“I was always looking for subtle cues, like when the doctor said, ‘Everything’s OK right now,’ I’d think, ‘But what about tomorrow?’ ’’ A few weeks after she found out she was pregnant, Rebecca Thomas, 29, of Detroit started to feel paralyzing fear. “I was afraid to move the wrong way, change the sheets, to exercise,” she says. Before the pregnancy, she’d worry from time to time, but she had never had anxiety grip her like this. “I remember one evening I didn’t move at all because I thought if I didn’t move, I could keep something from going wrong,” Thomas says.
There was nothing high risk about her pregnancy to trigger the anxiety, and no amount of reassurance from her doctor made her feel any better. “I was always looking for subtle cues, like when the doctor said, ‘Everything’s OK right now,’ I’d think, ‘Right now it’s OK, but what about tomorrow?’ ” Thomas never sought help because she thought these were normal pregnancy fears, so she just suffered through her pregnancy, unable to enjoy any of it.
After Thomas gave birth to her daughter, the anxiety remained; even worse, she developed postpartum depression on top of it. “I had fears I would do something wrong with the baby, and then I began to feel that I didn’t fit in anymore socially or that people were talking about me behind my back,” she recalls. When her daughter was about 4 months old, Thomas finally reached out to a therapist for help.
Thomas became pregnant again about a year later, and recognized feelings of depression at about 16 weeks. She waited another month to talk to her doctor, who gave her a prescription for the antidepressant Lexapro. It still took her a few more weeks before she used it.
“At some point I decided that I didn’t want to not enjoy another pregnancy, so I filled the prescription,” she says. Thomas began to feel much better and sailed through the rest of her pregnancy. “I wish I had taken it even sooner,” she says.
Why it happens} Almost every pregnant woman has moments of worry about her developing baby, especially when it’s time for prenatal testing. But for some women, the fears are constant and affect their ability to function normally. The stress hormone cortisol and other hormones that increase during pregnancy may be associated with the surge in both anxiety and depression. Experts believe that anxiety disorders are at least as common during pregnancy and postpartum as depression, possibly even more so, and the two often go hand in hand.
The signs} Anxiety that is persistent, intrusive or out of proportion; irritability; inability to sleep because of fears; waking up with a racing heart; difficulty concentrating.
Who’s most at risk} Women who have experienced anxiety or depression in the past.
Risks of not treating} The elevated cortisol is thought to affect a baby’s developing nervous system, says Tom O’Connor, Ph.D., a professor of psychiatry and psychology at the University of Rochester Medical Center in New York. Children whose mothers experienced higher levels of stress during pregnancy tend to have poorer cognitive functioning, are more reactive or more fearful, or have more behavioral problems like attention deficit or hyperactivity than children of mothers who were less stressed while expecting.
What works} Cognitive behavioral therapy can be very effective in reducing anxiety, especially when the therapy focuses on teaching relaxation and coping skills.
Some of the same SSRI medications that are prescribed for depression are also used to treat general anxiety disorder, but women should talk to their doctors about their risks and benefits. Calming drugs like benzodiazapenes are typically avoided during pregnancy because of known risks to the fetus.