The American College of Obstetricians and Gynecologists (ACOG) states that pregnant women with mild to moderate depression should seek therapy and support first, especially in the first trimester. Then, if that’s not effective, discuss adding an antidepressant, says Diane Sanford, Ph.D, author of Life Will Never Be the Same: The Real Mom’s Postpartum Survival Guide (Real Moms Ink).
The current advice for the many women with major symptoms who are already on antidepressants when they become pregnant is to stay on their medication. “We do not recommend that women with severe depression go off their medication—unless it is known to be hazardous to their babies, as certain bipolar medications are,” says Sanford. Studies show that almost all such women who discontinued their medication relapsed by their third trimester, putting them at an increased risk for PPD.
To help keep depression at bay, exercise regularly and get enough sleep, which is crucial in how well you respond to any treatment, says Flynn. You can also undergo acupuncture: A recent study found that 63 percent of women who had major depression during pregnancy experienced a 50 percent or greater reduction in symptoms after acupuncture treatments, compared with 44 percent of women who received sham acupuncture or got massages. Several studies have also shown that omega-3 fish oils can be effective in easing depression.
BODY IMAGE GONE AWRY
“I automatically went back to the one thing I could control—food and my body. All those old obsessive-compulsive voices came back strongly.” Ann Marie Hopwood, 34, had struggled with anorexia on and off for 20 years, and the worst of it—carrying a mere 63 pounds on her 5-foot-6-inch frame—was behind her. She was up to 113 pounds, newly married and had just gotten her master’s degree in counseling so she could help others with eating disorders. And then, despite her thinness and many months of missed periods due to her anorexia, she got pregnant.
“I was a new wife and starting a new career and [being pregnant] was going to change my whole perception of who I was,” says Hopwood, who lives in Omaha, Neb. “So I automatically went back to the one thing I could control—food and my body. All those old obsessive-compulsive voices came back strongly.”
In her first trimester, between morning sickness and her anorexia, Hopwood lost 5 pounds. “It was a daily struggle to eat enough,” she says. She kept her eating disorder secret from friends, but her husband supported her through the pregnancy and made her promise to gain weight. “He checked in every day to make sure I was eating,” she says. She also self-treated with reiki, an energy healing technique, and turned to prayer for strength.
In the second trimester, with much effort, Hopwood managed to eat about 1,200 calories a day, still far below the 2,300 calories recommended for the average pregnant woman. Making matters worse, she over-exercised to burn calories. But by the end of her pregnancy, she had gained 17 pounds. Her son was born two weeks early, but healthy. Immediately after his birth, though, Hopwood lost 25 pounds and developed postpartum depression. She reluctantly started taking an antidepressant, which she says helped immensely.
Hopwood is currently breastfeeding and is worried about the possible weight gain when she stops. But she’s trying not to obsess about it. “It helps being a role model, knowing that I have this little boy to take care of, and I have to be alive and healthy for him,” she says.
Why it happens} Pregnancy taps directly into the very issues that contribute to eating disorders—concerns about weight gain, changes in body shape and a loss of control over what’s happening to your body and your life. But these disorders, which include anorexia (extreme weight loss, often achieved by starving yourself), bulimia (binging and purging) and binge eating often go undiagnosed during pregnancy.
While up to 4.5 percent of pregnant women have diagnosed eating disorders, the actual numbers are probably much higher because so many cases are undiagnosed or unreported. The good news is that between one-quarter and three-quarters of women who have a pre-existing eating disorder “get better” during their pregnancy; the bad news is that up to half relapse after delivering.
The signs} An increased focus on body shape and weight or a seriously negative body image and negative self-talk; inability to admit that you’re hungry or your eating habits have changed (including binge eating or extreme dieting); using laxatives, purging or exercising more than an hour a day specifically to burn calories. You can find self-tests like this one online: psychcentral.com/quizzes/eat.htm.
Who’s most at risk} Women who’ve had any of the symptoms described above, even if they were never officially diagnosed or treated for an eating disorder; those who are anxious about how their body will change during pregnancy; pathological dieters (about one-quarter of such women develop an eating disorder).
Risks of not treating} Increased risk of miscarriage, preterm labor, Cesarean section, intrauterine growth restriction, postpartum eating disorders and depression; having a low-birth-weight baby or one with low APGAR scores, respiratory problems, delayed development and disturbed feeding behaviors.
What works} Cognitive behavioral therapy (CBT), which helps you work through negative thoughts and destructive behaviors, offers the quickest response for eating disorders. Dealing with long-term issues, such as poor self-esteem or chronic perfectionism, will take more time to address, says clinical psychologist Sari Shepphird, Ph.D., an expert on eating disorders and author of 100 Questions and Answers about Anorexia Nervosa (Jones & Bartlett Learning). Experts recommend tackling the most harmful symptoms first. “For example, addressing such extreme behaviors as purging and laxative abuse is key,” says Shepphird.
Taking medication to treat eating disorders is not typically recommended during pregnancy because CBT is so often effective. It’s also helpful to practice relaxation techniques like deep breathing and yoga, and to join a support group, as women with eating disorders tend to isolate themselves because of shame and embarrassment.