Dealing With Depression During Pregnancy – Part 6

Whether or not to take antidepressants drugs was a difficult decision.

Stage 2. Gaining knowledge.

Hearing the diagnosis.
Receiving a definitive diagnosis, while difficult for some women, created a sense of relief and hope, and was a turning point for the women: it signified an identifiable, manageable disorder, justified and explained how they were feeling, and created a sense of relief, comfort, and hope upon hearing that they were “not the only one” to feel this way.

Many of the women had knowledge of postpartum depression, but few knew that depression could occur during pregnancy. One woman summed up this turning point as follows:

So, it’s sort of almost a relief to find out that you are not the only
one, and there are actually reasons behind it. (#20) (Note: As mentioned in Part 1, confidentiality was maintained by assigning each participant a code number).

Although many of the women were embarrassed and ashamed, they were not surprised to be diagnosed with depression; it confirmed what they “already knew”. This was expressed by one participant as:

It was one of those things that you kind of know, but you don’t
really admit it to anyone, even to yourself. (#19)

Seeking information
The question that was paramount to the women was whether or not to take antidepressants. The experiences of women varied considerably in their quest for information. Some found their family physician helpful:

But, he [family physician] was very open, probably because I
came with some informed sort of knowledge already, but he was
very willing, he did research on it as well, and he brought a
couple of studies to my attention. (#7)

Others reported that their family doctor “wasn’t really equipped to deal with the question” of antidepressant use. However, all women received information about depression and its management from the psychiatrist which was “really helpful”, and which many found sufficient.

She told me everything, and she also told me I could call
Motherisk and ask them. I didn’t call them, because I
thought about it, and her information was good. (#21)

Motherisk is a teratogen information counseling service based in Toronto, Canada. This program offers women who are pregnant, planning, or breastfeeding, a phone-in help service to answers questions about the risk or safety of medication use.

Others “wanted to check it out” for themselves and actively engaged in obtaining information via the Internet. One woman described her search for information as follows:

I started off with Motherisk and then medical journals online and
abstracts.
I’ve definitely read stuff like on Safe Parent Web Site,
or Baby Centre Web Site. I tend to not trust them as much….. I
don’t go into the whole journals, but usually just reading the
abstracts is enough to get a summary. (#7)

Stage 3. Taking control

The process of taking control, which is grounded in the personal and social context of the women’s lives, has three interrelated properties, making a plan, assessing progress, and balancing the risks. It is important to note that the properties making a plan, assessing progress and balancing the risks are not unidirectional, that is, the information flow and subsequent actions, may occur in either direction. As the depressive symptoms change over time, the assessment is updated, and the plan is reformulated. Nevertheless, the overall process is cyclical and moves in a clockwise direction. This is signified in the text and in Figure 1 by preceding the first word of each property with (Re).

(Re)Making a plan
Women spoke of “making a plan” in collaboration with their psychiatrist for managing their depression. Making a plan was informed by the women’s recently acquired knowledge, pragmatic knowledge, and their own and their husband’s values and beliefs about medication use. All women actively participated in, and took responsibility for, the management decision.

Although influenced by their husband’s concerns and beliefs, none of the women relinquished control of the management decisions to their husband. The act of doing so afforded the women a sense of regaining control over themselves and their lives and gave hope when they had been without hope.

It was comforting, and prepared me to say okay, how far am I
willing to go, not only medication, but therapy wise. I think that
set me in motion to say I am taking control over my moods, my
disorder. (#16)

Re(Assessing) progress
Assessments of the women’s mood were formally undertaken by the psychiatrist, and informally by the women themselves. If a woman’s mood worsened, or if she saw herself as “stagnating”, the plan was modified.

Changes included increased frequency of counseling sessions, incorporation of antidepressants in a management strategy that had been free of antidepressants, or, for those already taking antidepressants, an increase in dose.

She was doing that test, the EPDS. She would check the score each
time. It was very high in the beginning, and then slowly when I
started taking the medication, it became low. (#21)

(Re)Balancing the risks
In order to determine an acceptable management plan the majority of women undertook a risk assessment of the available management options. Accepting psychotherapy or counseling was not problematic for any of the women. However, for many women, whether or not to take antidepressants was a difficult and multifaceted decision. The women lamented the fact that there were no “black and white” answers, and struggled with what they perceived to be a complex decision.

The women considered: the risk of untreated depression to the fetus and to themselves; the likelihood of developing postpartum depression (PPD) and the associated risk to the baby, themselves and their family; and the potential risks to the baby of antidepressant use during pregnancy.

One woman articulated her concerns as follows:

You want to put the baby first, but, at the same time, you’re just
balancing out what is the risk to the baby of having a mom who is on
Prozac versus what is the risk to the baby of having a mom who is,
really can’t cope and is falling apart. I kind of got to the point where
I was like, well, I can only do the best I can as a mom. (#7)

Women tried to decrease the perceived risk to the fetus by taking as low an antidepressant dose as possible. For example, “I was kind of just teetering on, like I was trying to take the lowest dosage possible to treat my symptoms.” (#18).

Part 7 will be published soon – Consequences of Becoming the best mom that I can – Regrounding self and regaining control.

The researchers were Heather Bennett, Heather Boon, Sarah Romans and Paul Grootendorst. The above is a partially modified reproduction of their research. Also their references have been omitted for ease of reading.

Reference:
Bennett HA, Boon HS, Romans SE, Grootendorst P. Becoming the best mom that I can: women’s experiences of managing depression during pregnancy – a qualitative study. BMC Women’s Health 2007, 7:13 (11 September 2007). © 2007 Bennett et al., licensee BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (
http://creativecommons.org/licenses/by/2.0).

Related articles:
Pregnancy and Vitamin D Deficiency

Dealing with Depression during Pregnancy – Part 1
Depression During Pregnancy – Part 2
Women With Depression During Pregnancy – Part 3
Pregnancy: Depression, Antidepressant Drugs and The Baby – Part 4
Pregnancy and Depression Seeking Support – Part 5