antidepressants pregnancyI struggled with undiagnosed antenatal depression and antenatal anxiety.  I felt like such a fraud.  My husband and I had planned for this baby.  I should have been overjoyed and glowing.  Instead I walked around in a fog of self-hatred, irritability, and unrelenting worry.  My internal monologue consisted of, “I should be happy, dammit!” Why couldn’t I enjoy this pregnancy?  It was my final pregnancy, and we were giving our nearly three-year old daughter a sibling.  Where was my pregnancy glow?  Why did I feel like all I did was complain, vent and whine?

Why couldn’t  I relax?  I felt so much pressure to get my oldest potty trained before the new baby arrived.  I felt like all loose ends needed to be tied up.  I had to finish my toddler’s baby book before the new baby arrived.  I had to make sure I was exercising daily.  I had to maintain a tight control on my blood sugar.  I had gestational diabetes with my first pregnancy, so I spent my final pregnancy watching my food intake.  Every time I heard a comment about “eating for two”, I wanted to rage.  I did not have that luxury of eating whatever I wanted.  The meal plan made me miserable.  If my numbers weren’t within the expected range, I immediately panicked.  I was terrified that my daughter would struggle with complications from my gestational diabetes.  Not even the ultrasound showing a healthy twenty week baby girl diminished those fears.  I felt like I had no right to complain or worry.  I knew what to expect.  I needed to just suck it up and deal with it.

Like postpartum depression, antenatal depression looks different for each mama.  My lovely friend Susan describes her antenatal depression like this.  “I just remember feeling a crushing weight and numbness. I wanted to not be pregnant anymore and had thoughts of throwing myself down the stairs. That’s what sent me to a perinatal psychiatrist. All my joy left like I was in a vacuum – and I was suddenly convinced a new baby was the end of everything as I knew it.”

My experience of antenatal depression differed from Susan’s.  My depression manifested itself in extreme irritability, bordering on rage.  I had no patience for anything – traffic, my husband, my daughter, my parents and my sister, my friends, and my co-workers. One of the triggers for my rage was my daughter’s refusal to take naps on the weekends.  I could barely control my reaction.  I would yell and scream at my husband.  I would need to leave the house to give myself an adult timeout.  I still cringe when I remember an epic tantrum that occurred during my seventh month of pregnancy.  I was at a concert at an outdoor venue.  I cut in front of everyone waiting in line for the bathroom and for water, simply because I was pregnant.  I was rude to everyone that day. I took out my rage on anyone in my path.  This irritability and rage manifested itself in full-blown postpartum depression and postpartum anxiety after my youngest was born.  I wish I had recognized these signs sooner.  I could have treated this during my pregnancy when my initial struggle began.

Antenatal depression and antenatal anxiety are not as widely known as the other perinatal mood disorders.  We do moms a disservice when we fail to screen for depression and anxiety during pregnancy.  We need to focus on both the needs of the mother and the needs of the baby.  Mothers are vulnerable during both pregnancy and the postpartum period.  Ask the pregnant mom how she is doing and really listen.  I read this amazing piece that Andrew Solomon wrote regarding depression in pregnancy.  Thank you Andrew for speaking up for both the mothers and the babies.  If you are feeling fragile, do not read Andrew’s piece.