Tuesday, August 7, 2012


On Prenatal Depression

Hairpin pal Jessica Grose has written a two-parter on prenatal depression: part one, part two.

46 Comments / Post A Comment


Ooh, excellent. I read Part 1 yesterday. I'm sure it goes without saying, but...don't read the comments.


@Ophelia Yeah, those people are crazy and mean. I got to the part about how bad her morning sickness was and was like OF COURSE you were depressed. I don't have a history of depression, but if I wanted to constantly vomit, I would spiral pretty quickly.


@OhMarie A friend of mine had horrible morning sickness during all of her pregnancies, and had to push her doctor to give her heavy doses of anti-nausea pills (the kind that chemo patients take). She said that it changed her life, and she tells all of her girlfriends about it, because that's something that you don't get unless you ask for it. Too many doctors are just like "morning sickness is normal!"


@Ophelia - I got to the one that said, "This is XX. Emotion is what drives the articles," and I was done. (Oh yeah also all the comments accusing her of "having an agenda." HELLO YES OF COURSE BECAUSE WHEN YOU WRITE SOMETHING YOU WANT TO CONVINCE PEOPLE OF SOMETHING. EVERYONE ON THE INTERNET HAS AN AGENDA INCLUDING YOU, ANONYMOUS COMMENTER.)

Sorry for yelling. Obviously I am putting way too much energy into this. Pardon me while I go sit in a dimly-lit room for a few minutes.


@Ophelia Yeahhhh I read some of the comments and was all "I need to stop assuming that the rest of the internet is like the hairpin because actually people are terrible."


This was so gorgeous!@n


Dooce wrote openly about meds in pregnancy too.


Also, can we talk about "This is partly because they’re not thoroughly informed about them and partly because their bias remains to protect the fetus first and the mother second. “An obstetrician’s job is to protect the pregnancy, to have the healthiest full-term baby,” Fitelson says."

Because that's bothering me a WHOLE LOT. And I'm kind of surprised that's stated as fact? I'm sure there are some people who bring that bias to their job, but is that really The Job of an obstetrician?


@Ophelia I have zero experience with obstetricians, but I'm also really curious about whether this is an accurate statement.


@PatatasBravas Ditto. There must be an OB in the audience, yes?


@Ophelia ASK A MEDICAL PROVIDER WHERE YOU AT. I texted my friend in med school, but that's about it for my knowledge.

fondue with cheddar

@PatatasBravas Ask Lola! lola@thehairpin.com


@Ophelia This is just my experience as a patient, but I am quite sure that this statement is inaccurate for all but the most horrible, unhelpful OBs. My doctor supported and cared for me *and* my daughter when I was pregnant. It's not an either/or situation.

Electric Mayhem

@Ophelia Hi there! I'm an Ob/Gyn - great question. Actually, our responsibility as obstetricians is to protect both patients - the mother and the fetus. We balance the risks and benefits to both, and most (but not all) of the time, their interests are aligned. Whenever possible, we opt for medications/treatments that don't harm the fetus, and if there are potential risks to the fetus, we discuss with the patient.
However, in the case of a crisis (eg. medical emergency, unconscious patient), our first priority has to be the mother, and second priority the fetus. This is for obvious reasons - ie. if the mother doesn't survive, then the fetus can't. But it's also for important ethical reasons - so that women aren't considered merely vessels of reproduction, and so that women aren't denied adequate medial treatment just because they are pregnant.


@Electric Mayhem Thanks so much for the answer! You sound like a marvelous human being and a great doctor.

Electric Mayhem

@PatatasBravas Aw, thanks! My mom agrees with you.


@Electric Mayhem Ditto! That was a much more rational explanation! :)


@Electric Mayhem You are fabulous, and I feel much happier that you are out there doing what you do. :)


"In her memoir Love Works Like This, the journalist and psychologist Lauren Slater talks about her bout with prenatal depression, and writes that a specialist once told her that there’s a correlation between women who react badly to the birth control pill and women who become depressed during pregnancy."

Well, fuck.

In other news, this is really excellent.

sarah girl

@TheBelleWitch Oh man, I am fucked.

Judith Slutler

@TheBelleWitch @Sarah H. Yeah I was definitely like, ok I should be filing this info away for future reference. Basically I have every risk factor she named!


@Emmanuelle Cunt
Me too. I've already thought about this in regards to postpartum depression. Because history of depression? Yep. Bad reactions to HBC? Yep. But I've never heard of prenatal depression before so I really appreciate the article. Knowledge is power and all that.

I wonder how the experience with prenatal depression is different if one goes in all, "I have all these risk factors. This may become a problem. Let's get some systems set up before it reaches that point."


@TheBelleWitch Birth control makes your body think it's pregnant already, right? I guess that's how it works.


@Susanna It uses the same hormone--progesterone--as your body produces during pregnancy, but in a very different dose.


@TheBelleWitch HBC turned me into a sobbing, unbalanced mess, but I was, at worst, weepy and sometimes nervous when I was pregnant. I wouldn't fret too much.


@MmeLibrarian Thanks! I had some pretty differing reactions to various HBCs so I can see how pregnancy would be its own animal. Good to hear about your experience. It's something that's nice to know, though, because I was frequently told by doctors while I was on HBC that my unbalanced-ness probably wasn't a side effect of the pill, and maybe did I just need a new boyfriend? I'd hate to be pregnant and getting that sort of response without realizing that prenatal depression does exist.


@Susanna Actually, HBC makes your body think it's already ovulated. Check out the graph of hormone levels on the Wikipedia "Menstrual cycle" article. After ovulation (but before you get your period), progesterone levels peak above everything else. When your progesterone levels are hanging out up there, your body doesn't release another egg. HBC basically keeps your progesterone levels up there all the time.

For some reason HBC is always explained as "Makes your body think it's pregnant!" (it was explained this way to me, too). But it actually doesn't work that way, and explaining it that way leads to a lot of associated misconceptions. (Like people thinking that if they're taking HBC, then they'll test positive on a pregnancy test, whether or not they're pregnant. PSA: This is not true. If you're taking HBC, pregnancy tests will give results as accurate as they would for someone not taking HBC.)

sarah girl

It sounds like psychiatrists are slowly starting to realize that the risks of being unmedicated are higher than the tiny risk of being on select drugs. I have a friend with severe (medicated) bipolar who is planning to try for a baby within the next year, and she is already working with her psychiatrist to transition to meds that are lower risk for pregnancy; when I have spoken with my psychiatrist about various drug options, he always includes the pregnancy risk level in his descriptions (I'm not trying for a baby anytime soon, but he knows it's a future prospect). Small steps, and I don't know how those doctors' opinions would mesh with the OBGYN's opinion, but - it gives me hope.

fondue with cheddar

@Sarah H. YES. My sister-in-law went off her anxiety meds for her first pregnancy and had a nightmare of a time. If I remember correctly, during the second pregnancy she switched to something else for the first trimester and went back to her usual meds through the rest of it, and it was much better.


Ohhhh, man, I am in the middle-- well, beginning-- of doing my dissertation research on this very topic, which means I've read just about every piece of literature out there. It is astonishing how much handwaving goes on about an area where the evidence is truly conflicting and complicated.


as per usual, the hairpin is one of the few safe spaces on the internet. I hate how this discourse surrounding pregnancy tells women how they are supposed to feel and that they are not good enough (kind of like the one that surrounds weddings, and, let's be honest, the everyday experience of being a woman)

fondue with cheddar

@robyn.andrews So true. I feel a strong desire to hug the entire Hairpin universe daily.


@robyn.andrews Oh yeah, I just blithely scrolled down to the comments out of habit over there and it took me less than one comment to remember that I was at Slate. I guess I thought Double X would be better somehow? Now I long for my naive, trusting self of 15 minutes ago.


@robyn.andrews I helped a friend who is pregnant dye some streaks in her hair, and I was telling someone (a dude someone) else about it, and they were like, "oh no! Dye is bad! Can't she just wait a few months?" and I just got full of so MUCH frustration. I got sort of inarticulate about it, but the older I get I just really feel the world needs to understand that women get to make their own specific choices It's not about universal uninformed OPINIONS on how to stay pure to make perfect fetuses! This is a friend who won't drink caffiene at all, and has gestational diabetes that she's managing very well, if she wants a tiny streak of red dye in her hair, that's up to her! If you want to keep your name or change your name or get married in or out of a church or eat sushi while pregnant with quintuplets or WHATEVER, that's YOUR LIFE. ugh. Mind your own business world.

glow bug

Man, I really needed this article! I am almost 5 months into my pregnancy and between 1 and 3 months I was in depression hell. Luckily it stopped before I went back on antidepressants (I gave it a two week trial and in week two the depression lifted), but it was pretty hellish for a while there.


"During your first trimester, the doctor tells Slater, you are getting the progesterone equivalent of 400 birth control pills a day."

EXCUSE ME? I cry at RIDICULOUS things when I forget a pill one day and have to double up on the next.


@itiresias Yeah, I am pregnant and that quote explained a lot.


@itiresias Also, I think perspectives like this can help dudes/future dads sympathize and understand better instead of being all, "Ladies be crazy right?!" The chemical breakdown lends a serious, more defined explanation. Then again, I believe in science.


Guys, these articles really scared me. (In part because I read the comments. Don't read the comments.)

I have depression and anxiety and PCOS and a propensity to develop large ovarian cysts if I'm not on the pill. And I lived with unmedicated depression and anxiety for years, and it was awful. I don't want to go back to that.

And I just turned 30, and I've been feeling more and more like I want to have kids, but I don't know how I can have kids and start my career at the same time (finishing up a Ph.D in the biomedical field now, planning to go into industry rather than academia). And I'm worried that IT'S ALREADY TOO LATE and I should have gotten married and pregnant at 22 (I was with my now-husband when I was 22, but we weren't ready to get married, much less have babies), and worried about how much time and money it will take to get pregnant with PCOS.

And now I have a WHOLE NEW issue to panic about -- if I do get pregnant, I'll hurting my baby by taking my antidepressant, and I'll be hurting my baby if I don't take it and get severely depressed because of hormones. And it all seems to add up to NO BABIES FOR YOU BECAUSE YOU ARE CRAZY AND BROKEN and that makes me want to cry.

Also, it seems like every lady I'm friends with on Facebook is having a baby, including the other ones doing advanced graduate degrees, so I kind of feel like a failure already because I'm not pregnant.

TL;DR I have many issues surrounding pregnancy.

(I'm not even going to start with my anxieties surrounding the idea of adopting. Finances, ethics, psychology.)

Electric Mayhem

@snowmentality Hi! Please don't panic. (I'm an Ob/Gyn). You have some important issues but these are not insurmountable. Find a good ob/gyn and a psychiatrist who will work together to determine the risks and benefits to you of continuing vs. stopping the medication. I can tell you that most of the time I continue pregnant women on psychiatric medication because the risks of stopping far outweigh the risks of continuing. When you are thinking of getting pregnant, see an obstetrician for preconception counseling. Find a good one who explains things and makes you feel comfortable. You should be OK. (And yes, even with PCOS you can get pregnant.)


@Electric Mayhem Awwww. Thank you. Hearing someone who actually knows their stuff say "Yes, issues, but not insurmountable issues" actually makes me feel a lot better.

I will try not to panic!


@snowmentality When I read this post I thought 'prenatal depression - do they mean how it feels to want to have a child but know you can't have one any time soon, while watching everyone around you have children?'. Because that is how I feel. And then I read the comments and felt mean because this is an important issue... but your comment made me feel a bit better because you expressed the same thing! I completely sympathise with feeling like a failure even though that is totally not true for both of us (and others), I'm sure. hugs.


@snowmentality hey, I have those things too! Except, also, I have a 13 month old son. I had some prenatal depression/anxiety, but acupuncture worked for me (seriously. I had been off paxil for a couple years when I got pregnant, so when the anxiety roared back I decided to try acupuncture first. And it was amazing).
Oh, and I thought it would take years, but my husband and I decided just to play it cool--very unlike us--and not plan or chart or anything like that and see what happened. (Because doctors make me crazy and there would be enough once I was actually pregnant) I got pregnant after about 11 months. We had decided after 12 months we would start charting (which PCOS makes, umm, hard) and possibly talk to my dr about clomid, etc.etc. But we didn't need any of that. And I'm 33 and had an incredibly easy pregnancy aside from the anxiety/depression, no PPD, and no trouble breastfeeding. An absolutely horrific birth experience, but the rest was awesome.
Anecdotally, thus, it is all possible without lots of time or expense!

Carrie W.

I'm done having kids and I wish I had known that prenatal depression existed. I'm 39 now and have four kids (ages 4-10). I joked about prenatal depression later, not realizing it was a real thing. Mine was very mild compared to what I read in the article. (I've never been on birth control pills, so I can't comment on that).

My symptoms were more feeling sad, overwhelmed, and angry. During the fourth pregnancy I yelled a lot at my children. I knew this had to be the last one because I didn't want my kids to have to deal with that. My husband was always calm and super supportive. Looking back, I doubt I would have been prescribed any meds because it was mild, but I wouldn't have felt so guilty about not being full of joy and bliss.

Of course I love all my kids and I'm glad I have them. But Ack! Pregnancy and breast feeding and no sleep and tantrums have taken their toll on me. There are stages in life, and young motherhood won't be considered my absolute favorite. But it does get easier! (Of course, I don't have teenagers yet, so I might be heading towards a trial there!)

Regina Phalange

I remember Jessica from her early Jezebel days - great articles, wonderfully written. My circle of friends are starting to have babies, and I sense that a lot of the mamas feel pressure to be the all-knowing, poised Madonna. I encourage them to vent to me if they need to, because frankly, that shit cray.

Deen Mohd Dar@facebook

I must say it is also known as postpartum depression or baby blues. Depression in pregnancy can be normal for some new moms, but after becoming a mom ppd will cause problems. I remember a article about prenatal depression in which have read a short information and came to know that it lasts for months. It is dangerous for a new mom to hide the truth because new mom can hurt her baby and can cause lot of problems. She can not concentrate and feel low mood etc. It is wired disorder and if it remained untreated can cause depression whole life.

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