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    The Pre-Partum Blues

    If you're battling depression before the stork has even made its delivery, you're not alone, says new research.

    In fact, suffering from depression during pregnancy is even more common than battling the blues once the baby is born, says a study in the Aug. 4 issue of the British Medical Journal.

    According to the principal investigator, the findings call for more research into a neglected subject that has been deeply shrouded in stigma.

    "The understanding -- at least in the public mind, and to an extent, in many health professionals -- is that postnatal depression is a particular depression," says Dr. Jonathan Evans, a consultant senior lecturer in psychiatry at the University of Bristol in Bristol, England. "In trying to see what was particular about postnatal depression, we found that in fact, depression was more common during pregnancy than following childbirth."

    To find out whether its characteristics were unique, the researchers turned to data from a larger study of 14,541 women in Avon County, England, who were expected to deliver a child between April 1, 1991 and Dec. 31, 1992. Of those, 13,799 had a child that survived at least one year postpartum; 9,028 of them finished the questionnaires.

    They filled out the questionnaires at eight weeks and 32 weeks during the pregnancy and at eight weeks and eight months after birth.

    Evans and his colleagues found that 88 percent of women had higher depression scores at 32 weeks of pregnancy compared to eight weeks after birth. At 32 weeks, 13.5 percent of the women scored above the diagnostic threshold for probable depression, compared to 9.1 percent at eight weeks postpartum and 1.6 percent throughout.

    Between 18 weeks and 32 weeks of pregnancy, more mothers scored at higher levels of probable depression that between 32 weeks of pregnancy and eight weeks after birth.

    Moreover, the symptoms were remarkably similar. "It doesn't seem to be different in any way," Evans says, adding that depression after childbirth doesn't appear to last any longer than depression during pregnancy.

    "A lot of clinical effort has gone into recognizing and treating depression postnatally. A lot of research effort has gone into ways of trying to screen for depression and identify it postnatally," says Evans. "But what has been relatively neglected has been depression during pregnancy."

    "Depression during pregnancy may be as important as depression postnatally and needs to be researched further," he says, adding that doctors and patients need to recognize depression during pregnancy.

    "It's not surprising to be depressed during pregnancy. One's not weird or different or odd to have depression in pregnancy; in fact, it's remarkably common." Evans adds that these findings should help destigmatize depression both during or after pregnancy.

    Dr. Lee Cohen, director of the Perinatal and Reproductive Psychiatry Program at Massachusetts General Hospital in Boston, says that although the study used a screening method rather than a diagnostic tool to measure depression, the massive size of the study makes it a valuable contribution.

    "There's clearly a stigma associated with depression," says Cohen. "As with the postpartum period, I think there's sort of fantasy or myth that [pregnancy is] all going to be good. That it's all about pastel and pink. And it's not."

    "This has got to be the platform for investigation of how to effectively treat depression during pregnancy," he adds. Women can be treated without drugs, using psychotherapy, especially for milder cases of depression. In more severe cases, certain types of antidepressant drugs are relatively safe for pregnant women.

    The researchers don't yet know whether there are any particular factors, such as whether the pregnancy is unplanned, whether it is a teenage pregnancy or whether the mother has had previous miscarriages, that put a mother at increased risk for depression during pregnancy.

    However, Cohen says that the history of depression is the strongest risk factor for depression during pregnancy.

    Evans and his colleagues hope to study depression during pregnancy in greater detail, including its consequences.



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