Growing a baby is hard work.
Your body will go through a lot of changes as your baby grows and your hormones change.
Pregnancy is supposed to be one of the happiest times of a woman’s life, but for many women this is a time of confusion, fear, stress, and even depression.
Listen in as Dr. Steven Bergin discusses depression during pregnancy.
Selected Podcast
Depression During Pregnancy
Featured Speaker:
Steven C Bergin, MD
Dr. Steven Bergin's special Interests are routine and high-risk pregnancies, urinary incontinence, pelvic floor reconstruction, and comprehensive women's health. Transcription:
Depression During Pregnancy
Melanie Cole (Host): Depression during pregnancy can be a very difficult and sensitive subject. Statistics from the American College of Obstetrician and Gynecologists suggest that between 14-23% of women may suffer from some form of depression during pregnancy. My guest today is Dr. Steven Bergin. He’s an obstetrician/gynecologist with Apsirus Health System. Welcome to the show, Dr. Bergin. Tell us a little bit about depression in women that are pregnant because pregnancy itself is exciting and scary but what’s going if women are becoming depressed as well?
Dr. Steven Bergin (Guest): Well, in the previously cited statistic from the American College of Obstetrician and Gynecologists, it’s very evident that his condition is quite common. Unfortunately, most of the time, it may be missed and according to the general statistics, the instance of minor depression, which we are usually dealing with can occur in well over 30% of women during the lifetime. Of course, during pregnancy, even though they are supposed to be happy—euphoric, if you will--many times, if one is really listening and one is really looking at the patient as a whole, one can identify underlying factors that could put that patient at particular risk.
Melanie: Dr. Bergin, just as women sometimes mistake their symptoms of heart disease for stress and things, depression in a woman, as you say, can be easily missed because so many of those symptoms can mimic pregnancy up and downs, hormonal changes. So, how do you catch it? What are we supposed to look for?
Dr. Bergin: Basically, I would have to say that when you encounter an individual who’s pregnant, it’s not a bad idea, first of all, to find out whether there has been a previous episode of depression in the past and also to look to see whether there are any other chronic illnesses in the background and, really, when you talk to the patient to see whether or not they’re responses are somewhat over reactive to questions posed regarding their health or how they generally rate their health overall. Individuals who are depressed, typically, give a much more pessimistic outlook about their overall health.
Melanie: That’s an interesting thought that they can be a little bit more pessimistic. Do they seem more scared about bad things happening during their pregnancy?
Dr. Bergin: it’s interesting that you pose that question because in the first pregnancy not so much. In the second pregnancy the realities about what they encountered in the first make them take a step back and to become more critically analytic of what their situation is.
Melanie: Do we know--besides just, maybe, general cause--do we know if hormones and our raging pregnancy hormones are involved in this?
Dr. Bergin: Well, there’s been a lot of speculation and a lot of discussion. The absolute ideology of the causation or the mechanism behind this really is not known but it is recognized that being pregnant is a very great risk factor for depression overall.
Melanie: We hear so much in the media, Dr. Bergin, about postpartum depression and baby blues and the differences between those. So, what are you calling pregnancy depression? Is there a term for it?
Dr. Bergin: Well, depression in itself is really a continuum of many different types of symptoms. Postpartum blues are probably to be expected and, I would say, we see it--depending on the study you look--at between 40-80% of our patients overall. The key factor with postpartum depression is usually the complaint of feeling overwhelmed, being teary eyed, being unable to cope with the changing situation. They usually reach their peak by about the fifth day postpartum. If these complaints are persistent for over two weeks and then, usually, by that time they become more involved with more physical type complaints, then you’re dealing more with a minor depressive episode rather than the postpartum blues.
Melanie: So, when we are talking about clinical depression and there’s medication involved but pregnant women get terrified to take any kind of medication. What are some of the treatments available if you do determine that a woman is suffering true depression during her pregnancy?
Dr. Bergin: Wel,l there are numerous methods to manage the patient. One is pharmaco therapy, as you’ve outlined. That would include the anti-depressant class and there are about three or four different classes within that group overall. Basically, what we do is that if a woman comes in and she is being treated actively for depression, we do not recommend removing the medication. There’s a lot of low- to moderate-quality data that would suggest that possibly the anti-depressants can have a negative impact but, given the fact of the low quality, the management is still to treat the mother, make sure that she’s in the best mental health she can be in order to protect the outcome for the baby.
Melanie: What about things like exercise that, if she was an exerciser before she was pregnant she can keep going, but as a mode to help with depression, it can sometimes be limiting for pregnant women, especially as they gain more and more weight.
Dr. Bergin: Well, it can be limiting but we still encourage a woman to be physically active mainly because of the fact Then, it does enhance the development on internal endorphins which are really mood altering and do make us feel better overall. Even those of us who will never be pregnant, going to the gym does exactly help our outlook and our mood overall.
Melanie: What role does nutrition play? If a woman is feeling scared, nervous, depressed, crying, any of these things that we’re discussing, are there foods that you recommend to your patients and your women that maybe could help them a little bit? Because they might turn to alcohol or something to try and work on their depression and we don’t want they to do that.
Dr. Bergin: Basically, there aren’t any real dietary managements out there. Basically, it’s dealing with the person or recognizing the fact that she may be anorexic or has a loss of appetite. Of course, we are watching and monitoring her weight and, of course, if we detect that she’s in a minor depression, we are going to, obviously, have the patient come back much more frequently than the standard four week intervals in order to elicit a psychotherapy approach, meaning an interpersonal discussion so that we try to keep the symptoms at a minimum.
Melanie: Dr. Bergin, we don’t have much time left but, how do you distinguish between the normal anxiety of being scared of being a new mother and being nervous about having the baby and the delivery, the labor--all of these things--and something that would be called “clinical”?
Dr. Bergin: Well, there are really two simple questions that you can really ask these patients in order to detect whether or not you’re dealing with just the normal pregnancy anxiety or whether, indeed, these people are at a great risk or are, indeed, depressed. The first would be over the past two weeks have you felt down, depressed or hopeless? The second is: over the past two weeks, have you felt little interest or pleasure in doing things? A positive response to either one of those has a high degree of sensitivity and, to a lesser degree, specificity that you better look at this patient a little closer.
Melanie: That was a great answer. Dr. Bergin, in just the last minute, here, give your best advice for women that are pregnant that are feeling sad or someone that they love is starting to notice some of these things about them.
Dr. Bergin: The first thing I would say is to try to get past the social stigma of mental health. That’s one of the greatest impasses that we run into is that people may have these feelings but they’re fearful of bringing it out for the simple reason that they may be looked upon in a different way. I encourage all patients--and I do talk to them about this. I also point out the fact that it’s not just the pregnant women but even the physician who’s taking care of them that can have, in my own personal case, seasonal affective disorder. So, I have a sense, in terms of what they are experiencing, and, basically, I encourage them to be open, forthright and, for the most part, I believe that most of the patients I see really can equate to the fact that we’re all equal.
Melanie: Beautifully put, Dr. Bergin, and why should women come to Aspirus for their care?
Dr. Bergin: Well, I would say to all women that they ought to seek good, quality care where ever they might be. I would have to say, yes, I believe I belong to an organization that provides quality care and who cares about the patients that we treat; that they’re not just numbers, but they are, indeed, individuals, and that we hope that they all have great pregnancy outcomes.
Melanie: Thank you so much for being with us today. You’re listening to Aspirus Health Talk. For more information you can go to aspirus.org. That’s aspirus.org. This is Melanie Cole. Thanks so much for listening.
Depression During Pregnancy
Melanie Cole (Host): Depression during pregnancy can be a very difficult and sensitive subject. Statistics from the American College of Obstetrician and Gynecologists suggest that between 14-23% of women may suffer from some form of depression during pregnancy. My guest today is Dr. Steven Bergin. He’s an obstetrician/gynecologist with Apsirus Health System. Welcome to the show, Dr. Bergin. Tell us a little bit about depression in women that are pregnant because pregnancy itself is exciting and scary but what’s going if women are becoming depressed as well?
Dr. Steven Bergin (Guest): Well, in the previously cited statistic from the American College of Obstetrician and Gynecologists, it’s very evident that his condition is quite common. Unfortunately, most of the time, it may be missed and according to the general statistics, the instance of minor depression, which we are usually dealing with can occur in well over 30% of women during the lifetime. Of course, during pregnancy, even though they are supposed to be happy—euphoric, if you will--many times, if one is really listening and one is really looking at the patient as a whole, one can identify underlying factors that could put that patient at particular risk.
Melanie: Dr. Bergin, just as women sometimes mistake their symptoms of heart disease for stress and things, depression in a woman, as you say, can be easily missed because so many of those symptoms can mimic pregnancy up and downs, hormonal changes. So, how do you catch it? What are we supposed to look for?
Dr. Bergin: Basically, I would have to say that when you encounter an individual who’s pregnant, it’s not a bad idea, first of all, to find out whether there has been a previous episode of depression in the past and also to look to see whether there are any other chronic illnesses in the background and, really, when you talk to the patient to see whether or not they’re responses are somewhat over reactive to questions posed regarding their health or how they generally rate their health overall. Individuals who are depressed, typically, give a much more pessimistic outlook about their overall health.
Melanie: That’s an interesting thought that they can be a little bit more pessimistic. Do they seem more scared about bad things happening during their pregnancy?
Dr. Bergin: it’s interesting that you pose that question because in the first pregnancy not so much. In the second pregnancy the realities about what they encountered in the first make them take a step back and to become more critically analytic of what their situation is.
Melanie: Do we know--besides just, maybe, general cause--do we know if hormones and our raging pregnancy hormones are involved in this?
Dr. Bergin: Well, there’s been a lot of speculation and a lot of discussion. The absolute ideology of the causation or the mechanism behind this really is not known but it is recognized that being pregnant is a very great risk factor for depression overall.
Melanie: We hear so much in the media, Dr. Bergin, about postpartum depression and baby blues and the differences between those. So, what are you calling pregnancy depression? Is there a term for it?
Dr. Bergin: Well, depression in itself is really a continuum of many different types of symptoms. Postpartum blues are probably to be expected and, I would say, we see it--depending on the study you look--at between 40-80% of our patients overall. The key factor with postpartum depression is usually the complaint of feeling overwhelmed, being teary eyed, being unable to cope with the changing situation. They usually reach their peak by about the fifth day postpartum. If these complaints are persistent for over two weeks and then, usually, by that time they become more involved with more physical type complaints, then you’re dealing more with a minor depressive episode rather than the postpartum blues.
Melanie: So, when we are talking about clinical depression and there’s medication involved but pregnant women get terrified to take any kind of medication. What are some of the treatments available if you do determine that a woman is suffering true depression during her pregnancy?
Dr. Bergin: Wel,l there are numerous methods to manage the patient. One is pharmaco therapy, as you’ve outlined. That would include the anti-depressant class and there are about three or four different classes within that group overall. Basically, what we do is that if a woman comes in and she is being treated actively for depression, we do not recommend removing the medication. There’s a lot of low- to moderate-quality data that would suggest that possibly the anti-depressants can have a negative impact but, given the fact of the low quality, the management is still to treat the mother, make sure that she’s in the best mental health she can be in order to protect the outcome for the baby.
Melanie: What about things like exercise that, if she was an exerciser before she was pregnant she can keep going, but as a mode to help with depression, it can sometimes be limiting for pregnant women, especially as they gain more and more weight.
Dr. Bergin: Well, it can be limiting but we still encourage a woman to be physically active mainly because of the fact Then, it does enhance the development on internal endorphins which are really mood altering and do make us feel better overall. Even those of us who will never be pregnant, going to the gym does exactly help our outlook and our mood overall.
Melanie: What role does nutrition play? If a woman is feeling scared, nervous, depressed, crying, any of these things that we’re discussing, are there foods that you recommend to your patients and your women that maybe could help them a little bit? Because they might turn to alcohol or something to try and work on their depression and we don’t want they to do that.
Dr. Bergin: Basically, there aren’t any real dietary managements out there. Basically, it’s dealing with the person or recognizing the fact that she may be anorexic or has a loss of appetite. Of course, we are watching and monitoring her weight and, of course, if we detect that she’s in a minor depression, we are going to, obviously, have the patient come back much more frequently than the standard four week intervals in order to elicit a psychotherapy approach, meaning an interpersonal discussion so that we try to keep the symptoms at a minimum.
Melanie: Dr. Bergin, we don’t have much time left but, how do you distinguish between the normal anxiety of being scared of being a new mother and being nervous about having the baby and the delivery, the labor--all of these things--and something that would be called “clinical”?
Dr. Bergin: Well, there are really two simple questions that you can really ask these patients in order to detect whether or not you’re dealing with just the normal pregnancy anxiety or whether, indeed, these people are at a great risk or are, indeed, depressed. The first would be over the past two weeks have you felt down, depressed or hopeless? The second is: over the past two weeks, have you felt little interest or pleasure in doing things? A positive response to either one of those has a high degree of sensitivity and, to a lesser degree, specificity that you better look at this patient a little closer.
Melanie: That was a great answer. Dr. Bergin, in just the last minute, here, give your best advice for women that are pregnant that are feeling sad or someone that they love is starting to notice some of these things about them.
Dr. Bergin: The first thing I would say is to try to get past the social stigma of mental health. That’s one of the greatest impasses that we run into is that people may have these feelings but they’re fearful of bringing it out for the simple reason that they may be looked upon in a different way. I encourage all patients--and I do talk to them about this. I also point out the fact that it’s not just the pregnant women but even the physician who’s taking care of them that can have, in my own personal case, seasonal affective disorder. So, I have a sense, in terms of what they are experiencing, and, basically, I encourage them to be open, forthright and, for the most part, I believe that most of the patients I see really can equate to the fact that we’re all equal.
Melanie: Beautifully put, Dr. Bergin, and why should women come to Aspirus for their care?
Dr. Bergin: Well, I would say to all women that they ought to seek good, quality care where ever they might be. I would have to say, yes, I believe I belong to an organization that provides quality care and who cares about the patients that we treat; that they’re not just numbers, but they are, indeed, individuals, and that we hope that they all have great pregnancy outcomes.
Melanie: Thank you so much for being with us today. You’re listening to Aspirus Health Talk. For more information you can go to aspirus.org. That’s aspirus.org. This is Melanie Cole. Thanks so much for listening.