The Dark, Dirty Secret of Prenatal Depression

It’s been quiet around here lately, no?

*casts a guilty glance*

I know. I know.

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To get you quickly up to speed: the Knish is just fine. He’s very active and I believe he has waged a war against my belly button from the inside. I think he knows that I really don’t want my innie to become an outie and he’s on a mission to pop it out, one kick at a time. At nearly 28 weeks along, the time is flying by. I’ve got another run-in with a glucose test next weekend. Fingers crossed, I’ll pass it.

We have a follow-up ultrasound in two weeks. I can’t wait to see him again.

Other than that, the belly and boy continue to grow. I am (finally) gaining weight. And I’m nesting like crazy.

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Speaking of crazy…

I’ve certainly felt like it. For a while now, actually. And it’s been over the last few months that I’ve stumbled upon probably one of the dirtiest, darkest secrets about pregnancy they never really tell you about. And I’m not talking about pooping while birthing (although, yeah – pretty dark and dirty).

I’m taking about prenatal depression.

And no, that’s not a typo. I know – it seems like I should be saying “post-partum” depression but no – ooooh no friends. It can start LONG before your baby ever gets here.

And no one really talks about it.

The Dark, Dirty Secret of Prenatal Depression

It’s interesting really. I do so much vocal, out-loud advocacy for the infertility community because as far as I’m concerned, infertility is nothing to be ashamed of: it’s a disease. And yet, I haven’t posted here because I’ve been so ashamed of dealing (or rather, not dealing very well at all thank you very much) with prenatal depression, which is just as much of a disease as any other.

I’ve clammed up about what it’s like to live with this kind of depression in the very ways I advocate others to fight through when dealing with their own infertility. And then it just became layer after layer of guilt, of feeling like a phony, a sham…

Who am I to tell others to speak out when I’m just cowering in shame over here?

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I’m finally opening up about this in more detail here because of this Slate article, found via a link on a completely unrelated topic sent to me by a friend:

“Despite these stats, prenatal depression is still relatively under the radar, and many obstetricians are not well-trained in its complexities. Until very recently, doctors didn’t even know a woman could get depressed during pregnancy: They thought antenatal hormones protected against it. And women who have prenatal depression don’t want to talk about it. You’re supposed to glow while pregnant, not spiral into darkness.”

(Source: Not Just the Pregnancy Blues: Why isn’t anyone talking about prenatal depression?)

As I read this article last week, the tears just began to flow. I found myself unconsciously nodding along to Grose’s words. I’ve definitely felt detached from this space here because I’ve been carrying such survivor’s guilt. But then at the same time, there’s this vicious part of prenatal depression that harps away at a woman’s psyche: “You should be happier for this pregnancy.”

Now add that infertility layer on top and you might see why I’ve felt crippled by this depressive weight lately. It’s been an oppressive, silencing wedge between me and my writing for the past month.

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Prenatal depression is more than just “feeling blue.” It’s struggling to get out of bed in the morning. It’s constantly worrying about every thing you put into your mouth and your body: will this harm my baby? It’s worrying about whether or not I’ll be able to give birth vaginally or via cesarean (which is still up in the air right now).

It’s not just worrying about what kind of mother you’re going to me or getting the pre-parenthood jitters. It’s finding yourself trapped by paralyzing, irrational fears and then being equally as terrified that all of your worrying and stressing out and trying to suppress the random bursts of tearful sadness are hurting your baby.

It’s not eating enough when your baby needs the nutrition the most. It’s counting down the hours until you can go to bed for the night so the day will be over quicker.

It’s watching your marriage morph into something that confuses and scares you because your partner is confused and scared about the kind of woman you’re turning in to: a woman one who can barely function. And all he wants to do is understand and help.

And all you want to do is sleep.

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Numerous studies have pegged the rates of prenatal depression at more than 10 percent of women, and yet the myth persists that pregnancy protects you from melancholy. And it’s a dangerous one. The lack of public conversation about prenatal depression and the fallacy of the happy, glowing mother-to-be can block women from recognizing the problem and seeking help.”

(Source: Not Just the Pregnancy Blues: When should a pregnant woman take antidepressants?)

I’m seeing a therapist who works specifically with women and couples who are undergoing fertility treatment and especially women who are pregnant after treatment. She’s amazing – there’s a level of understanding and intuitiveness she possesses that makes opening up in our sessions so much easier than a therapist who just doesn’t understand the emotional complexities of pregnancy after infertility.

At my last session, she threw out the idea of possibly adding medication. Not a requirement – just a recommendation with a referral to a psychiatrist who works with pregnant patients. It’s a loaded suggestion for sure, and one I know that’s fraught with deep opinions on either side. To give you an idea of where I’m at when it comes to medication beyond my thyroid meds during pregnancy, consider this: when I had a fever of 101° back in January, while I had a nasty cold, I had a full-on panic attack meltdown about having to take Tylenol until my fever broke.

That said, I’m seriously considering resuming antidepressants for the first time in almost six years. This is an extremely personal decision, one that I’m making very carefully with my husband.

(I know it’s a loaded issue for some and I just ask that for the sake of my own decision-making process, please leave any loaded opinions out of the comments for now. Right now I just need support on trying to forge ahead in the healthiest way possible for me and my baby.)

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I’ve got some more thoughts on all of this, but this post is already pretty verbose so I’m going to save it for a second post tomorrow, one that I hope you’ll join me in sharing your thoughts with me.

Stay tuned tomorrow for The Untethered Boat of Pregnancy and Parenting After Infertility.

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Comments

  1. Kristina Kent says

    Thank you so much for sharing. Opening up about this must have taken great courage. I hope that you find solace and happiness soon. And try to remember that taking care of yourself = being a good mom. I know it seems counterintuitive, but it’s true. So whatever you and your husband decide is right for your family is the right answer. Good luck :)

  2. Kati Teniente says

    I feel like you just dug into my brain and wrote excatly what I’ve been feeling for the past 8 weeks. I thought it was ” crazy pregnancy hormones ” but I too have the same overwhelming thoughts . Right know I’m 10 weeks along , and I have a head cold . My husband suggested I take some Tyenol .. I freaked out !
    Thank you sooooooooooo much for sharing this . Its a wonderful feeling to know I’m not in this alone . I was also be bring this topic up with my OB today

    Kati Teniente
    http://www.bigfatpostive,finally.com

  3. says

    Oh, Keiko. My friend, I am so glad that you are talking about this very, very serious topic. I am just now coming to terms that I have my own bouts of depression, and when I think back over all the years, I can see those times that I always considered “slumps” dotted through my memory like photographs in an old album. One of those slumps — which I now know was full-on depression — was during my pregnancy with Kaelyn. It was triggered by a lot of factors…finally getting a diagnosis of PCOS for the IF that had long plagued me, the failure of my first surrogacy transfer with my first set of IPs, a touch of PTSD from a uterine cancer scare, the fact that I decided to end the surrogacy journey before we went for a FET, the fact that we decided to pursue another pregnancy of our own while my former IM had to start back at square 1, stressing over going back to fertility treatments, the guilt that weighed me down when I got pg 4 months later and my former IM was still moving towards transfer with her new surrogate (hard feelings there, being the pregnant one with an infertile friend)…it just went on and on and on. I spent much of that pregnancy terrified that my luck would finally run out. Something bad would happen. Karma would come back to bite me in the ass for ending the surrogacy (even though there were valid reasons for me to do so)/getting pg with my own. Something. I barely held myself together through the first trimester, then out from nowhere, I had a day of bad bleeding at 15 weeks. That was what broke me. The bleeding turned out to be a one-time freak occurrence, but the emotions it caused lasted for the next 15 or 16 weeks. I put on a happy face and plugged through each day the best that I could, but I was spent — both physically and emotionally — from having to fake the funk all day long. The fog lifted on its own eventually. It helped that things worked out for my former IM (Kaelyn and her daughter, Ella, are exactly 2 months apart)…but a lot the healing came from absolving myself of the guilt that I really didn’t need to carry at all.

    That’s a long story just to say this — I didn’t get help for my depression. I didn’t even have the presence of mind to call it depression. In my mind, what I was feeling was a natural and normal response to deeply stressful situations. It wasn’t until after the fact that I could look back and consider that maybe my emotions were extreme and were something more than just a “slump.” I managed, over a period of time, to pull myself out of it, but not everyone will or can, and that’s okay. The truth is that I shouldn’t have had to struggle at all, and it could have been easier if I’d sought help.

    You are already leagues ahead by being able to claim what you’re feeling for what it is. You’re getting help and are considering taking medication for it. I APPLAUD you for that, and I am hopeful that as you continue forward, you’ll be able to find the place in which you can once again feel truly happy (not just “theoretically” happy).

    xoxoxo

  4. says

    Keiko,

    I live in NH about an hour from Boston. My husband works in Wellesley and long story short we plan on moving to the city to be closer to my husbands job. One of the things that concerns me is after 2 years of IVF and 3 miscarriages if I get pregnant I am going to need the support and help from a therapist. I currently see one in NH that I love and it’s not impossible for me to keep seeing her when we move but it would definitely be tricky logistically. I’d love if you could share with me the name of the practice or person you see if they’ve been that helpful. I’d love to look into them and see if they’d be able to help me in my situation. I don’t suffer from depression but do have anxiety. This entire process is so difficult and I’ve found support where I am but am concerned about moving and having to start all over again. The great thing about Boston is its close enough for me to check the place out before we move and hopefully have a smooth transition between the two therapists.

  5. says

    I am so sorry that you’re dealing with this. I wrote about a study in Navigating the Land of If that found that women who utilize fertility treatments are 4 times more likely to get pre- or post-natal depression. And knowing those statistics, I wonder why clinics themselves don’t do more follow-up (or pass the baton to the OB) to make sure women aren’t suffering in silence. I’m glad you’re getting help now, and talking about it. The brain is just an organ, just like your uterus. You need to take care of both.

    Once upon a time (she stopped writing in 2011), there was a blogger on the blogroll who wrote exclusively about prenatal depression after IVF. Let me know if you want me to forward you a link to her archives. She was pretty well-known in the blogosphere.

  6. says

    Oh Keiko, I’m SOOOOO glad you wrote this (but so sad you had to.) I can imagine what you’re going through because during my first (successful) pregnancy was when I experienced my first attack of generalized anxiety. As a depression suffer myself, I did not know what to do with the crippling anxiety I was feeling. I literally could not cope. I finally started taking an SSRI to deal with it and I’m glad I did. It was definitely a difficult choice to make so I understand your hesitation and uncertainty. I hope you can come to a decision that feels right for you and that makes this pregnancy more bearable. I’m so sorry you are going through this terrible darkness, it’s just so fucking unfair. But thank you for being brave enough to talk about it so that others don’t feel so alone and maybe are inspired to get help. Prenatal depression and anxiety are real things and they need to be understood and treated.

    Abiding with you.

  7. Jennifer says

    When I first got pregnant via frozen embryo transfer, I was SO worried about miscarriage and a friend said to me “this baby is so, so strong! look at what she had to go through to even get to this point” – that helped me a lot when I agonized about whether to eat/drink/consume something while pregnant and when I continuously wondered if I was doing the right thing. Your baby has already gone through alot to get where he is and he is a super star!

  8. sdear says

    I am 1 week behind you in my pregnancy after a long struggle w/ i/f and oh my god I could have written this post. I was a total wreck at my 20w ultrasound – more anxiety than depression, but still. I am seeing a therapist weekly but also put in a low dose of Zoloft and oh.my.goodness., what an amazing difference it has made. I absolutely feel like this was the best choice for me and baby.

    Hang in there. Thinking of you. I honestly had no idea I could be walloped by this while pregnant. :(

  9. says

    Thank you for sharing your struggle. As a woman with a history of anxiety and depression currently a year deep into infertility treatments, I often fear depression once I’m pregnant. I know it’s a very real possibility, and that going through infertility makes me more likely to suffer from it. I’m sure my own history of depression won’t help. Thank you for being brave.

  10. says

    I’m glad you’re talking about it, and I’m glad you’re getting help.

    I didn’t have depression during pregnancy, but I did have a lot of detachment issues (stemming from the infertility and recurrent losses). Even though I was getting multiple injections a day, taking a handful of pills a night, all for the sake of the baby- I still had trouble believing there was a baby in there, and he would come out alive someday. So I didn’t have depression, but I wasn’t “happy” enough for everyone in our families. I didn’t react with as much gusto and fever as they would have liked. I wasn’t giddy or glowing, I was scared and detached.

    Pregnancy was hard for me, not in the same way as it is for you, but it was hard. Just wanted to say that I can relate, in some way, and I’m sorry you’re dealing with this. Wishing you strength as you work through this.

  11. says

    Mel beat me to this. Dee has talked with me extensively about how women live through infertility and loss are significantly more likely to suffer from prenatal and post-partum depression. Yet, too often, this goes untreated. It’s assumed that because you’re finally pregnant, you should be happy and glowing. Never mind the mind-fuck that you previously had been living with and is likely looming.

    I’m incredibly happy to hear you’ve found an amazing therapist to work with. My hope is that you can work with her to find the treatment that is best for you, Larry and the Knish.

    Finally, like speaking out about infertility, I’m so glad you’re speaking out about your experience with this disease. It’s not easy to do and many feel a lot of shame. But, I think like infertility and loss, it’s important to talk about. Otherwise, how will anything change? Keep writing. And remember, no shame.

  12. says

    I don’t have any particular words of wisdom here, but just wanted to send you a message of support. Hang in there, Keiko. You’ve been so strong for all of us for so long. There is no shame in needing a little help now. Hang in there, dear one!

  13. says

    Keiko, thank you so very much for writing about your experience with pre-natal depression. I was shocked to read the Jessica Grose article you cited and surprised I hadn’t heard more about it. Now reading through the comments here is eye-opening. This is why it’s so important to tell our stories and I know you will help others through this. Thanks you for having the courage to do this.

    (((Hugs)))

  14. says

    I would first like to offer you a BIG ASS HUG. I too suffered from prenatal (and severe postpartum) depression. The crushing guilt and shame of feeling this way when I should “just be grateful” and then being told flat out by another IFer (IRL, no less) to “get the f*ck over yourself because you are getting what you want.” More anxiety. More guilt. More shame. I was lost. I was adrift. I wanted to not wake up anymore. And then I started to talk openly in this community, albeit VERY cautiously about this very issue and started to heal a little. Because unfortunately, the “just be grateful” attitude is heavy and pervasive in this community. Sometimes I feel like it our dirty little secret,,, our version of “just relax!” But taking the bold steps, like this post, to discuss these very REAL issues of the pregnancy/parenting part of this journey will hopefully help to not only erase the stigma, but open up more avenues of support.

    I wrote about the article you linked to above at PAIL a few months back: http://pailbloggers.com/2012/08/22/news-item-not-just-the-baby-blues/ Though, I have to admit that I was much more reticent to reveal the true depth of my experience out of fear of being told that I simply wasn’t grateful enough. Being grateful has nothing to do with it… being human does. Thank you for shedding more light on this very real issue.

  15. says

    Keiko, I am sorry to hear you’ve been having a hard time. As Mel and others have already said, there is a high co-relation between infertility/loss and prenatal & postpartum depression, and it’s really not surprising when you really think about it. Glad to hear you have found such a good therapist — and as for the anti-depressants, you do what you need to do for your baby AND yourself. (((hugs)))

  16. says

    Keiko,

    I just want to say THANK YOU for talking about this. It does need to be spoken about. I was depressed when pregnant with my twins, and after they were born, and you’re right that there is so much shame that boils up when you’re pregnant after infertility. When I managed to speak about my blues to a few people in a light sort of way, more than once I got, “Be happy, this is what you wanted!” sort of comments. It’s horrible. :(

    I have written on this in my article on depression and infertility in general (http://infertility.about.com/od/copingwithinfertility/a/Infertility-And-Depression-101.htm), but I have plans to also write separate articles on prenatal depression and postpartum depression. I think they are very important to talk about. I’m glad you’re doing your part to spread the word, too. People need to know they are not alone, that there is help, and that their depression isn’t any indication of who they are as a person (or how much they appreciate their pregnancy — not related at all!)

    (((hugs))) You’re awesome, never forget that.

    Rachel

  17. says

    I hope you find strength to fight it off with whatever means necessary. You are right, prenatal depression is not as well-known and recognized as postpartum depression. I remember reading somewhere that 10 to 15 percent of women get it…
    Unfortunately women who suffers from it have also higher risk of developing post-natal depression. The babies may be affected as well. I don’t want to make it any worse than it is but I think (and this is not a medical advice) you should definitely do something about it. Even though I’m in general against drugs, this might be the situation where you might not be able to manage without them. The risks are just too great for you and your baby to ignore it. Talk to your doctor or counselor. Seek advise from those women who are or were in similar position. Maybe there are alternatives you haven’t thought of yet.
    I know it’s easy to talk about it and give advice when I’m not the one that is suffering…Big hugs and be brave.

  18. E Rice says

    Keiko- I HIGHLY recommend the psychopharmacologist Dr. Marlene Freeman at MGH. I saw her through my whole pregnancy due to horrible anxiety and she really made me feel comfortable and “safe” with the decisions I made around medication.

    I wonder if we saw the same therapist as well. (LN?) The one I saw was amazing. We’ve since moved out of state and I miss her! I haven’t found anyone nearly as good.

  19. says

    Oh Keiko – you wrote this post a while back and it has really stayed with me. First off I want you to know how brave I think you are for sharing your story – and for asking for help.

    Second, I was at a TedX event this past weekend and heard a woman talk about her own story of peri-natal depression. The way she described having to ask for help from SO many different people before she found someone who ‘heard’ her and helped her – its just wrong, but partly because we just. don’t. talk. about. it. She is doing a documentary about pre/post natal depression and I want you to know about each other… You both have so much passion in advocacy.

    http://www.darksideofthefullmoon.com/Darksideofthefullmoon/The_Film.html

    Finally, I want to tell you that medication was/is a saving grace for me. I was lucky to have an OB who was acutely attuned to ppd and immediately recognized that I was at risk. She encouraged me to consider meds during my pregnancy and post delivery. She encouraged my husband to be aware of my mood and be part of the decision making team. She evaluated my support network and encouraged me to reach out in advance of needing them. Every woman should be so lucky. I have no doubt that my story would be very different had I not been held together by a deeply compassionate and fully engaged network of support this past year.

    I can’t help but reflect on the need for public policy to address the social and health systems necessary for a healthy population. As you know only too well, speaking up as one person is the first step in any kind of social change movement. Gotta love you Keiko!

    xoxo – Foxy