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FDA-cleared, non-medication depression treatment
Treating Depression during Pregnancy: Safe Options for You and Your Baby
Erika Krull, MSEd, LMHP
Medically reviewed on 12/4/2020 by
Dr. Kimberly Cress
Texas Regional Medical Director
Pregnancy is supposed to be a happy time, so why do some expecting mothers have feelings of overwhelming doubt and anxiety? If you're feeling unsettled or sad, you may think there's something wrong with you as a parent—but these feelings are actually common. You may be one of the many mothers quietly struggling with depression during pregnancy. If so, you may feel hesitant to speak up about it, but getting treatment for depression is essential. You deserve to feel healthy and well as you prepare for childbirth. Prenatal depression can be challenging, but it is treatable—and getting better starts with understanding your treatment options. If you're concerned about taking antidepressants while pregnant and want to learn about other treatment methods, Transcranial Magnetic Stimulation (TMS) could be worth considering.
When Prenatal Depression Develops
Depression during pregnancy is more common than most people believe. Still, it can be difficult to recognize and can cause expecting mothers to doubt themselves. Experts estimate that between 14 and 23 percent of expecting mothers have depression symptoms during their pregnancy. Some women feel ashamed to admit they're struggling. Despite improved openness about depression, the stigma still exists. This can be especially challenging when pregnancy and motherhood are portrayed as only positive experiences. Further, emotional depression symptoms can be easy to write off as an overreaction to pregnancy hormones. Physical symptoms such as fatigue and appetite changes can also mimic typical aspects of pregnancy. Pregnant women most at risk for developing depression typically have experienced one or more of these issues:
- High levels of stress in daily life
- One or more current or previous mental health conditions, especially anxiety or depression
- Low levels of social support
- Involvement in an abusive or violent relationship
Emotional ups and downs can be common in pregnancy and after childbirth, as well. Each time a baby is born into a family, everyone goes through an adjustment. And the stronger presence of hormones, stress, and fatigue can all play a part. The difference between typical emotion swings and prenatal depression is that these symptoms persist and become worse, causing dysfunction. Ongoing sadness, constant crying, or feelings of disconnection are signs of something more serious. Talking with your doctor can help you understand if you may be experiencing depression.
Impacts of Delaying Treatment
Expecting mothers with depression often feel frustrated when pursuing depression treatment. They want to feel better, but in many cases, they're concerned about potentially exposing their babies to an increased risk of adverse impacts from starting antidepressant medication. Some expecting mothers delay medical treatment and endure their depression symptoms for weeks or months. Counseling therapy is a safe choice, but it may not be enough to help them feel like they can perform daily activities again. While some may be hesitant to seek treatment initially, untreated depression can ultimately cause more harm to mother and baby. Without effective depression treatment, an expecting mother may be less likely to take care of herself. Depression during pregnancy can lead to physical, mental, and emotional symptoms that interfere with healthy self-care habits. This may eventually lead to:
- Eating a diet lacking in nutritious food
- Inconsistent eating patterns
- Not drinking enough water
- Skipping prenatal medical appointments
- Engaging in risky behaviors like smoking or using substances
When a pregnant woman neglects her needs, she's not the only one at risk for consequences. Untreated depression during pregnancy is linked with low birth weight and preterm birth, both of which can cause long-lasting health issues for babies. Prenatal depression also increases the risk of developing a form of postpartum depression. "Baby blues" are a common period right after birth when a mother can feel more emotional or sad than normal. While the baby blues are mild and usually resolve on their own after a few weeks, postpartum depression is the presence of stronger, more persistent symptoms and requires treatment.
TMS as a Safe, Non-Medication Option
While all medications carry some risk, there are effective antidepressants used during pregnancy. However, if you don't feel comfortable taking antidepressants to treat your symptoms, don't avoid getting help altogether. Instead, consider a non-drug option like TMS. TMS treatment involves gentle magnetic pulses directed at specific areas of the brain that regulate emotion. A TMS device is placed close to your scalp to deliver these pulses for approximately 20 minutes. The average treatment course consists of 30 to 36 sessions spanning six to nine weeks. Experts think that TMS relieves depression symptoms by improving the way neurons communicate with each other. This positive effect has been shown to reduce symptoms as soon as the fourth week of treatment.
So, what makes TMS a safe option for you as an expecting mother? TMS is non-invasive and involves no medications. Some people experience mild discomfort, such as a brief headache. But these effects are typically short-lived, and most people feel comfortable going about their normal activities immediately after a treatment session. Nothing enters the bloodstream, and the magnetic pulses are not harmful to you or your unborn baby.
Prioritizing Treatment for Prenatal Depression
During pregnancy, you're more watchful than ever about what you put into your body. If you're experiencing depression, you may be weighing the pros and cons of antidepressant medication. Instead of putting off essential depression treatment, consider TMS therapy as a safe option. Keep both you and your baby healthy by getting the depression treatment you need.
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Starting any medical treatment for the first time can leave you with questions, especially if you’re looking forward to the benefits it may bring. It’s no different when you’re preparing for your nasal esketamine treatment. Your previous mental health treatments may have consisted solely of taking antidepressants at home or visiting a therapist’s office for cognitive behavioral therapy (CBT), so nasal esketamine is probably a new treatment experience for you. If you're wondering what it's like to start nasal esketamine and get ready for your first session, keep reading. Getting Started with the Nasal Esketamine Treatment As with any new treatment, you’ll first talk to your primary care provider or psychiatrist about whether nasal esketamine is a good fit for you. Alternatively, you can schedule your esketamine nasal spray consultation with a treatment center (such as Greenbrook) that has certification by the FDA’s Risk Evaluation and Mitigation Strategy (REMS). At Greenbrook's REMS-certified nasal esketamine treatment centers, our Greenbrook-affiliated psychiatrists and psychiatric nurse practitioners will review your medical history and also conduct our own assessment to help determine whether nasal esketamine treatment is right for you. Certain conditions, including blood vessel disease and a history of psychosis, may make treatment a risk for you. Make sure you discuss all previous and present conditions with your doctor or nasal esketamine provider before beginning treatment. If the medication is deemed a good fit, you’ll receive your prescription from the Greenbrook-affiliated provider. Your Greenbrook Care Team will put together a personalized care plan for the weeks and months to follow. Keep in mind that you will need to take a standard (oral) antidepressant along with your nasal esketamine treatment. There are two important regulations to note when it comes to preparing for treatment: Each treatment is followed by a mandatory two-hour observation period. This means you will need to plan to stay at the center for at least two hours following your self-administration of the esketamine nasal spray. You cannot drive during the rest of the day after treatment and must arrange for transportation. These regulations are mandatory. It may be helpful to sit down and plan out several weeks’ worth of transportation once you know your treatment schedule. In addition, if you’re wondering what to bring for the treatment, we recommend entertainment such as an audiobook or playlist of favorite songs and a pair of headphones. You may want them during the two-hour observation period. What to Expect During Nasal Esketamine Treatment On the day of treatment, you’ll need to stop eating any food two hours before your appointment and stop drinking all fluids 30 minutes before you come in. Your Greenbrook Care Team will confirm that you are prepared for the two-hour observation period and that you have a ride home. You’ll get the opportunity to practice using a “trainer sprayer” that mimics the real nasal esketamine sprayer but does not release any medication. The Care Team will encourage you to use the restroom and set up your preferred environment in your private treatment bay or room. Some patients like reduced lighting, for example, while others don’t request light adjustments. You’ll complete a depression scale before each treatment session. Your Greenbrook provider will confirm that the dose kit is yours, show you how to administer it, and then hand it to you. Each sprayer contained 28mg of Spravato esketamine nasal spray. Patients usually start with two sprayers (56mg) and soon increase to 84mg (three sprayers) per treatment. But, your dosage maybe vary. Should you be left with a metallic taste by the spray, the Care Team will offer suckers to help make the flavor dissipate. After your dose, you’ll be encouraged to lie back in your comfortable recliner. While most patients enjoy a quiet setting, Greenbrook is prepared to accommodate patients with a more animated reaction to the medication. You may feel sleepy, dizzy, mildly dissociated, and/or nauseated during treatment. Greenbrook's Care Team is readily available if you need assistance. How to Prepare for after your Nasal Esketamine Treatment Most side effects begin to wane in the second hour of observation, but if you’re wondering, “Is it safe to drive immediately after nasal esketamine treatment?” the answer is a resounding no. In addition to the mandatory ride home, you will need to block off time to rest and let side effects fully dissipate. This extended rest period is especially important in the first weeks of treatment when you’ll have treatment twice a week. Do not drive or operate machinery of any kind until the day after treatment. Just take it easy, relax, and take care of yourself. If you’re unsure what activities you can do or should avoid during this time, talk to your Care Team for more information. While side effects tend to dissipate completely after a good night’s sleep, many nasal esketamine patients begin feeling relief from depression symptoms within hours of their treatment. Other Tips in Preparing for Your Nasal Esketamine Treatment At Greenbrook, we make every effort to schedule your treatment in the afternoons or whenever it is most convenient for you. We encourage you to see each treatment session as an opportunity to relax and take care of your mental health. If you have any questions or concerns, talk to your doctor or the Greenbrook Care Team. At Greenbrook, we’ll help you feel at ease when preparing for each treatment session. Schedule A Free Consultation To get started with nasal esketamine, schedule your free consultation today.
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