Antepartum Depression

I made an appointment with a therapist for later this week.

I am worried about antepartum depression. As a psychologist, you would think a self-diagnosis would be simple. However, mixing in pregnancy symptoms makes it more complex and I decided after calling off work twice last week that I need to be proactive.

Antepartum depression, or depression that occurs during the pregnancy, is more common then most realize, affecting 12 - 20% of women by some estimates. There are many risk factors, including previous history of depression, pregnancy complications, and IVF among others.

Here are the symptoms of depression:

1. depressed/sad mood, 
2. loss of interest in normal activities and relationships (called anhedonia), 
3. fatigue, 
4. concentration difficulties, 
5. sleep disturbance (insomnia or hypersomnia), 
6. psychomotor agitation or retardation (physically feeling agitation or slowed down), 
7. significant weight loss or weight gain, 
8. thoughts of death or suicide, 
9. feelings of worthlessness or guilt.

A diagnosis of depression is warranted when a significant number of these symptoms is present, more often then not, for greater than two weeks, results in impairment in life functioning, and isn't better explained by something else.

This last part complicates things. Pregnancy, combined with a long-lasting respiratory illness that I can't seem to shake from a lowered immune system, also can cause many of these symptoms. It begins with sleep disturbance (in my case, both insomnia and hypersomnia) and fatigue. The fatigue results in concentration difficulties. The fatigue and changing body shape then escalate into psychomotor retardation. Then I am no longer productive and feel like a less-then-adequate mother to my toddler... and now we have feelings of worthlessness and guilt. Significant weight gain clearly doesn't even count in this scenario.

That leaves depressed mood, loss of interest in normal activities, and thoughts of death/suicide. Those are really the only symptoms that can't be explicitly tied to pregnancy. I can clearly rule out the last of these. So how is my mood and my interest? Mostly, "blah".

This is what has me concerned. I haven't felt any lasting joy in this pregnancy. I am too tired to care about much. Objectively, there are some very exciting things going on around me - at work, with family, etc., but I struggling to find enthusiasm for them. Last week, I called in sick two days in a row. The first day was mostly due to illness, but then I realized by the second day that I was really just avoiding work. And I love my job and it is going really well. But I struggle to get there and make an effort. How much of this is due to fatigue versus depression? I can only compare to my last pregnancy, when I don't recall feeling quite this miserable.

So I made an appointment. Because talking to someone and getting another opinion never hurt.

Thankful

I have not felt creative lately. Actually, I have still been feeling low energy and unenthusiastic about most things; blog-writing, work, pregnancy. Despite this, I keep chugging along. In reality, I am grateful for where I am at and what is going on in my life. I need to do a better job of embracing this.

I am thankful to be pregnant with our second child. We are extremely lucky that our IVF was successful on the first attempt for both pregnancies. We are blessed with what is currently a second healthy pregnancy with minimal complications currently. I will be 18 weeks tomorrow and thus far have only had to contend with fatigue, intermittent nausea, and growing heartburn. It is thus far remarkably similar to our last pregnancy. At my last OB visit, my blood pressure was excellent and my weight was "good". (I am up more weight then I would have liked at this point given starting off overweight again, right around 11 pounds, but it's too bad so I am just accepting it for it is.)

I am thankful for my daughter. She lights up my life and brings me such pride and joy. Yes, there are days when I feel too tired and apathetic to be a good parent and lose interest in her repetitive play, but mostly I love watching her grow and develop.

I am thankful for my husband. Lately, likely due to some hormonal surges, I have felt such a renewed of love for him. I cannot believe that we've been together for over a decade now and we still enjoy each others' company. He is such a great father and I am so lucky to have him as a partner.

I am thankful for my job. It is secure and it generally brings me a sense of accomplishment and goodwill. There are many days that it also brings me stress, but I would also never be content in a job without a challenge. It also provides an income that helps us to feel relatively financially secure.

I am also thankful that we are currently in a place where I am optimistic we will be able to weather the next four years. We both have stable jobs and a 30-year-mortgage in a home we love. Our daughter will hopefully have no memories of a time when the country turned its back on women, immigrants, and minorities. I have full faith in MLK's words that "The arc of the moral universe if long, but it bends towards justice".

Still here. Still Pregnant.

I am alive. I am still pregnant.

We went forward with telling my immediate family during the break between the wedding and reception. Our daughter changed into "nap" clothes from the dress she was wearing in the hopes she would nap during the break. Her nap clothes consisted of a shirt that said "Big Sister, Est. 2017". She walked out proudly, with no real idea what message she was delivering, and the family quickly caught on. They were excited. My mom expressed concern that "she's so young", being all of 2.5 years when the new baby will arrive, compared with the 4 year age gap between me and my next youngest sister. I made multiple comments that it was extremely early and we were still guarded.

The morning of my second blood test, I bled again for the last time. The test came back high and with a good doubling time.

Two weeks after this, at approximately 7 weeks gestation, I had my last ultrasound with the RE. One healthy heartbeat. I could feel C's relief. My own disappointment felt selfish and unnatural. They offered no explanation and no real concern for the bleeding.

I put off the first OB appointment because of my experience last time. Then I panicked because I wanted to have the nuchal translucency scan completed and we were approaching the deadline for scheduling this and would be out of town one the weeks in the acceptable window. My daughter came to the appointment did very well "reading books" during the PAP test and full exam. No confirmation of life was completed, but I was okay with this because I knew what to expect this time.

Instead I scheduled the nuchal translucency scan as soon as possible to confirm life. I think I was secretly and partially hoping that they missed something during the first ultrasound. That the second embryo implanted and was growing secretly this whole time. That the bleeding was not a miscarriage.

The scan went well. All is normal with minimal risk for the screened genetic conditions. Still one baby, now the size of a strawberry.

I have been feeling a near-constant combination of nausea and heartburn. It almost feels like constant car-sickness. All topped off with overwhelming fatigue. Sometimes the nausea is worse and sometimes the heartburn is the dominant symptom, but I am rarely getting full relief.

I debate with myself if I feel worse then last time or if it just seems worse because I am now juggling pregnancy with mothering a toddler and home-ownership, in addition to the full time job I managed last time. Either way, it has not been pleasant.

I feel guilty for being a "lazy" parent. I feel apathetic towards my work. I often feel disengaged with this pregnancy, despite my tightening waistband. I have been obsessed with trying to guess the gender, both hoping this well help me to feel more connected and also anxious that my daughter may never get to experience sisterhood.

Officially beginning the 13th week, I am hopeful the second trimester will bring more enthusiasm and less negativity.