Q&A: pregnancy blues--when to see a therapist

Fran writes:

"I'm almost eight weeks into my second pregnancy (first ended in miscarriage) and have been feeling horrible both physically and emotionally. I know that anxiety and mood swings are par for the course, especially in the first trimester, but am wondering at what point you draw the line and say, "This is not just pregnancy," and seek outside help. I don't mean this to sound scary--I'm not suicidal, by any means. But I do get very black sometimes, and (on top of feeling horrible) spend a lot of time wondering if this is okay, or if crying all afternoon and feeling hopeless warrants a discussion with the doctor."

I think if you're wondering if you should see a therapist, you should see a therapist.

And I mean that for pretty much all of life, not just pregnancy. Because if you're feeling like you think you might need professional help, or even just an objective paid listener, you should find one. I think it's easy to feel like going to a therapist means admitting that there's something really wrong, but it doesn't mean that at all. It just means that you need someone to give you some feedback or help you formulate a plan to deal with whatever it is that's stressing you.

It's not even that big a commitment. You can go see a therapist just once even, and for some situations that's all it takes. When I was very depressed during my first pregnancy, I saw a therapist who specialized in women's issues around pregnancy and mothering. I don't remember if I had two sessions with her or three, but that was all it took to get me to a better place so I could get through the rest of the pregnancy. (The September 11th attacks happened when I was almost four months along, and I really credit those sessions with the therapist and the things she had said to me about pregnancy with helping me deal with the event and my grief and that whole ball of wax.) And deciding to see the therapist was a big step in deciding to take myself and my own feelings seriously for a change. That was a big thing for me.

So to me it sounds like you definitely need to see a therapist. Whether or not it's "just pregnancy," it doesn't matter. You should go see someone who can help you through this time and all the conflicting emotions and the bad physical sensations and the fear and guilt and all of that. You should decide that your feelings are important, and you can take yourself seriously. You can ask your OB for a recommendation, or call a midwifery practice or birth center and ask for one. If you know any childbirth educators, they'll have good recommendations, too. You definitely want someone who's worked with pregnant women before and who understands those special issues.

Did anyone else see a therapist during pregnancy? Or did you tough it out and now wish you'd seen someone? It was only when my therapist sent me a newspaper clipping about prenatal depression that I realized it wasn't just me, that there are tons of us who get depressed during pregnancy.

Comments

[Sandra]

Lauren Slater, a psychologist, wrote a great book about her pregnancy experiences (in diary format) which also included prenatal depression. I think it's called Love Works Like This.

I did see a therapist off and on during my pregnancy, but I had been seeing him before, too. I kind of wish I had found a woman to work with during the pregnancy; it seemed like there was a lot my male therapist just didn't get, even though he had kids.

[Amanda]

I totally understand. I worked from home during my pregnancy, in a new town, and had few supports locally. I felt so down so much of the time, was sick all day everyday until the 8th month. I cried every day, and finally went to see a therapist. The funny thing is, I am also a therapist, but sometimes it's hard to practice what we preach. Honestly, I went in, talked to her, cried a lot, and felt 100% better afterwards. I actually only went for one session, but we left it open so that I could go back anytime. I actually felt better once I made the appointment - before I ever went in! One thing I would recommend is that you get a therapist who has kids - mine did not, and admitted this, which somewhat discounted what she had to say, but regardless, it did the trick. Good luke to you. Hang in there, and continue to take care of you physical health - get some exercise, do something enjoyable for yourself!

[laura]

I saw a therapist during my pregnancy and it was invaluable. I had (and still have) a lot of issues around working while pregnant/ being a WOHM especially due to the fact that I really really hated my job at that time, and my spouse was dead set against my making a change. This led to my feeling very trapped and panicky and hopeless. The therapist helped me tremendously to identify my needs, formulate a game plan for achieving them, and formulate day to day coping strategies. I maxed out my visits under my insurance plan (6) and at that point I was comfortable discontinuing the vists for awhile. I went back to her for a series of 6 visits again the next year. I consider the entire experience to have been worthwhile and productive, and encourage Fran to be proactive and seek a little outside, objective help in coping with all of the changes that her pregnancy brings. Pregnancy has a tendency to bring all sorts of background issues into new relief, and the extra hormones make all of the feelings involved that much more raw. A therapist with experince can help sort all of that out.

[Amy]

I became horribly depressed during my pregnancy, so much so that after the first trimester, I went back on the anti-depressant that I had been taking prior to becoming pregnant. We weighed the whole risk-benefit thing and decided that me laying in bed and crying 16 hours a day could not be any better for the baby than the miniscule amounts of Zoloft that would reach him. The meds took the edge off but I did not truly feel like myself again until my son was born. I think that when we have our second I will stay on the medication the whole time- I just don't think I can go through the same kind of depression with a toddler. (By the way, my son was born perfectly perfect and I did not have a bit of post-partum depression.)
I found a book that was so very helpful to me and I would definitely recommend reading it- Pregnancy Blues by Dr. Shaili Misri. She has done extensive research on depression during pregnancy and the effect of hormones on mental health. She also has a website, www.wellmother.com

[Summer]

I know first-hand how difficult it is to be pregnant after a miscarriage. It's terrifying, and it's easy to feel guilty about being scared and not enjoying what people claim should be a happy time. I didn't see a therapist during my post-miscarriage pregnancy, but I did work with a hypnotherapist. I went to her for Hypnobirthing instruction, but we wound up spending the bulk of our time dealing with my fears and sadness. She also taught me some EFT (emotional freedom techniques, it'll pop right up if you Google EFT) to use at home when the terror and depression welled up.

I'm not knocking traditional psychotherapy, just suggesting another route that might appeal to some women in similar situations. The hypnobirthing worked well for labor, too....

[Tanya]

My comment is EXACTLY what Amy just wrote. How interesting! Although I wasn't crying during my pregnancy, I did feel off a lot of the time.

About 2 weeks after my son was born (just now in June) I went back on my Zoloft and plan to stay on it if I have another pregnancy.

And I'm just popping out now to the library to get that book she suggests.

Thanks for this great site and wonderful readers and commenters.

[SJ]

I am 8 weeks too and am seeing a therapist who specializes in post/prenatal issues - like Moxie said, the visits can as few or as many as are important for you - I started out seeing her every two weeks when I was sorting out trying to get pregnant again, and then moved to every three weeks, and now monthly. It's true that just the act of acknowledging that I needed help was huge. Good luck!
I recommend asking your midwife/OB for referrals to someone who specializes in these issues - I think there are really specific challenges hormonally and culturally, for pregnant women and moms.

[BrooklynGirl]

I saw a therapist while I was struggling with infertility and continued to see her through my eventual pregnancy because I was so anxious. It helped tremendously.

[hedra]

I did 'before' in a big way, because I could see issues coming from that far off. That made a huge difference. I later did some 'afters' too.

Pregnancy after a loss is a whole separate ball of wax. BTDT far too many times. My midwives were surprised that I coped as well as I did, especially with repeated losses. Each one was (thankfully) different and unique, but the whole process of pregnancy after loss is just harder.

I found that my main support (after family, friends, and the tools I'd gained in therapy) was a message board/forum JUST for pregnancy after loss. (I used StorkNet for that, but there are plenty of others.) Being able to talk to other moms who had been through the same things was a huge help. Kind of like group counseling.

I'd also recommend checking with fertility clinics for their recommendations for therapists, because so many of their patients have had losses of various sorts. Someone familiar with pregnancy loss and/or high risk pregnancy (not saying yours is, just that some of the 'themes and coping issues' are related) in addition to general pregnancy and prenatal depression may be an added bonus.

[wavybrains]

I had a very black late 1st/early second trimester of this much-wanted pregnancy. Counseling made all the difference in the world. I also found the book "Understanding Your Moods when You're Expecting," to be invaluable. Here's a link: http://www.amazon.com/Understanding-Your-Moods-Youre-Expecting/dp/0618341072
If you and your therapist feel that you might benefit from medication, try to find a psychiatrist who specializes in reproductive/women's health. My health care team and I decided that for me, the risks of my depression remaining untreated were greater than the risks of medication. But, because my doctor consulted with a Reproductive Psychiatrist, we were able to take several steps that my usual doctor wasn't aware of including monthly monitoring of the amount of medication in my system. This allowed my doctor to precisely adjust my dose and allowed me piece of mind that the amount of medicine in my system was far below the recommended amounts. Don't feel bad for getting help or for needing help. Getting help now can help reduce your risk of serious post-partum depression. Much of my counseling has focused on coping strategies and tools to use to prevent a relapse after the baby is here. The book also helps you to come up with such a plan. Good luck & know that you are not alone in these struggles!

[Karin]

I saw a therapist before and all during my pregnancy and stopped at 8 months. Like many of the other commenters I found it very helpful. I wasn't depressed, but I felt *stuck* in my life. I knew I wanted a family but I wasn't taking the steps to realize my desire. Seeing a therapist helped me take that step and then was really helpful in helping me transition to motherhood.

It's a big change & having someone objective to help is great.

[Lisa]

My first pregnancy ended in miscarriage and my subsequent pregnancy was filled with awful days when I would imagine all sorts of terrible things that could befall my baby. I didn't recognize my depression and wish that I had sought help. Pregnancy after a loss sucks so much because you are robbed of a certain innocence. But it doesn't have to feel that way.

[Fran]

Thanks SO much for all your comments--it really helps to know this isn't so uncommon. It was particularly encouraging to hear from the folks who work at home--I too work from home (and just moved to a new town), and while I like what I do very much, it is kind of isolating, and I'm worried about what this might mean for me once I actually have the baby. Some part of me thinks the baby might actually get me out more; some part of me dreads being even more cut off. And the worries about miscarrying again certainly haven't helped. In any case, my OB recommended a therapist after the miscarriage, but I never called; I think I will now. Bless you guys.

[swissmiss]

I'm seeing a therapist now (I'm in my 25th week). At about 12 weeks my OB referred me to the therapist he refers his PPD patients to - he's seen me through one pregnancy already and he observed enough to think I was at risk for PPD in this pregnancy - apparantly therapy during the pregnancy can actually either stave off full blown PPD after the birth or markedly minimize its effects. And you have a pre-existing relationship with a therapist.

So I've seen her several times and it's been very helpful to have a safe place to talk about fears/worries/uncertainties and not feel guilty about it.

[Patti]

I second Amy's comment, I had the exact same experience and used the same book - Pregnancy Blues by Dr. Shaili Misri, to help me get over the fear of taking Zoloft during pregnancy. I was so depressed that I did have suicidal thoughts, which scared me so badly I went to the doctor that very day. I didn't have ANY PPD, and felt just like myself as soon as my sweet baby left my body :) And she is a perfectly healthy, happy and brilliant 8 month old now. I also saw a therapist throughout my pregnancy, and she was available for the postpartum period, in case I did have any symptoms. If you do decide to use medication, be prepared to have your doctor want to wean you off for the third trimester, to lessen the chance that your baby will have withdrawals at birth. That scared me, and I chose to wean toward the end of my pregnancy, and I just doubled up on therapist appointments, took lots of vitamins and got lots of sun for the last trimester. Good luck. Depression during pregnancy is not discussed often enough. Thanks Moxie.

[Joceline]

My first pregnancy also ended in a miscarriage at 11 weeks. Up until the end of the first trimester in this pregnancy, I was constantly anxious, fearful, and terribly sad. I was not happy or excited to be a mom; I was so sure something would happen again and we'd have to deal with the whole grieving process for a second time. I don't think my depression/anxiety was severe enough that I needed to see a therapist, but looking back, it certainly could not have hurt. Those were bad days, but they are gone now!

[rouver]

I spoke with a friend who saw a therapist (not pregnancy related, but wait for it...). I told her how I thought I'd never be able to see a therapist. I figured I'd tough it out. That I'd feel like some sort of wuss who felt sooo sorry for themselves...that I'd just need to suck it up. She pointed out that if you were SICK, if you had the flu, if you had allergies, any other problem, you would SEE A PROFESSIONAL. You would seek HELP. There is a stigma associated with mental problems, emotional problems, etc. There is no shame in getting help when you aren't feeling well, regardless of the cause. I really appreciated her perspective.

[Cat]

I saw a therapist when I fell pregnant. It'd been trying to get pregnant for a long time, and one surgery and 2 years later when I did finally get pregnant I was completely freaked out and couldn't even get myself to tell my family! What I thought was going to be a really happy time turned into a LOT of soul searching and anxiety. The therapist helped a great deal in sorting out my feelings and with understanding them they passed. Within a few weeks I was feeling happy and excited about my baby to be. I have a beautiful 10 month-old boy now and I'm thankful for her help.

[Amy]

I just wanted to add that while weaning off the medication towards the end of the pregnancy is often recommended, it is still something to weigh the pros and cons on. My doctor described some of the supposed withdrawal symptoms of a newborn whose mother had taken zoloft- irritability, crying, and an irregular sleep-wake cycle- sounded like a normal newborn to me! I lowered my dosage as far as I could and not feel like driving off a bridge and my son did not show any signs of withdrawal. I am not trying to push you one way or the other, just know that you can discuss the options with your care provider.

[Moxie Massage]

Just wanted to say hello. We found you and liked your blogging name!

[anon-mouse]

I lost my 1st pregnancy at 9 weeks and was depressed the entire pregnancy that I carried my son. I have a "pregnancy journal" and in every entry, the spot for "mood" ranges from "meh" to "awful". :(

I had been on an antidepressant and weaned myself off it without consulting my dr to get pregnant; and had stopped therapy about a year or two previously. I don't recommend my method!!

I wish I had at least had therapy, maybe meds too. Being in therapy is IMHO wonderful - someone who you can talk to about aything, at any length, who can't get annoyed at you for bringing up the same thing over and over. :)

Good luck - prenatal depression is awful, and I felt like even more of a failure that I wasn't "glowing" and enjoying every minute. :P

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Excellent post, let me just add that each year, according to the WHO, ill-health as a result of pregnancy is experienced sometimes permanently by more than 20 million women around the world. Furthermore, the lives of eight million women are threatened, and more than 500,000 women are estimated to have died in 1995 as a result of causes related to pregnancy and childbirth. Greetings

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