Depression in Pregnancy and Post-Partum

As summer approaches, I am delighted to see men and women alike out and about working out, showing off their bikini bodies, demonstrating their public displays of affection, and looking very care-free.  An abundance of pregnant women seem to glow every summer, and they certainly don’t go unnoticed, especially in their midriff-bearing summer-wear.  Historically, pregnancy was thought to be a time of emotional wellbeing.  Although I don’t want to be a Debbie-downer during this exciting time for those of you “in-bloom”, this is not always the case; therefore, I believe this is an important topic to cover in any wellness forum for those it directly affects as well as their loved ones, friends, and family.
Am I at risk?
Depression, the leading cause of disease-related disability amongst women, is highest during the reproductive years.  About 10-15% of women experience depression during pregnancy, according to recent studies.  While the risk is highest in those who have been depressed or anxious in the past, about 7% have their first depressive episode during pregnancy.   The risk is increased in those with a family history of depression, particularly depression during pregnancy and post-partum.
Frequently, doctor and patients alike will discontinue antidepressant medications when someone becomes pregnant or is thinking about getting pregnant.  This can lead to dangerous relapses during a very vulnerable time for a woman and her family, and patients should discuss these decisions at length with a specialist before determining the best course of treatment.  Finally, the greatest risk for post-partum depression is untreated depression during pregnancy; therefore, hiding behind the symptoms while pregnancy is not going to make them go away.
What are the symptoms?
Depression during pregnancy manifests similarly to any depressive episode, but can be complicated to signs and symptoms related to the pregnancy, specifically.  It is important to realize that untreated depression can affect prenatal care; studies have shown that women will decrease prenatal vitamin use, not gain weight appropriately, use drugs and alcohol to manage symptoms, and even make decisions to terminate pregnancy solely due to untreated depression.  Some symptoms of a healthy pregnancy (including increased fatigue, awakenings, and weight gain) are difficult to differentiate from depressive symptoms and should be evaluated.
To treat or not to treat?
Many pregnant women and their partners have come to me concerned about being on medications during pregnancy.  They are almost always surprised to hear my answer.  While any medication counts as an “exposure” to the fetus in the pregnancy and must be evaluated on a risk/benefit basis, depression and anxiety are also “exposures”.  In some studies, the risks of depression and anxiety (whether due to the chemical imbalances they create in our body or the effects that the mood changes have on our lifestyles) created more harm than the risks of antidepressants.  While therapy is sometimes the most positive option, as it may eliminate exposure to both the depressive chemical changes as well as the medications, it is not always effective enough.  Medications for depression can be very safe and can certainly be considered in those patients with moderate to severe depression after thorough discussion with a physician.
I’m not pregnant.  Why should I care?  What can I do to help?
If you know someone who you are concerned may be depressed during pregnancy or post-partum, the simplest thing you can do it reach out to her.  Many new-to-be mothers and new mothers are overwhelmed and feel alone and scared to reach out to others.  New moms often feel they are supposed to be happy and are ashamed to feel otherwise.  However, mood changes like depression can be devastating to a pregnant woman and can even put her at risk for suicide or homicide to her newborn.  It is therefore important that we raise this issue with the general public, inform mothers that they are not alone, and view this as a real disease with serious consequences.  While it’s always nice to see expectant mothers hiking Runyon Canyon or enjoying a healthy smoothie on the beach, there are still those in hiding this summer waiting for a friend or loved one to reach out to them.  Help is available, and whether it’s you or someone you know, you can certainly make a difference.

6 Reasons Why Yoga Enhances Pregnancy

First here’s the soppy part…
My love for yoga is a true love, one that has soulmate written all over it. I know this because it’s a relationship that has weathered storms and hung in there through life’s ups and downs. We’ve argued, we’ve ignored each other and at times I might have even despised you yoga but just like any true friendship or soulmate you’re are always there for me when I need you most. You hold up the mirror, make me pause, reflect and ultimately grow.
To anyone who hasn’t ever set foot in a yoga class or perhaps only dabbled in a few classes here in there I know this all sounds completely abstract, annoyingly esoteric and frankly if I didn’t love yoga so much, I’d be chaffing my nuts too.
Like any successful and nurturing relationship this has taken time and hard work. It’s taken devotion, grit and incorporating yoga into every part of my day and life.
I thought I couldn’t love it any more…

6 Reasons Why Yoga is Even More Amazing with a Baby-on-Board.  

1. Breathing and stress reduction.
Your hormones are surging, your butt is now a booty and climbing the stairs feels like a freaking marathon. But that’s ok. Pregnancy is one big transition, one huge unstable, uncertain journey of highs and lows, self-doubt and immeasurable excitement. Motherhood will be the same. Life is the same. Yoga teaches you to keep calm and breathe through it.
Yoga is a fundamentally a moving meditation and the practice itself is 100% about breath and using this to center and relax yourself no matter what’s going on around or inside you. Deep, slow, mindful breathing has the ability to calm the central nervous system like no other technique out there. Yoga’s anti-stress benefits are a host of biochemical responses and there’s research to prove it.
The deep breathing decreases catecholamines, hormones produced by the adrenal glands in response to stress. Lowering levels of hormone neurotransmitters — dopamine, norepinephrine, and epinephrine — creates a feeling of peace and some research points to a boost in the hormone oxytocin. This is the “trust” and “bonding” hormone that’s associated with feeling relaxed and connected to others and this hormone even gets transmitted across the placenta to bubby!
Learning ujjayi breathing (yogic breathing) prepares you for labor and giving birth by teaching you to stay calm when you need it most. Fear and panic make the body stop producing hormones like the aforementioned oxytocin that help the birth process and this in turn slows or stops labor’s natural progression. Essentially a regular yoga practice will teach you how to use breath to relax.
2. You stop being a p*ssy.
On the surface yoga may seem all sweetness and light but really it’s not. It’s discipline and dedication and some ugly stuff can come up, leaving your true nature exposed. You inevitably become more aware of your habits, good and bad. You notice when you’re pushing yourself too hard and the flip-side of that is you are also very cognizant of when you aren’t nutting up and putting your best foot forward. Pregnancy can be a time when women are far to easy on themselves and use it as an excuse for all sorts of unproductive habits and behaviors. Being a complaining, pain in the butt ain’t fun to be around for anyone. Sure, we need to listen to our bodies and cut ourselves some slack but it’s that doesn’t mean it’s an excuse to stop functioning to your fullest potential or highest self.
3. Health. 
This age-old practice has unlimited health benefits. It keeps you fit, limber, tones your muscles, and improves your balance and circulation, with little, if any, impact on your joints. A mindful yoga practice will enhance your pregnancy and work on muscles that every pregnant woman needs to keep strong, like the spine, obliques and the very, very important pelvic floor. No one wants to be peeing their pants when they laugh just because they’ve had a baby. It also helps to open parts of your body that will need to ‘open’ in labor like the hips and pelvis.
Most women, with the guidance of a qualified prenatal teacher can practice with no worries about harming the baby. In fact, some common complaints during pregnancy such as fatigue, backaches, headaches, nausea or even moodiness can be completely alleviated. Yoga has also been proven to reduce high blood pressure, slow the heart rate, balance hormones and of course manage stress.
4. The tools you take off the mat and into the world.
A bi-product of a regular yoga practice is cultivating acceptance, patience, the ability to let go, compassion and non-judgment. I’m not saying I’ve completely nailed any of these but man, I’ve got more tools in my tool box when it comes to dealing with anything life throws at me and pregnancy has thrown me more than a few curve balls. It teaches you to turn inward and look to yourself for answers not to external influences, people or things.
5. Connection with your baby.
You and the little beam of light inside you are on this journey together. As you become more observant of your own body, you become more in tune with the little person growing inside you. When you are calm and centered you can turn your mind and energy inward toward your tiny buddy which helps develop a bond before birth. All the feel-good chemicals produced by this are felt by both mother and baby.
6. Trust.
Yoga has taught me to lighten up, to trust life’s process and to trust myself. It’s given me a confidence in myself I’ve never had before. Of course this will forever be a work in progress but I have a powerful sense of my own strength, vitality and goddess-ness even as my body rapidly changes. As I move towards giving birth and being a Mama this is probably the most important of all.
One of the wonderful things about yoga is that you can start anywhere, anytime. You are NEVER too old or too inflexible. If you’re pregnant and new to yoga then a prenatal class is the best way to start. Even beginners will feel positive effects immediately. It’s important to have an experienced teacher who has worked with women in all trimesters. He/she will be able to help you work with props like blankets and bolsters and show you the optimum poses to encourage a healthy, stress-less pregnancy.
There really isn’t a more incredible way to enhance your pregnancy, deepen your connection with yourself and your baby.