Are you pregnant, or plan to be in the near future? 

Now is the best time to schedule an appointment for pregnancy counseling or pregnancy therapy. Even if it is a single get-to-know-you session, having a therapist who already knows you and your history makes it easier to ask for help in the future. This is particularly important if you are at higher risk for a perinatal mood disorder because:

• you have had a mood disorder before (anxiety, depression, bipolar disorder)
• you struggled with infertility
• you have experienced a pregnancy loss
• you have significant stressors in a major life area (relationship, financial, health)
• you have a history of trauma, including a previous traumatic birthing experience

With so much going on during pregnancy, it is easy for both women and medical providers to overlook signs that a mood disorder is developing.

So, I want to set the record straight. If you have any of the following symptoms more often than not during pregnancy, they are warning signs not to be ignored:

• Worry that consumes your thoughts. Worry that makes it hard to enjoy things. Worry that keeps you up at night. Yes, every woman worries some about whether baby is growing well, about whether baby will be healthy, about what labor will be like. But these worries should be fleeting, not constant and disrupting.
• Deep, constant, extreme fatigue that lasts past the first trimester and is accompanied by sadness or feeling emotionally numb.
• Inability to fall asleep after 20 minutes of laying quietly. It is normal in pregnancy to wake multiple times through the night to go to the bathroom or, in the last trimester, from physical discomfort. But if you are unable to return to sleep, especially if it is because you can’t turn off your mind, it is a sign that something else is going on that needs to be addressed.
• If you aren’t able to do what you need to do because you are counting, recounting, cleaning, organizing, and ordering baby items or things needed to prep for birth (or anything, really!)
• Constant sense of sadness or intense irritability.
• Crying daily. Some moodiness is normal during pregnancy. Crying daily is not.

You may not have a mood disorder, but if you have any one of these symptoms it is a good idea to have an evaluation. Even a few sessions of planning and support can help prevent significant difficulties later on.

A Word (or two) on Medication

Finally, if you have been taking medication for a mood disorder and are planning to become pregnant, it is important to consult your healthcare provider in deciding whether or not to continue that medication while pregnant. All medicine has risks for the fetus, but an untreated mood disorder also has known impact on fetal growth and development. There are medications you can take during pregnancy. Eighty percent of women who stop medication when they become pregnant have a relapse of their mood disorder during pregnancy. If you choose to stop medication before or during your pregnancy, having a therapist who can help you watch for signs of relapse, and who can provide treatment if needed is a way you can take care of yourself and your growing baby.