Moms-to-be expect to be filled with happiness and excitement, not hopelessness and despair. But the fact is, pregnancy does not make women immune to depression.

Fluctuating hormones, morning sickness and fatigue create psychological stress, all of which can lead to depression. Studies suggest up to 23 percent of expectant mothers are depressed at some point in their pregnancy.

``It's very difficult for them to even admit sometimes that it's happening,'' notes Elizabeth Bonet, a Plantation psychotherapist certified in treating mood disorders during pregnancy. ``After all, they are under immense pressure to consider this the happiest time of their life.''

But women who are pregnant face tough choices when it comes to coping with depression. Over the years, studies have linked some antidepressants to increased risks of miscarriage, low birth weight and congenital heart defects.

On the other hand, depression during pregnancy can take a toll on both mother and fetus. ``It affects their diet and nutrition, which can affect the baby's growth,'' says Nigel Spier, chief of obstetrics and gynecology at Memorial Regional Hospital in Hollywood. ``There are certain stress hormones that can be released in severe depressive disorders which increase the risk for preterm labor.''

Substance abuse is another concern, as women who are depressed during pregnancy are more likely to abuse alcohol or drugs. They also have a higher rate of postpartum depression, which can affect the baby's development.

The issue has unsettled women and their doctors for decades, and there are no simple answers. While a new report outlines several treatment strategies, it stops short of settling the debate over the use of medication during pregnancy.

Julie Davis of Sunrise battled depression for years, and got it under control with the help of psychotherapy and medication. Then she got married and started thinking about becoming a mom, which presented a whole new dilemma.

``I was nervous about being on medication while I was pregnant,'' she recalls, having heard reports that antidepressants might not be safe for the baby.

Davis hoped to come off her medication when she decided to get pregnant. ``I tried to stop taking it under a doctor's care,'' she said. ``I spiraled into a terrible depression.''

With advice from her psychiatrist, Davis switched to a different antidepressant -- one that was considered to be well studied and relatively safe during pregnancy. Davis remained on the medication throughout both of her pregnancies and delivered two healthy children, now ages 6 and 9.

Taking drugs while pregnant was not ideal, she said, but she saw little other choice. ``At that point in my life, I couldn't not be on the medication and function.''

A recent joint report from the American Psychiatric Association and the American College of Obstetricians and Gynecologists, published jointly last month September 2009 in the journals General Hospital Psychiatry and Obstetrics and Gynecology, added to the debate over the use of antidepressants.

The report, entitled ``The Management of Depression During Pregnancy,'' included an extensive review of previous research. It found that evidence linking certain selective-serotonin reuptake inhibitors, or SSRI's, to an increased risk of miscarriage, low birth weight and congenital heart defects is inconclusive.

Join the discussion

The Miami Herald is pleased to provide this opportunity to share information, experiences and observations about what's in the news. Some of the comments may be reprinted elsewhere in the site or in the newspaper. We encourage lively, open debate on the issues of the day, and ask that you refrain from profanity, hate speech, personal comments and remarks that are off point. In order to post comments, you must be a registered user of MiamiHerald.com. Your username will show along with the comments you post. Thank you for taking the time to offer your thoughts.

     Showing: Oldest first Newest first Most-recommended first Least-recommended first

@Nyx.AuthorDisplayName@ wrote on @Nyx.PostedAtTime@:

@Nyx.repliedToText@

@Nyx.replyAnswerText@

Reply to this Comment @Nyx.Recommender@ @Nyx.AbuseReporter@