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Clinical Depression Prior to Pregnancy - What Do I Need to Know Before Conception?
By Karen Kleiman, MSW
Q.I'm being treated for clinical depression. Do I need to know anything special before I get pregnant?

A. This is an excellent question and you are smart to be vigilant about this before moving forward with your decision to get pregnant. The answer really depends on several things:

  1. Your personal history of depression: How many episodes? How severe? What treatment? How did you respond to treatment?

  2. Your family history of depression: How prevalent is it in your family? How severe?

  3. Your current situation: What treatment are you currently receiving? Is your treating physician comfortable continuing treatment during and/or following pregnancy? Have you evaluated your support network and determined it to be sufficient?

It goes without saying that we hope you do not experience depression during your pregnancy or the postpartum period. However, your history of depression does increase your risk, so it's best to prepare for the possibility and then hope for the best.

A point I emphasize in one of my books, What Am I Thinking? Having a Baby After Postpartum Depression is that one of the best things you can do to prepare for pregnancy and the postpartum period is to fortify your resources. This includes: your professional support team, your personal and family support team, as well as your physical and emotional self. Everyone on board needs to be on the same page. For instance, you and your husband should discuss how you both feel about being on medication during pregnancy, if that is indicated or during breastfeeding, if you should decide to breastfeed. This is just one example of a potential area of dispute; people have very strong and passionate opinions about this. As a professional who specializes in this area, I would emphasize that there are, in fact, medications you can take that are compatible with pregnancy and breastfeeding, but this always requires a risk/benefit analysis on an individual basis. And of course, it is always preferable to support women with non-pharmacologic interventions whenever possible.

So my first suggestion would be for you to discuss this decision with your doctor and/or therapist. Make certain you are being treated by someone who is both familiar with the options as well as someone who holds opinions that are consistent with what you and your partner desire. You will find that there are more and more clinicians who are specializing in this area. [For a list of therapists who are experts in perinatal mood disorders you can check out Postpartum Support International or you can see a list of clinicians who have taken the post-graduate training program that we offer at The Postpartum Stress Center]

In summary,

  1. Eat well
  2. Rest
  3. Exercise
  4. Maintain an open dialogue with your partner
  5. Activate your support system
  6. Review plans with healthcare team
  7. Make specific plan regarding your treatment, meds, etc.
  8. Resume or continue therapy for support
  9. Be proactive; do not presume you will not get depressed
  10. Be your own best healthcare advocate; get information, reach out for support, protect yourself.

Karen Kleiman, MSW, Director, The Postpartum Stress Center, is author of several books on postpartum depression. Her newest book, Therapy and the Postpartum Woman: Notes on Healing Postpartum Depression for Clinicians and the Women Who Seek Their Help (Routledge) will be available August, 2008.

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