Pregnancy Blues: What Every Woman Needs to Know about Depression During Pregnancy
By Shaila Kulkarni Misri, M.D.
Before we discuss how and why depression is likely to affect women both during pregnancy and in the postpartum period, it's important to understand that, in general, women are statistically more likely than men to experience a major depression at some point in their lives, and particularly during their reproductive years. A recent article in a prominent medical journal referred to depression as a modern version of the bubonic plague. Unlike the plague, depression is not a contagious disease, and yet it plagues a staggering number of people, the majority of whom are women.
The statistics alone are overwhelming. The World Health Organization has determined that depression affects approximately fifty million people throughout the world. More than 15 percent of the population is afflicted with this illness and a large proportion with its associated disabilities.
Major depression, as defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM-JV-TR) of the American Psychiatric Association, is the most common of all the psychiatric disorders; with the exception of high blood pressure, it is the condition most commonly encountered by family physicians. Depression is the cause of more functional impairment and poorer quality of life than diabetes, heart disease, or high blood pressure. Is it surprising, then, that depression has a worse prognosis than any medical disorder except advanced coronary artery disease? In fact, IS percent of people diagnosed with depression ultimately commit suicide.
For women in particular, the statistics are even more devastating. The prevalence of depression in women is about 20 percent as opposed to 10 percent in men, according to the National Comorbidity Survey. In other words, women are twice as likely as men to suffer from depression, and in the United States specifically the lifetime rate of risk for depression is 1.7 to 2.4 times greater for women. In 1990 the World Health Organization found it to be the leading cause of disability in women of childbearing years.
Medicine has made great strides in recent years, discovering the causes of, curing, and even wiping out various diseases, but despite the shocking numbers recorded for depression, until 2002 the U.S. Preventive Services Task Force and the Agency for Healthcare Research and Quality didn't even recommend screening for depression because its symptoms were so amorphous and its incidence did not seem sufficient to warrant the outlay of public funds.
Depression Is Insidious
Amorphous or nebulous as its symptoms may he, at least at the outset, depression is also insidious. It you break a bone or scald yourself with boiling water, there is immediate acute pain, and the source of that pain is instantly apparent. Depression, however, doesn't present itself with such obvious and immediate symptoms. Rather, the mental and physical changes it causes creep up gradually, sometimes over a period of years, eating away at and eroding one's quality of life, and very often the person who is suffering is the last to recognize what's happening to him-or more likely, her
When she came to see me, Nora was twenty-three years old and contemplating her first pregnancy. Her mother, a high school teacher, was there to support her on this visit. A lovely green-eyed, raven-haired young woman, Nora remembered having felt "blue" and missing school as far back as when she was just fourteen years old. Her mother, who was an intelligent and rational woman who had modeled the value of education through her work, simply couldn't understand why her daughter, of all people, wouldn't want to go to school. Of course, she had tried to reason with Nora (reason, after all, was the only way Nora's mother knew to approach problem solving), and after that, Nora did go to school, but she spent her days roaming the halls and visiting with friends, not attending classes. Her mother was shocked and felt completely helpless when, at the end of the year, the principal informed her that Nora was being left back because she'd missed so many classes.
At that point, the only way Nora's mother was able to cope with the situation was not to deal with it at all, so she shut herself oft from her daughter completely. And Nora's father, a salesman who spent much of his time on the road, remained totally clueless about what was going on at home.
When school began again the following fall, Nora didn't even have the energy or wherewithal to pretend she was going to class. She spent most of her days in bed sleeping and found it difficult to complete even the simplest of tasks. Not until then did Nora's aunt insist to her parents that this was clearly not normal behavior for a fourteen-year-old girl and that Nora desperately needed professional help.
What's particularly sad to me about Nora's story is the fact that her condition had to deteriorate to the point where she was virtually nonfunctional before anyone intervened. It her pain had been physical rather than emotional, her mother would certainly have taken action, but because her symptoms were so difficult to pin down, and because she herself was incapable of articulating what she was feeling, Nora lost a significant portion of her defining adolescent years to her undiagnosed depression. Now she wanted to be certain that it her depression returned during her pregnancy, she would be able to recognize its symptoms so that she could start treatment as soon as possible.