Pregnancy is a major life event. While generally a happy one, mood changes are normal and women can feel alternatively anxious or depressed about the coming baby. Women who have had an anxiety disorder or major depression prior to their pregnancy may be at risk for a worsening of symptoms, a continuation of their symptoms or, in a small number of women, an improvement in their symptoms during the pregnancy as well. Anxiety and depressive disorders may also appear for the first time during pregnancy.

While it is normal to be occasionally fearful or anxious about inevitable changes a new baby will bring, it is not normal to feel like Linda, a 30-year old massage therapist who towards the end of her first trimester, developed clear signs of depression - early morning wakening, difficulties sleeping, concentrating and eating, major-league fatigue and extremes of mood. With a strong family history of depression, these feelings were not totally unexpected; being severe, Linda was treated with antidepressant medication which she was able to discontinue towards the end of her second trimester.

Fortunately, she remained well and was not depressed for the rest of the pregnancy. However, following the birth of a healthy baby, Linda developed full-blown postpartum depression, for which she was again treated with antidepressant medication for some six months. Although thrilled with her new baby, Linda decided against going through another pregnancy which might again be shadowed by depression, a personal decision that can be difficult to make.

In point of fact, major depression is not that common during pregnancy, affecting somewhere between 4 and 12% of women. If it does occur, symptoms are most likely to develop during the first three and the last three months of a pregnancy, with the second trimester generally being a happier time. Women can also develop severe anxiety for the first time during pregnancy. Because symptoms of anxiety and pregnancy can share similar symptoms, separating out which feelings are related to an anxiety disorder and which are related to pregnancy can be challenging.

Exaggerated feelings and symptoms which impair function are more likely to be related to an anxiety disorder, and less likely the result of pregnancy, however. Signs of an anxiety disorder during pregnancy include a churning stomach and nausea, rapid heartbeat, dizziness, feelings of tingling and numbness in the hands, shortness of breath, crushing sensations in the chest, and a sense that something terrible is about to happen.

These symptoms clearly can make any pregnancy difficult. Without treatment, they are also likely to recur, and women who experience anxiety during their pregnancy should seek medical help.

Treatment During Pregnancy

It is probably best to avoid any medication out of concern for potential drug effects on the developing infant, at least during the first trimester of pregnancy. This is a very personal decision, however, and if a woman is in acute distress, treatment with the appropriate medication may be necessary. Some antidepressant medications also would appear to be safer to use during pregnancy than others, and women who require medical therapy should discuss this with their doctor. Behavioral therapy may help some women learn better coping strategies until such time as medication is safer to take, should it be necessary. (See Medication in Pregnancy and Breastfeeding for more information).

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