The fetus is also affected

Sheila Marcus Photo: Martin Vloet

A recent U-M study of nearly 3,500 Michigan women revealed a troubling pattern of under-diagnosis and under-treatment of depression during pregnancy. Conducted by researchers from the U-M Depression Center, the study suggests that as many as one in five pregnant women may experience symptoms of depression during pregnancy, but few receive treatment for it.

“Doctors used to think of pregnancy as a ‘honeymoon’ away from depression risk, but this is turning out to be a myth,” says Sheila Marcus (M.D. 1983, Residency 1991), a clinical assistant professor of psychiatry at the U-M Medical School, who directed the study. “We now know that the hormones and brain chemistry involved in depression are affected by changes in other hormones related to pregnancy. And we know this can affect the fetus, also.”

According to Marcus, growing scientific evidence suggests that hormone imbalances associated with depression can adversely affect the fetus or put a woman at higher risk for postpartum depression. Fortunately, Marcus notes, recent studies have shown that some standard depression treatments — including some antidepressant drugs — do not appear to increase the risk of birth defects.

Explains Marcus, “We need to educate women about the signs of depression, and encourage them to be open about how they feel during pregnancy and after delivery, rather than feeling guilty and embarrassed.”

Recurrence of depression during pregnancy is a significant issue that deserves special attention, Marcus says. Because of depression’s cyclical nature, women who have had depression at any time in their lives may be symptom-free when they become pregnant. But data from the U-M study suggests they are twice as likely as other women to develop depression during pregnancy — and their increased risk of post-partum depression is well-known.

Twenty percent of the pregnant women in the U-M study scored high on a standard survey of depression symptoms, but of those, only 13.8 percent were receiving any mental health counseling, drugs or other treatment. Only about 24 percent of those who had suffered from depression in the last six months were being treated for depression during pregnancy. About half the women who were taking medications for depression before they became pregnant stopped once they conceived.

Many women believe that antidepressants are unsafe for pregnant women and fetuses, says Marcus. Some drugs — such as lithium, used to treat the bipolar form of depression — are indeed associated with an increased risk of birth defects. But no increased risk has been found with other drugs.

Studies show that babies born to depressed mothers have lower birth weights, higher risk of premature birth and birth complications, delayed cognitive and language development, and more behavioral problems, according to Marcus. Even minor depression, Marcus notes, may affect the fetus.

Marcus hopes the results of her study will help clinicians and women understand the importance of recognizing and treating depression in pregnancy. “Women with a history of depression should be targeted for more intensive assessment during early pregnancy,” Marcus says. “And clinicians should watch for depression in those who are not working, are unmarried, have health complaints, and those who use alcohol and cigarettes during pregnancy.”

In addition to Marcus, the study’s authors include Heather Flynn, Ph.D., a psychologist and member of the U-M Depression Center Women’s Mood Disorders Program; and Frederic C. Blow, Ph.D., and Kristen L. Barry, Ph.D., of the U-M Department of Psychiatry and the VA Ann Arbor Healthcare Center. The research was funded by the University of Michigan Health System.

—KG

For an expanded version of the story:
www.med.umich.edu/opm/newspage/2003/pregdepression.htm

Information on women and depression:
www.med.umich.edu/womensguide/pages/23.html

U-M Depression Center:
www.med.umich.edu/depression