Not Always 'The Happiest Time'; Understanding pregnancy and depression.(Cover story)

Byline: Lisa Miller and Anne Underwood (With Joan Raymond and Emily Flynn Vencat)

Let's just say that you are among the millions of women for whom pregnancy was not bliss. You may have felt cranky or anxious, exhausted or fat, moody, stressed, nauseated, overwhelmed, isolated or lonely. You may even have felt bad about feeling bad. Now let's say that you, like Lynne Walder, are a jet-setting executive who loves life. But then you get pregnant, and what was supposed to be the happiest time in your life triggers a flood of hormones and changes that make it feel like the worst thing that ever happened to you. Walder, 39 years old and from Nottingham, England, felt her mood plummet six months after she conceived. Although she put on a brave face to her colleagues, her family and her doctor, to her private journal she confided thoughts of suicide. "There's this collusion around motherhood and pregnancy," she says. "Everyone makes you believe it's fantastic and wonderful, but for some of us, it's destroyed us."

Contrary to conventional wisdom and medical lore, pregnancy does not necessarily equal happiness, and its hormones do not protect against depression. Doctors estimate that up to 20 percent of women experience symptoms of depression at some point during their pregnancy--about the same as women who are not pregnant. Even as postpartum depression has become TV-pundit fodder, the problem of depression during pregnancy has remained hidden--largely because most people still assume that pregnancy is or should be the realization of every woman's dream. When she was training as a psychiatric resident in the 1980s, Katherine Wisner, now a professor of psychiatry and OB-GYN at the University of Pittsburgh, remembers being told not to worry about pregnant patients who were, in her view, "very ill." Pregnant women, her teachers said, are "psychologically fulfilled."

Finally, pregnancy-linked depression is coming into the open. A series of studies, published this year in medical journals, is looking at all aspects of the problem--with special focus on the effects of antidepressants on the health of pregnant women and newborn babies. These studies have launched, for the first time, a serious debate among doctors over the risks and benefits of treating pregnant women with medication. "There are still unanswered questions" about SSRIs and pregnancy, says Lee Cohen, a psychiatrist at Mass General Hospital in Boston and author of one of the recent studies. "But the doctors--the psychiatrists, the OB's--can't be cavalier, and can't presume that [without treatment] things are going to be fine."

Pregnancy probably doesn't cause depression, per se, but can trigger it in women who may already be genetically predisposed. In a series of experiments published in The New England Journal of Medicine in 1998, ...