidepressants remains so strong. “There’s a general stigma with taking antidepressants at any stage of life, but in pregnancy this stigma increases since women are already in such a vulnerable state,” says Lakshmin. “Most women are really afraid of doing anything that could harm their babies. Our culture puts a lot of pressure on expectant mothers to be perfect.” I’d always imagined my pregnancy would be blissfully happy—an image reinforced over and over again by my social media feed full of glowing friends in flowy, chiffon dresses softly cupping their bellies for Pinterest-worthy pregnancy photoshoots.
It’s comforting to know that I’m not the only one who feels ashamed. A woman I know recently told me that when she was pregnant, her mind was in a particularly dark place but she feared that telling someone she felt depressed could result in her baby being taken away when he was born. For months she resisted medication because she thought that being a medicated mom equalled to being a bad parent. She has since started medication but is too ashamed to tell her in-laws, and she has gone from wanting multiple children to writing off any future pregnancies.
I have no doubt that deciding to take antidepressants saved my life. Within a couple of weeks of starting an SSRI, I felt dramatically stabilized.
But even though being on medication has generally made me feel more positive about pregnancy and capable of parenting, depression is a demon that leaves behind lingering feelings of inadequacy and guilt. Before every ultrasound appointment, my heart seizes with the fear that something will be wrong, something that I caused. And as my due date gets closer, my fear of relapsing into depression increases.
That fear isn’t entirely unfounded; with each episode of depression, there is an increased likelihood of another one. One depressive episode increases the risk of another one by 50%, two to 70%, and three episodes to 90%, says Sudeepta Varma, M.D., a psychiatrist and assistant professor at NYU Langone Medical Center in NYC, which is why she thinks pregnant women with prenatal depression should be continuously monitored. “Having partner support or family and community support is key,” she says. “So is having a game plan for after the delivery.”
Because of my history with depression, I’ve been warned that I am at a high risk of postpartum depression. This is another reason why, along with regular obstetrician visits, I see a perinatal psychiatrist monthly. And because my depression left me feeling untethered and anxious, I have to continuously take steps to alleviate my anxiety. Some days that means forcing myself to do prenatal yoga. Other times it means creating lists of things to get done before the baby (like scheduling a tour of the hospital I plan to deliver at because having that little bit of control can make all the difference to an anxious soul like me).
Even on medication, I still have the occasional bad day. But even the worst of days is nothing like that dark pit of despair I found myself in at the start of my pregnancy. As I write this, I am seven months pregnant. I take an antidepressant daily, and there is no doubt in my mind that this little white pill saved me and my unborn baby’s life.
Maria Kari is a freelance writer and immigration lawyer. She infrequently tweets at @mariakari1414.
Originally Appeared on Glamour