Until the 30th week, Suzanne Sevlie's second pregnancy had been progressing well and she was happy and healthy. But in the final weeks of her pregnancy, a close friend's death left Sevlie depressed and frustrated with her inability to connect with her unborn child.
"I thought I just don't feel right. I don't feel like I'm happy," Sevlie said. "There was a point where I literally felt like I wanted to cut my stomach out because I was so detached from the baby at that point."
Sevlie had experienced depression once before when she was 15, for which she received medication and counseling. But after high school and through her first pregnancy at age 23, Sevlie had no mental health issues. Her depression during her second pregnancy was a development she would not accept.
"I didn't take [medication] when I was pregnant because I didn't know there were any options," said Sevlie, whose obstetrician recommended monitoring when she told him how she felt. "I knew once the baby came I could do that if I wanted to... But I knew that if it got out of control it could have an effect on the baby and my family. I thought: this is not happening!"
Having depression during pregnancy puts everyone, from parents to clinicians, in a precarious position. Depression can be harmful to a mother and her developing baby. But taking antidepressants also pose risks since a fetus can be affected by any substance a mother introduces to her body.
Past guidance on depression during pregnancy has been mixed, with obstetricians and psychiatrists often offering conflicting advice on management. But a new report that combines recommendations from obstetricians and psychiatrists may mean that women are poised to receive better prenatal mental health care.
Today, the American Psychiatric Association and the American College of Obstetricians and Gynecologists released a collaborative report that sums up past research and is the first to offer concrete guidelines for treating depression in pregnant women. The report was co-published in the journals Obstetrics and Gynecology and General Hospital Psychiatry.
"[The report] is an excellent synthesis of what is known in the literature to date about the risks of both mood disorders during pregnancy and the risks of using antidepressants," said Sheryl Kingsberg, chief of the Division of Behavioral Medicine at University Hospitals Case Medical Center. "The basic guidelines have been to make the decision on an individual basis and to recognize that non-treatment of depression is not benign. I think it provides the 2009 update that has been needed."
Between 14 and 23 percent of pregnant women experience depression during pregnancy and, as of 2003, 13 percent of pregnant women took antidepressants to combat the illness.
Based on criteria such as the severity of depressive symptoms, past success with psychotherapy and the patient's desire to be on medication, the report provided guidance on evaluation and treatment options for women with depression who wish to conceive or who are already pregnant.