By Kim Hooper | July 19, 2021

"​Many men struggle with mental health after becoming fathers. But stigma and societal norms keep them from getting help."

"When I was pregnant with my daughter, my husband and I took a parent prep class in which they talked at length about the signs of maternal postpartum depression. My husband took detailed notes. After all, I had a history of depression and occasionally fell down dark, deep rabbit holes from which only medication and therapy could pull me out.

My husband, on the other hand, is the epitome of stable. When his parents died in our first few years of knowing each other, I required more comforting than he did. If I had taken bets on who between us would suffer depression following the birth of our daughter, every single one of our loved ones would have bet on me. And I wouldn’t have blamed them.

But it wasn’t me.
​
I’d never thought about the possibility of men struggling with depression after the birth of a child. At the time I was focused on the well-being of our daughter, as well as my own physical and mental health. But men do struggle also.
​
As many as one in six men can experience high levels of anxiety in the postpartum period, and about 10 percent of new dads experience postpartum depression. In the 3- to 6-month postpartum period, that rate climbs to 25 percent.

Perhaps the fact that my husband was low on my list of concerns contributed to the problem, a problem that dramatically impacted the first three years of our family’s life.

Recognizing depression
One weekday morning in 2019, while watching our then-21-month-old daughter sitting in her high chair, shoveling fistfuls of oatmeal into her face, my husband said:

“I hate this time of day.”

“Why?” I asked. From where I stood, it was all rather pleasant.

“I just hate parenting,” he said. “It’s relentless.”

I was not surprised to hear this. I had suspected a problem and had even started reading about postpartum depression online.

The Diagnostic and Statistical Manual of Mental Disorders defines depression “with peripartum onset” as a major depressive episode during pregnancy or within four weeks after birth. For men, this may develop more slowly over a full year.

Typically, symptoms of a major depressive episode may include feeling sad, crying, having recurrent thoughts of death and losing interest in activities. According to Sheehan D. Fisher, an assistant professor of psychiatry and behavioral sciences at Northwestern University, symptoms for men can differ.

“The actual DSM diagnosis of depression doesn’t always fit how men experience depression,” Dr. Fisher said. For men, symptoms may include frustration, agitation and irritability, an increase in dopamine-boosting activities (drinking, drugs, gambling) and isolation.

That was my husband — frustrated, irritable and detached. He went to bed before 7 p.m., claiming exhaustion, though I was the one getting up with our daughter every night. He snapped at the littlest things. He just wanted to be left alone.

I tried to help with pep talks: “She’s a good kid! We’re so lucky!” Then I remembered how, when I was depressed, such cheerleading only made me feel worse, as if I was letting others down with my inability to snap out of it.

So I whisked our daughter off to playgrounds, giving him time to lounge on the couch or obsessively clean, something he’d taken up as a hobby. I encouraged him to go surfing or grab a beer with a friend, but he shrugged off these suggestions.

I tried to initiate conversation, by asking how he felt. He just kept saying, “I’m fine,” a lie familiar to me from my own depression days. Unlike women, men are often socialized to value independence, dominance, stoicism, strength, self-reliance and control over their emotions, and many see weakness as shameful."​

By Christin Perry | February 25, 2020

​"Almost as soon as those two pink lines pop up on a pregnancy test, your hormones get the message that something's different at mission control. Progesterone and human chorionic gonadotropin (hCG) begin pumping to signal your body to halt production on your next menstrual period, and begin forming that cluster of cells into a mini-you instead. As you probably already know, as these hormones get to work, you'll experience an onslaught of early pregnancy symptoms like nausea, fatigue, and breast tenderness.

As pregnancy progresses, our bodies produce extraordinary amounts of estrogen and progesterone, says Aumatma Shah, fertility specialist and naturopathic doctor at the Bay Area's Holistic Fertility Center. "These two steroidal hormones are key to creating dopamine and serotonin, two neurotransmitters in the brain that are important in feeling calm and happy. This is why a lot of women feel amazing when pregnant: Pregnancy offers a surge of hormones and neurotransmitters that help us feel great."

But what happens to those feel-good pregnancy hormones once your baby is born? "Unfortunately, immediately postpartum and the week following delivery, estrogen and progesterone will both plummet. Simultaneously, there will be a surge in prolactin and oxytocin," says Shah.

These wildly swinging hormones are to blame for those crazy emotions you'll experience after giving birth. Here's a closer look at what happens to your hormones postpartum and when so you know what to expect—and so you know the loony emotions you're feeling are all completely normal.

​What Happens to Hormones Immediately After Giving Birth?
The birth of your sweet bundle of joy is undoubtedly one of the most exciting moments of your life. No matter how long you labor or what time you give birth—yes, even if it's at 3 a.m.—you'll likely feel an amazing, indescribable high when you meet your baby for the first time, or shortly thereafter. But those surging hormones will plummet over the next few days. Here's what's going on:

• Progesterone and estrogen decrease as soon as baby and the placenta are delivered.
• Oxytocin surges immediately following birth to compensate for the initial drops in progesterone and estrogen. This hormone is responsible for that strong mothering instinct you'll feel, but you'll probably still experience some "baby blues" in the first few days postpartum as the oxytocin works itself out of your system, says Shah.
• Prolactin increases to encourage breast milk production.

Postpartum Hormones at 3 to 6 Weeks
After those first few weeks pass, you may start to feel those rollercoaster-like emotions start to regulate a bit as you begin to get into the groove of caring for baby and get used to the lack of sleep. Ashley Margeson, a naturopathic doctor says, "the first three months are a bit of a whirlwind of sleep loss and emotions as your system runs mostly on adrenaline to move you through the day."
​
Around the six-week mark, she says, symptoms of postpartum depression may begin to show as those positive post-birth hormones continue to fade. "The changes you should look for closely are not wanting to shower or focus on hygiene, being afraid of leaving your baby with someone else, not being able to sleep fully due to continually checking on baby, and lack of desire for common tasks like eating, drinking, being around people, and leaving the house."

By: Pregnancy & Postpartum TV | March 6, 2019

"Prenatal Yoga Bedtime or Prenatal Yoga Before Bed. Help get to sleep with this prenatal bedtime yoga or prenatal bedtime stretch. Prenatal yoga bedtime as a pregnancy insomnia remedies."

By Wendy Wisner | Medically reviewed by Carly Snyder, MD |Updated on June 14, 2021

"What Is Prenatal Depression?
Prenatal depression, also called perinatal depression, is depression experienced by women during pregnancy. Like postpartum depression, prenatal (or perinatal) depression isn’t just a feeling of sadness—mothers who experience this mental health disorder may also feel anxious and angry. 

You've likely heard of postpartum depression—and that's a good thing. The more that postpartum depression is talked about and understood, the more mothers will seek the help they need so that they can feel better and live full and healthy lives as new moms.

But prenatal depression is a maternal mood disorder that hasn’t gotten nearly as much attention as it should. While prenatal depression can be treated, many expecting mothers don’t even know that it’s a “thing” and therefore don’t seek treatment for it.

Many feel ashamed to even share how they are feeling. After all, you are supposed to be overjoyed and excited when you are expecting a baby, right? It’s easy to feel guilt and shame when you are feeling the exact opposite.

Here’s what you should know about prenatal depression, including how common it is, what to look for in terms of symptoms, and most importantly, how to get help.

​How Common Is Prenatal Depression?
Like postpartum depression, which impacts as many as 1 in 7 new moms, prenatal depression is actually quite common.

According to a journal article by Maria Muzik, MD, and Stefana Borovska, published in Mental Health in Family Medicine, 13% of pregnant moms experience depression.

​As the authors note, perinatal depression (both prenatal and postpartum) is even more common among mothers facing adverse experiences, such as a history of depression or economic hardship.

“The prevalence of perinatal depression is even higher in vulnerable groups with certain risk factors,” the authors explain. “Young, single mothers, experiencing complications, with a history of stress, loss or trauma are far more likely to succumb to depression. Furthermore, one study found that up to 51% of women who experience socioeconomic disadvantage also report depressive symptoms during pregnancy.”

It's important to note prenatal depression doesn’t discriminate: You can experience it whether or not you have pre-existing risk factors. Always remember there is no shame in experiencing a serious bout of depression during pregnancy, and you are not alone.

​Causes
Similar to postpartum depression, experts can’t pinpoint one particular cause of prenatal depression, but have hypothesized that it’s likely caused by a confluence of factors—a “perfect storm” of triggers that come to a head for some mothers during their pregnancies.

Either way, it’s important to note that whatever caused your prenatal depression, it most certainly wasn’t your fault. There was nothing you did wrong, and you are not a bad mom (or going to be a bad mom).

“Depression and anxiety during pregnancy or after birth don't happen because of something you do or don't do—they are medical conditions,” notes the Academy of American Pediatrics (AAP).

“Although we don't fully understand the causes of these conditions, researchers think depression and anxiety during this time may result from a mix of physical, emotional, and environmental factors,” they add.

Symptoms
Prenatal depression manifests differently for every mom—you may even experience it differently from one pregnancy to another. It’s important to understand that anytime you feel overwhelmed by your emotions, unable to function in your day-to-day life, or just “off,” you should reach out to discuss your feelings with a trusted loved one or medical provider.
Here are some of the most common symptoms of prenatal depression:

• Anxious thoughts and excessive worry about your baby
• Feeling hopeless and overwhelmed
• Lack of interest in activities you used to enjoy
• Feeling guilt about how you are feeling, or guilt in general
• Feeling less interested in eating, or overeating eating
• Having trouble concentrating
• Having trouble sleeping
• Racing thoughts
• Anger
• Reluctance to follow prenatal health guidelines
• Not believing others when they try to reassure you
• Pushing others away, wanting to disconnect from loved ones
• Participating in unsafe prenatal activities, such as smoking, drinking, drug use
• Experiencing thoughts of suicide

If you are having suicidal thoughts, contact the National Suicide Prevention Lifeline at 1-800-273-8255 for support and assistance from a trained counselor. If you or a loved one are in immediate danger, call 911. 
For more mental health resources, see our National Helpline Database."

By: Robin Elise Weiss, PhD, MPH | June 14, 2021

"Affirmations are statements that you use intentionally to instill a sense of positivity and purpose in your mind about a particular subject. You can use these short phrases and sentences to help yourself focus on and accept a positive message that you wish to remember.Affirmations are an example of using positive thinking to set an intention and increase the likelihood of positive results. Even better, they are simple to do, free, and accessible to all.

Why They Work
While there is no guarantee that affirmations will actually change the outcome of your pregnancy, some studies suggest that affirmations can reduce stress and anxiety—which can make it easier to rest, eat, and avoid issues such as headaches and fatigue. Plus, positive thoughts tend to cultivate positive feelings, which may help to make your pregnancy experience more enjoyable and relaxed.

Studies show that using positive affirmations impacts brain pathways, increasing activity in the areas of the mind responsible for self-worth, self-regulation, and core values. Researchers believe that making a regular practice of saying affirming statements can effectively shift your focus from negative emotions or stressors to your own expansive capacity to cope, bolstering your confidence and bringing you new ideas, strategies, energy, and hope for the future.

​Write Your Own
The beauty of positive affirmations is that you can write your own to use whenever you like. They can be said out loud or silently in your head, quietly whispered to yourself, or written down. In lieu of writing your own, you can also use one you have read or heard elsewhere. If it makes you feel strong, positive, and hopeful, then you're on the right track.
Remember, your affirmation should be in the present tense, as if what you wish to happen is already occurring. For example, someone who is worried about coping with childbirth might say, "I am strong." A person who is trying to get pregnant and having difficulty might say, "I am a good parent to my child."

This person might decide to repeat the affirmation every morning as a reminder of their goal and to foster their hope for this desired outcome. During infertility treatments, they might visualize this affirmation while undergoing procedures and tests, as well. During pregnancy, daily pregnancy affirmations may serve to enhance the mother's bond to their growing baby while also alleviating the worry that something might go wrong.

How to Do It
​Anything that speaks to you can work as an affirmation. If you're unsure, brainstorm statements that connect to the feelings, values, and intentions you want to affirm. If you have a specific worry or negative thought that keeps coming to mind, try flipping it around to a positive one.

If you catch yourself thinking, "I can't do this," counter that with, "I can do this." "Childbirth is scary" becomes "childbirth is beautiful." Simple is good. Setting your positive intention can literally change your mind.

​To help you get started writing your own affirmations, consider beginning with phrases like the following:

• Breastfeeding is
• I am
• I believe
• I feel
• I know
• My baby is
• My body is open to
• My body knows
• My heart is
• My labor is
• My mind is open to"

​"When we meet with women for perinatal psychiatry consultations, we now ask about vaccinations.  It’s not something we typically do, but after the last year, we are now getting involved in their decisions regarding vaccination against COVID-19.  Just as we counsel women to avoid alcohol and to consistently take their prenatal vitamins, providing information on the COVID-19 vaccine is an important aspect of promoting the health of pregnant and postpartum women.  

Considering a growing body of evidence indicating that pregnant women are more likely to have certain manifestations of severe COVID-19 illness,  including admission to the ICU and mechanical ventilation,  the American College of Obstetricians and Gynecologists (ACOG)  has urged the CDC’s Advisory Committee on Immunization Practices to include pregnant and lactating women in the high-priority populations for COVID-19 vaccine allocation.   ACOG clearly states that all pregnant and lactating people should be allowed to receive the vaccine, and that their decision to do so should be based on a careful discussion of risks and benefits with their healthcare provider.   

From our vantage point, there are other benefits to the COVID-19 vaccine.  During the past year, before the vaccination was available, we watched as pregnant and postpartum patients undertook the most extreme forms of lockdown.  Many of these women were literally housebound: never leaving the house and cutting off contact with friends and family, while at the same time taking on more childcare responsibilities as outside care providers and day care centers were no longer available.  And all the while wondering what would happen if they or a member of their family felt ill?

We are yet to fully appreciate the impact of the COVID-19 pandemic on perinatal women, but preliminary studies indicate that during the lockdown, pregnant and postpartum women reported higher levels of stress, loneliness, depression, and anxiety.   And this is not really a surprise.  So many of the things we typically recommend to reduce stress and social isolation, such as exercising regularly or spending time with friends and family, vanished.

While it might seem like the pandemic is fading into the distance, the resurgence of the pandemic in places like India and Brazil where immunization rates are low, we cannot be so sure about this.  So far the most successful way to avoid becoming seriously ill with COVID-19 is to get vaccinated.  
​
A recent article in Medscape, however, suggests that mothers appear to be less likely to get vaccinated than others in the general population.  According to a recent poll from Morning Consult, about two-thirds of adults in the US have either already been vaccinated against COVID-19 or plan to do so.  In contrast, mothers are the most likely to be hesitant about the vaccine.  In this study, 51% of the mothers reported that they are unwilling to get vaccinated or are uncertain about getting vaccinated, at 51% (compared to 32% of other women and 29% of fathers)."

Overview
"For a new mom-to-be, experiencing sleep deprivation after the baby is born is a given. But you probably didn’t realize that it could also occur during the first trimester of pregnancy.

Most women experience sleep problems during pregnancy. Pregnant women tend to get more sleep during their first trimesters (hello, early bedtime) but experience a big drop in the quality of their sleep. It turns out that pregnancy can make you feel exhausted all day long. It can also cause insomnia at night.

Here are some of the most common culprits for insomnia during early pregnancy, plus a few tips to help you get a better night’s sleep.

What is insomnia?
Insomnia means you have difficulty falling asleep, staying asleep, or both. Women can experience insomnia during all stages of pregnancy, but it tends to be more common in the first and third trimesters. Between midnight bathroom breaks, out-of-control hormones, and pregnancy woes such as congestion and heartburn, you might be spending more time out of your bed than in it. The good news: While insomnia might be miserable, it’s not harmful to your baby.

Sheer logistics play a role as well. By the end of a pregnancy, many women have a hard time just getting comfortable enough to sleep well. During the first trimester, you might not have much of a baby belly to accommodate, but there are other issues that can prevent a good night’s sleep.

What causes insomnia during pregnancy?
Expecting? There are many reasons you might be wide awake in the wee hours. These can include:

• need to urinate frequently
• nausea or vomiting
• back pain
• breast tenderness
• abdominal discomfort
• leg cramps
• shortness of breath
• heartburn
• vivid dreams

Other causes of insomnia can be stress-related. You might feel anxious about labor and delivery, or worry about how you’ll balance work with being a new mother. These thoughts can keep you up at night, especially after your third visit to the bathroom.

It can be difficult to distract yourself from these thoughts, but try to remember that worrying isn’t productive. Instead, try writing down all of your concerns on paper. This will give you a chance to consider possible solutions. If there are no solutions, or there is nothing you can do, turn the page in your journal and focus on another worry. This can help empty your mind so you can rest.

Being up front with your partner about your feelings and worries can also help you feel better.

Develop a bedtime routine
One of the best things you can do to manage insomnia while you’re pregnant is to set up good sleep habits.

Begin by trying to go to bed at the same time every night. Start your routine with something relaxing to help you unwind.

Avoid screen time at least an hour before bed. Blue light from the TV, your mobile phone, or tablet can have an impact on your body’s circadian rhythm. Try reading a book instead.

Taking a soothing bath might also make you sleepy. Just be careful that the temperature isn’t too hot — that can be dangerous for your developing baby. This is especially true during early pregnancy.

To be safe, avoid hot tubs.

Diet and exercise
Diet and exercise can have an impact on your sleep.

Drink up
Drink plenty of water throughout the day, but minimize drinking after 7 p.m. Try to avoid caffeine starting in the late afternoon.

Eat to sleep
Eat a healthy dinner, but try to enjoy it slowly to reduce your chances of heartburn. Eating an early dinner can also help, but don’t go to bed hungry. Eat a light snack if you need to eat something late in the evening. Something high in protein can keep your blood sugar levels steady through the night. A warm glass of milk can help you feel sleepy, too."

​

"​Seaneen Molloy was excited to discover she was expecting her second baby during lockdown. With a history of mental illness, she carefully planned the pregnancy, but when her baby arrived she experienced the "terrifyingly rapid" onset of a crisis which left her unable to hold baby Jack."

"Having a baby is supposed to be a joyful experience, and for lots of women it is. However, up to 20% experience mental ill health during pregnancy and the year after birth. Tragically, suicide is the leading cause of death in new mothers.
Women who already have a mental illness are at a high risk of relapse during pregnancy - that's women like me.

I have a diagnosis of bipolar disorder and an anxiety disorder. This meant that pretty much from the moment I became pregnant, the perinatal mental health team were involved.

This includes specialist midwives, psychiatrists, nurses and social workers whose goal is to support women to stay well, and intervene quickly if they don't.

Normally, I manage my mental health by being careful with my sleep and leading a pretty boring life away from overwork and alcohol, but pregnancy chucks in a host of factors you have no control over.

Hormones rage through your body, wreaking havoc upon your mood, your energy levels and your ability to keep your lunch down. You either can't stay awake or are awake for hours - peeing a thousand times and being hoofed by tiny feet.
I had managed to stay well, and off medication, for years, but in the run-up to birth antipsychotic medication was introduced to prevent postpartum psychosis. This can cause women to develop delusions and lose touch with reality.
It's the one I was most at risk of developing due to my history of bipolar disorder, but in the end, I experienced postnatal anxiety.

My mental health had been largely OK during my pregnancy and my labour and after-care were carefully planned.
I had a calm elective Caesarean section due to a traumatic first birth, a room of my own and the baby was whisked away on his inaugural night so that I could get some all-important sleep (this bit was hard - it went against every natural instinct). A procession of midwives, doctors and social workers visited to see how I was doing.

Although I found it intrusive, it helped me feel safe. When I was discharged from hospital with my baby, Jack, I felt swaddled in care and confident everything would be OK.

It was a complete shock that I did get ill.

In the chaos of newborn-life I forgot a dose of my anti-clotting medication which is given to mothers after C-sections.
And this one tiny event broke my brain.

I went from mildly chiding the home treatment team for their postnatal visits, because I was fine, to a full-blown mental health crisis within about 12 hours. It was terrifyingly rapid - which is why perinatal mental illness can be so deadly.

My mild anxiety exploded into an all-consuming panic that I was going to die imminently from a blood clot in my lung. I couldn't think of anything else but the black terror of certain death that was coming for me - how I was going to leave my children, how I'd brought a new child into the world never to know me.

I called out-of-hours GPs describing symptoms I was convinced I had, sobbed, screamed and couldn't breathe. I terrified my husband and myself.
​
Then we hit the emergency button.

The psychiatrist came over with the home treatment team. They took my fears seriously, which I appreciated, and gave me a physical examination and the missed dose of medication. My antipsychotic medication was increased to the maximum dose and benzodiazepines - a type of sedative - prescribed, to try and calm me down.

I wasn't allowed to be left alone and the mental health team were to visit me every day where I tried to articulate my terror to their masked faces.

At first I resented their visits, but they became a 30-minute space where I could let down the exhausting facade and share how I was really feeling.

My anxiety then transformed into an obsession that Jack was going to die. I was afraid to leave the room and rested my hand on his chest all night.

If my husband took him out to the shops with his brother, I cried and paced about, imagining they had all been hit by a car. I texted him incessantly.

Everyone was saying I needed "rest", so he tried to give me space. But after the second or third breakdown, he agreed to keep his phone on loud and to answer quickly. The home treatment team also advised he give me clear timescales so I knew when to expect them home.

​But the medication also caused intense restlessness. I couldn't sit still. I couldn't get comfortable enough to hold my baby for more than a minute."

"This is a question we often hear.  One of the challenges in answering this question is the interpretation of the word “best”.  On one hand, the best antidepressant is the one that is the most likely to be effective.  On the other hand, the best antidepressant is the one that carries the least risk when used during pregnancy. What this means is that there is no single answer.  Each situation is different, and our recommendations are based on a careful assessment of the patient’s course of illness, treatment history, past medication trials, and the most up-to-date information on reproductive safety. Added to this calculation is the understanding that untreated depression also carries some risk in terms of maternal well-being and has been associated with worse pregnancy outcomes.  

Stay with the Same Treatment or Switch?
We often meet with women who have switched to a different antidepressant medication in preparation for pregnancy.  Other women make a switch when they discover they are pregnant.  These switches are motivated by the belief that there is a “safer” medication to be used during pregnancy.  The reality is that most of the antidepressants taken by women today are relatively safe and carry a very low risk to the developing fetus.  What separates one antidepressant from another is that some medications have more data to support their reproductive safety than others.  But even this distinction is disappearing; we have data to support the use of most SSRIs (with less data on fluvoxamine or Luvox), the SNRIs duloxetine (Cymbalta) and venlafaxine (Effexor), and bupropion (Wellbutrin). Tricyclic antidepressants, although not commonly used today, also have data to support their reproductive safety.  

MAO Inhibitors: 
We have very little data on the reproductive safety of the MAO inhibitors. In addition, MAO inhibitors may have serious interactions with other medications frequency used during pregnancy and labor and delivery, specifically medications used to manage pain, such as nalbuphine (Nubain) and meperidine (Demerol).  In women taking these medications, we are likely to suggest switching to another antidepressant with a better reproductive safety profile.  

Mirtazapine (Remeron):  
At this point, we have less data on the use of the newer antidepressants. There is some data on mirtazapine, with the most recent study including 334 cases of neonates with prenatal exposure to mirtazapine.  While these data are reassuring and there is no indication that mirtazapine carries significant teratogenic risk, the number of mirtazapine exposures remains small.  Ideally we would like to have data from 600-700 exposures to get a better estimate of risk.  Making decisions regarding safety on studies with small sample sizes can lead to miscalculations of risk in either direction.

Other Antidepressants: 
The data is even more limited with regard to the use of vortioxetine (Trintellix), vilazodone (Viibryd), levomilnacipran (Fetzima). If there are effective alternatives, we typically recommend switching to another antidepressant.  
In settings where we have limited data regarding the reproductive safety of a particular antidepressant, we may consider switching to an antidepressant with a better characterized reproductive safety profile.  It is important, however, to carefully consider the benefits and risks of making this switch. With any switch, there is the risk of relapse when making a change in the maintenance treatment. Thus, there are situations where we recommend continuing an antidepressant with limited reproductive safety information because there are no effective alternatives and the risk of relapse is significant.  

What About Zoloft? Isn’t Zoloft the Safest?
At some point in the early 2000s, there emerged the belief that sertraline (Zoloft) was the safest antidepressant to use during pregnancy, and many women taking other antidepressants were encouraged to switch to sertraline during pregnancy.  It is somewhat unclear where this opinion came from — maybe one paper suggesting lower placental passage of sertraline compared to other antidepressants; however, there is and never was any solid data to support the assertion that sertraline is safer or the safest antidepressant.  Reflexively switching women to sertraline puts women at risk for recurrent illness.  

While sertraline is effective for the treatment of depression and anxiety and is a reasonable choice for many women, one problem with sertraline is that it tends to be under-dosed. The typical starting dose is 50 mg; however, many individuals will need 150 mg to 200 mg to effectively manage their symptoms.  Especially when sertraline treatment is initiated in the primary care setting, we often see women whose dose is too low to effectively manage their symptoms.   

What About Paxil? Doesn’t It Cause Heart Defects?
The most current data regarding the use of paroxetine (Paxil) during pregnancy does not indicate an association between the use of paroxetine during pregnancy and risk for cardiovascular malformations.  However, in 2006, GlaxoSmithKline (GSK) elected to change product label warnings for the antidepressant paroxetine (Paxil), advising against the use of this drug by women who are pregnant. This decision was based on two preliminary studies which suggested a small increase in the risk of cardiovascular malformations among infants exposed to paroxetine in utero. For many years, this concern regarding risk of heart defects resulted in recommendations that women taking paroxetine should either stop paroxetine or to switch to a different antidepressant during pregnancy.

However, in 2008, a study from the Motherisk Program in Toronto reported on the outcomes of over 3000 paroxetine-exposed infants and found no association between the use of paroxetine during pregnancy and increased risk of cardiovascular malformations.  Nonetheless, some women and their treaters continue to feel uncomfortable with the use of paroxetine during pregnancy. Furthermore, many websites (including reputable sites like the Mayo Clinic) continue to urge women to avoid paroxetine during pregnancy because of the risk of malformations. 

At this point, we typically do not recommend switching from paroxetine to another antidepressant for pregnancy. Although paroxetine is an SSRI, there are definitely situations where an individual may respond better to paroxetine than to other SSRIs. Thus, switching to a different antidepressant may increase risk for relapse. 

What About Lexapro? And Pristiq?
There are some newer antidepressants that are derived from older parent antidepressants.  For example, citalopram (Celexa) is a racemic mixture, composed of R- and S-enantiomers (or mirror images) of citalopram.  While the S-enantiomer is clinically active, the R-enantiomer is not.  Escitalopram or Lexapro contains only the active S-enantiomer.  Because the S-enantiomer is contained in the original citalopram formulation, we can infer that the reproductive safety of escitalopram (Lexapro) is the same as that of citalopram (Celexa).
Another example is desvenlafaxine or Pristiq.  For venlafaxine to be effective as an antidepressant, it must first be metabolized by the body to desvenlafaxine.  Pristiq contains only the active metabolite desvenlafaxine.   Because desvenlafaxine is a metabolic byproduct of the original venlafaxine formulation, we can infer that the reproductive safety of desvenlafaxine (Pristiq) is the same as that of venlafaxine (Effexor).

The Bottom Line
No two situations are identical; thus, we must carefully consider each woman’s clinical history and preferences in order to select a treatment plan that makes sense.  Ideally this discussion should occur long before a woman is pregnant, so that there is ample time to consider the various options and to make changes, if necessary.  

When we meet with women to discuss the use of antidepressant medications during pregnancy, we typically consider a number of issues:

1. Determine the risk of recurrent illness: Has she had one episode of depression or does she have recurrent depression? If she has attempted to discontinue antidepressants in the past, how long was she able to remain well without medication? If she has had prior pregnancies, what happened to her mood during pregnancy and the postpartum period?
2. Assess the severity of previous episodes of depression: Did the depression contribute to missed days of school or work? Psychiatric hospitalization? Suicidal ideation? Self-harm? Suicide attempt?
3. Review past medication trials: What antidepressants have been effective in the past? Which antidepressants have been ineffective? Assess dose and duration of treatment to determine if the trial was adequate.  
4. Identify factors that may mitigate risk: Has psychotherapy been helpful? Is this an option for decreasing risk for relapse? What about other non-pharmacologic interventions: mindfulness, meditation, yoga, acupuncture, exercise?
5. Discuss options for pharmacologic treatment during pregnancy: What are the antidepressants most likely to maintain stable mood during pregnancy? What is the medication with the best characterized reproductive safety profile? Does it make sense to maintain or to switch to a different antidepressant? Even if the woman ultimately decides that she would like to avoid medications during pregnancy, it is important to discuss options for treatment, in case she relapses during pregnancy and would like to resume treatment. 

We now have data to support the reproductive safety of a large number of antidepressants.  
The perinatal psychiatry consultation should be viewed as a collaborative venture, where provider and patient decide together what is the best option for treatment during pregnancy."

-​Ruta Nonacs, MD PhD

By: Love Amy Michelle | October 28, 2017

"Love Amy Michelle is a space for you to reconnect with yourself + to find some peace amidst the chaos."

​By MGH Center for Women's Mental Health | May 18th, 2021

​By MGH Center for Women's Mental Health | May 6th, 2021

"While we have relatively limited information regarding the prevalence of obsessive-compulsive disorder (OC) during pregnancy and the postpartum period. Previous studies have indicated that women may be more vulnerable to the onset of OCD during the postpartum period. Other studies indicate that women with OCD  may experience worsening of OCD symptoms during pregnancy and the postpartum period. 

A recent study published in the Journal of Clinical Psychiatry looks at the prevalence of OCD symptoms during pregnancy and the postpartum period. They speculate that using standardized instruments for the diagnosis of OCD may fail to capture perinatal OCD, and their study incorporates a detailed assessment of obsessions of infant-related harm and corresponding compulsions.  

In this study, 763 English-speaking women living in the Canadian province of British Columbia were recruited into this longitudinal study following women from the third  trimester of pregnancy until 9 months postpartum.  The Structured Clinical Interview for DSM-5 (SCID-5) was used to confirm DSM-5 diagnoses of OCD.

The weighted prevalence of OCD during pregnancy was 7.8%, and the weighted prevalence increased to 16.9% across the postpartum period.  The estimated point prevalence of OCD diagnosis was 2.6% during pregnancy (6 weeks prior to delivery) and increased to 8.7% at 8 weeks postpartum. The point prevalence of OCD remained high (6.1%) at 20 weeks postpartum.

The incidence of new OCD cases was estimated to be 4.7 new cases per 1000 women each week during the postpartum period.  By six months postpartum, the cumulative incidence of new cases of OCD was  9.0%.  Most cases emerged during the first 10 weeks postpartum.  

In total, the researchers observed that 100 women reported symptoms consistent with a diagnosis of OCD at some point during pregnancy or the postpartum period.  In this group, 60 of the women reported onset of OCD symptoms during pregnancy or the postpartum period.  The remaining 40 women reported that their OCD symptoms preceded the pregnancy.  

High Prevalence of OCD During Pregnancy and the Postpartum Period
The lifetime prevalence rate of obsessive-compulsive disorder (OCD) has been consistently estimated to be 2%-3% in the general adult population in the United States.  The current study indicates that the weighted prevalence of OCD during pregnancy was 7.8% and increased to 16.9% across the postpartum period. Consistent with previous studies, Fairbrother and colleagues conclude that pregnancy and the postpartum period is a time of increased vulnerability to OCD.  In addition, new onset of OCD is relatively common  during pregnancy and the postpartum period, with 9% of women reporting postpartum onset of OCD in this study.  

These estimates of prevalence are higher than those reported in previous studies, a finding that the researchers attribute to using a more comprehensive evaluation of perinatal-specific OC symptoms, including intrusive thoughts of infant-related harm.  However, the authors note that some women joined the study after childbirth and may have been attracted to the study because of their experience of postpartum intrusive thoughts.  Nonetheless, this is one of the largest studies we have regarding the incidence of OCD during pregnancy and the postpartum period and is noteworthy in that it used the SCID to confirm OCD diagnoses.

Current guidelines for screening perinatal women do not specifically recommend screening for OCD.  This study indicates that perinatal OCD is relatively common and the authors recommend more careful screening for perinatal-specific OC symptoms.  They note that standardized assessments for OCD include questions about obsessions involving dirt, germs, arranging and ordering; however, perinatal OCD is more often characterized by intrusive thoughts related to harming the infant (e.g., unwanted thoughts or images of harming the infant on purpose, harm to the infant stemming from parental distraction or neglect, being sexually inappropriate with the infant).  Furthermore, given the shameful and horrifying nature of these thoughts, many women are hesitant to share these thoughts with others."

​-Ruta Nonacs, MD PhD​

By MGH Center for Women's Mental Health | May 5, 2021

By: Becky Vieira

"Dear Husband-I see you. Then and now. You might not think I did. 

I try to imagine what you endured. The pain, fear. While the primary focus was on me, my health and recovery, I know you were suffering also. Silently. Never saying a word of complaint.

I recognize all you did to get me where I am today. To get us here.

We thought we’d just be tired. That exhaustion would be the biggest of our problems once our son was born. Neither of us expected that I’d be gripped – no, controlled – by my postpartum depression. It was supposed to be the happiest time of our lives, not the living nightmare it soon became.

It started slowly, do you remember? We thought I was tired. That my hormones were adjusting yet again. But before we knew it I was underwater. The progression from healthy to dangerous transpired within days once that beast took hold of me.

How did you do it? We had a newborn. No idea what to do with him. You carried that aspirator in your back pocket at all times “just in case.” And while we watched him sleep for fear something would happen if one of us closed our eyes, I began losing my fight.

Yet you continued on.

I started to slip away. I wanted to leave, convinced you both would be better off without me. You held me when I needed it. Let me run into the street to scream, then greeted me at the door with a warm blanket and tea when I returned. Researched treatment. Medications. Called my doctor and hid my car keys when things got dark.

You also got up every morning and went to work. Held things together for us financially. All while receiving frantic calls from me. Coming home between meetings, at lunch. To check on us.

There was no guidebook for you. No one you could call to ask questions on how to handle the situation. I was wrapped in the support I found online from other mom’s with postpartum depression. But what did you have? No men on social media were presenting themselves as the husbands of women with PPD. You had nowhere to turn.

There are resources for PPD. Help. But no one can really tell you how to live through it. It felt as if we were thrust into a new universe, one that spoke an entirely different language. My mind started lying to me and my will to live was faltering. Our coping skills were stripped away and we had to find a way to survive. I needed to be healthy again.

You kept going, for all of us. Trusted your instincts and did the best you could. Yes, there were moments when I was angry over the things you said or did. But today I see that it was in my best interest. You always tried to help.
Even when I screamed at you and said horrible things. Threatened to walk out of your life because I was convinced you deserved better than a sick wife. You never gave up.

You should be proud of yourself and recognize all you did. I’m proud of you. And grateful you stayed by my side. I’ll never forget sitting on the kitchen floor, crying to you as I said, “I’m crazy.” You kissed me and said, “then I guess I’m crazy, too.” Our tears turned to laughter and I knew I’d never be alone.

We survived and our marriage is actually stronger today because of all we endured. You held it together so that I could fall apart safely. And then build myself back up again.

Yes, I spoke up. Got help. Worked on myself, started taking medication. But it would have been much harder without you by my side.

I know you suffered. Were scared. And probably angry, frustrated and hopeless at times. But I never saw that. I only felt loved and supported.
​
Thank you for everything. I see you and what you did for me and our family. And I’ll never forget."

​"If you think you may be suffering from postpartum depression, don’t wonder. Speak up. Talk to you doctor, partner, family and friends. If you are scared or worried about the stigma (I get it… we shouldn’t be concerned about that but of course we often are) and would rather talk to someone outside of your circle, you can call Postpartum Support International at 1.800.944.4773. If you just need a fellow mom to validate you and listen to your fears, find me on Instagram and reach out.
Anxious, overwhelmed, unhappy, or scared by how you feel? If you’re struggling emotionally, you could be depressed. Take this 10-question quiz to find out."

By: Melissa Willets

"If you're like me, your answer to the question: "Should I have another baby?" changes by the hour. I gaze at my sleeping, angelic children, snug in their beds at night, and think, YES! Definitely, the sooner the better, NOW. Then my kids are screaming, fighting over a single, blue crayon, and it's, NO! NO! NO! No more kids, ever.So how do you cut through those everyday moments of indecision, to get to the real answer of whether you should have another baby? Try asking yourself these six things:

1. How do you feel when you get your period?
Is it, relief or sadness? Last month my period was a welcome relief. I have a 10-month-old baby, a three-year-old, and an almost six-year-old. We've got enough going on! But this month it was different. I felt a little sad, and began to think, what if? What if our family is not quite complete yet? What if we had another baby?

2. How do you feel when you see a newborn?
Do you feel love sick, or just sick? I see an infant, and my heart swells. An involuntary, "aww," escapes my lips. I can't help it! I love how a newborn smells, I love her soft, delicious skin. Babies are heaven, pure and simple. And having another one is starting to feel like the greatest idea ever!

3. What do you picture your life to be like with another child?
Is life overwhelmingly hectic or charmingly challenging? I don't picture a scenario replete with loud crashes, screaming children, me trembling, gripping a too-full glass of wine, crying in frustration, as little people slowly take over my house, and my life. Instead, I see happiness. I picture smiles, hugs, cuddles, love and giggles. Oh, there's craziness too, believe you me. But mainly I hear The Beatles' song "All You Need Is Love," playing in my head when I imagine being a mom to four kids.

4. What would life be like if you didn't have another baby?
Arrow straight through the heart. Ouch. No, the truth is I've felt conflicted about having another baby for a while. Life is great the way it is. Life is full. We are parents to three, beautiful, funny, silly, smart, wonderful girls. Why mess with what is working pretty darn well for us? When I think this way, another baby seems like a bad idea...

5. What is your biggest reason for wanting another baby?
Is something still missing? Or, is it just hard to imagine closing that door yet? There are so many reasons I want another baby. I still long to feel a baby kick inside of me. I yearn to hold a newborn in my arms, knowing that I did that; I made that. I have also loved, loved seeing how my children love, and care about each other. Being witness to their sisterly bond has been the greatest privilege of my life. I know that adding to our family would just bring more love, and joy.
​
6. What is your biggest fear about having another baby?
I worry about tempting fate if we have another baby. Can I really be lucky enough to bring four healthy babies into the world? No one could be that lucky; it just isn't fair. Right? Sigh. I don't know."
​

By Uma Naidoo | December 07, 2018 | Updated March 27, 2019

"The human microbiome, or gut environment, is a community of different bacteria that has co-evolved with humans to be beneficial to both a person and the bacteria. Researchers agree that a person’s unique microbiome is created within the first 1,000 days of life, but there are things you can do to alter your gut environment throughout your life.

Ultra-processed foods and gut health

What we eat, especially foods that contain chemical additives and ultra-processed foods, affects our gut environment and increases our risk of diseases. Ultra-processed foods contain substances extracted from food (such as sugar and starch), added from food constituents (hydrogenated fats), or made in a laboratory (flavor enhancers, food colorings). It’s important to know that ultra-processed foods such as fast foods are manufactured to be extra tasty by the use of such ingredients or additives, and are cost effective to the consumer. These foods are very common in the typical Western diet. Some examples of processed foods are canned foods, sugar-coated dried fruits, and salted meat products. Some examples of ultra-processed foods are soda, sugary or savory packaged snack foods, packaged breads, buns and pastries, fish or chicken nuggets, and instant noodle soups.
Researchers recommend “fixing the food first” (in other words, what we eat) before trying gut modifying-therapies (probiotics, prebiotics) to improve how we feel. They suggest eating whole foods and avoiding processed and ultra-processed foods that we know cause inflammation and disease.


But what does my gut have to do with my mood?

When we consider the connection between the brain and the gut, it’s important to know that 90% of serotonin receptors are located in the gut. In the relatively new field of nutritional psychiatry we help patients understand how gut health and diet can positively or negatively affect their mood. When someone is prescribed an antidepressant such as a selective serotonin reuptake inhibitor (SSRI), the most common side effects are gut-related, and many people temporarily experience nausea, diarrhea, or gastrointestinal problems. There is anatomical and physiologic two-way communication between the gut and brain via the vagus nerve. The gut-brain axis offers us a greater understanding of the connection between diet and disease, including depression and anxiety.
When the balance between the good and bad bacteria is disrupted, diseases may occur. Examples of such diseases include: inflammatory bowel disease (IBD), asthma, obesity, metabolic syndrome, diabetes, and cognitive and mood problems. For example, IBD is caused by dysfunction in the interactions between microbes (bacteria), the gut lining, and the immune system.


Diet and depressionA recent study suggests that eating a healthy, balanced diet such as the Mediterranean diet and avoiding inflammation-producing foods may be protective against depression. Another study outlines an Antidepressant Food Scale, which lists 12 antidepressant nutrients related to the prevention and treatment of depression. Some of the foods containing these nutrients are oysters, mussels, salmon, watercress, spinach, romaine lettuce, cauliflower, and strawberries.

A better diet can help, but it’s only one part of treatment. It’s important to note that just like you cannot exercise out of a bad diet, you also cannot eat your way out of feeling depressed or anxious.
We should be careful about using food as the only treatment for mood, and when we talk about mood problems we are referring to mild and moderate forms of depression and anxiety. In other words, food is not going to impact serious forms of depression and thoughts of suicide, and it is important to seek treatment in an emergency room or contact your doctor if you are experiencing thoughts about harming yourself.
​

Suggestions for a healthier gut and improved mood
​

• Eat whole foods and avoid packaged or processed foods, which are high in unwanted food additives and preservatives that disrupt the healthy bacteria in the gut.
• Instead of vegetable or fruit juice, consider increasing your intake of fresh fruits and vegetables. Frozen fruits without added sugars/additives are a good choice too.
• Eat enough fiber and include whole grains and legumes in your diet.
• Include probiotic-rich foods such as plain yogurt without added sugars.
• To reduce sugar intake at breakfast, add cinnamon to plain yogurt with berries, or to oatmeal or chia pudding.
• Adding fermented foods such as kefir (unsweetened), sauerkraut, or kimchi can be helpful to maintain a healthy gut.
• Eat a balance of seafoods and lean poultry, and less red meat each week.
• Add a range of colorful fresh fruits and vegetables to your diet, and consider choosing certain organic produce."

By: ​Bethany Braun-Silva

"Expecting parents have multiple checklists of everything they need to get ready for their baby’s arrival. Cribs, bottles, car seats, and strollers are just a few of the essentials you need to consider before welcoming a new baby. But even before any of that, there’s the hospital bag checklist. A robe, a nightgown, slippers, and a few blankets are sure to make the list, but oftentimes, a postpartum recovery kit gets overlooked.

A postpartum recovery kit has what moms need to help with bleeding, soreness, and overall discomfort. You can create your own kit by buying things like disposable underwear, ice packs, and perineal spray separately, but there are also ready-made kits for moms that include all these things and more.

Many moms agree that postpartum recovery kits are a great choice. The Frida Mom Hospital Packing Kit for Labor, Delivery, Postpartum, for example, has over 1,000 five-star reviews on Amazon and a near-perfect 4.8-star rating. “I would 100% say that every postpartum experience needs this kit,” writes one customer. “I think it’s well worth the price for the comfort you’re getting.”

The Miloo Mom Hospital Labor and Delivery Gift Packing Kit for Delivery, Postpartum is also a great choice available on Amazon. One reviewer writes, “I was very impressed with my kit, and I used all of it when I was in the hospital.”

Convenience is so important when you have a new baby, especially when it comes to your healing. The first six weeks after giving birth are a critical time in the healing process, and having the right tools handy can make all the difference in your physical (and mental) health. If you’re pregnant or know someone who is, check out the postpartum recovery kits below."

By: Nourish with Melanie McGrice

"So you've just found out you are pregnant, congratulations!! It’s an exciting and happy time. But, it can also be very overwhelming!

​If you’re wondering which foods to avoid when pregnant, you've come to the right place. In today's episode of Nourish, prenatal dietitian Melanie McGrice reveals her list of the 21 most important foods to avoid when pregnant, and when you can eat them again.

Enjoy!"

By: ​Hilary Braaksma

"Pregnancy puts a lot of strain on your body, including at bedtime, which is why finding the best pregnancy pillow is so essential for many women.

Find a little relief for those aches and pains by sleeping with a pillow that’s designed to cradle and comfort your pregnant shape. The latest pregnancy pillows come in a wide array of sizes and shapes to fit your particular needs, whether you’re looking to alleviate back pain or to find a positioning solution as a stomach sleeper

From full-body styles to wedges, the options are plentiful. Some favorite brands include Boppy and Leachco, but they’re not the only brands to shop for some of the best pregnancy pillows available in 2020. Below are seven pregnancy pillows we recommend for an amazing night of sleep."

Moonlight Slumber Comfort-U Total Body Support Pillow​

"​The Comfort-U Pillow by Moonlight Slumber cushions every curve of your aching body with Fusion Foss fiber. It feels soft and stays soft, but it also provides support where you need it most with its classic “U” shape. This is the perfect pregnancy pillow if you want to feel like you’re engulfed in a giant cloud. ($99.95; amazon.com)"

​Boppy Total Body Pillow in Ringtoss

By: Cedars-Sinai Staff| October 21, 2019​

"The biggest misconception women have about exercising while pregnant is that they can't do it at all, says Dr. Keren Lerner, OB-GYN at Cedars-Sinai. "It's not uncommon for women to wonder if working out during pregnancy will put the baby at risk," says Dr. Lerner. "I get asked that a lot."

Not only is it safe for pregnant women to exercise, but engaging in physical activity while pregnant can be beneficial for the health of a woman and her baby.
It can reduce the risk of preeclampsia, gestational diabetes, and hypertensive disorders during pregnancy. It can also minimize discomfort.
The American Pregnancy Association recommends at least 30 minutes of physical activity every day for women who have a normal, healthy pregnancy. 

The best types of workouts for pregnant women
It's important to know that not all pregnancy workouts are created equal. 
Dr. Lerner says workouts like Barre and Pilates are great because they focus on core strength, which can make the delivery and recovery process easier. 
"Prenatal yoga classes can be great for mind, body, soul, and core," Dr. Lerner says, as long as women are careful not to overextend their backs with deep bends or twists.
She also recommends swimming, especially in the third trimester.
"When there's more weight being carried, a lot of women end up with back pain," Dr. Lerner says.
"Because gravity is less of an issue in the water, women tend to be more comfortable in the pool."
No matter what workout they choose, pregnant women should drink plenty of water and take a rest if they start to feel dizzy or lightheaded while exercising.

​Workouts to avoid when pregnant
All pregnant women should avoid contact sports, as well as activities like skiing, snowboarding, rock climbing, horseback riding, and scuba diving.
If the pregnancy is high risk, women should talk to their doctor about their workout options.
Women should also seek medical advice if they get injured while exercising.
While 30 minutes of daily activity during pregnancy is recommended, women who enjoy working out aren't limited to this, Dr. Lerner says.
"Certainly those who are used to working out or have active jobs or lifestyles can endure more," Dr. Lerner says.
"They just need to be sure they're listening to their bodies." 

"How can you tell if you're struggling with mental health during pregnancy and postpartum?"

By: Women's College Hospital

"Lifestyle changes to improve and prevent symptoms of depression and anxiety." 

By: Sarah Greenberg, MFT

• "Lifestyle changes can help people manage anxiety and depression, and take charge of their mental wellbeing.
• Some behaviors that are linked to improving or preventing anxiety and depression include addressing sleep issues, connecting with others, eating a nutritious diet and exercising.
• Change can be hard, especially for those with anxiety or depression, so it's important to be kind to yourself. 
• The best way to care for your mental health is the approach that works best for you. In some cases, professional help may also be needed."

"When Roy came to see me for longstanding symptoms of depression and anxiety (they often co-occur), he was hesitant at best. He wanted to feel better, but “getting treatment” didn’t fit with his narrative for what he was “supposed to be doing as a grown man” in his culture. He had a decent, consistent job, but felt his life lacked meaning and joy. He was so hard on himself and avoided others for fear of judgement.

I knew he’d run the other way if I jumped too quickly into a medical referral or diagnosis, so we started with the most human approaches — connecting about what was really going on for him, and exploring readily available lifestyle changes that aligned with his interest, motivation, and values. Within weeks, his spark started to come back, and within months he felt he had a new lease on life. He wasn’t suddenly happy all the time. But he felt a new sense of his capacity to take charge of his mental health.

Will everyone have an outcome like Roy from lifestyle changes? Definitely not — anxiety and depression are complex conditions with tremendous individual variation, varied underlying causes, and varied levels of severity. But can everyone benefit from learning the foundation for how to care for their mind either separately or as an adjunct to professional treatment? I believe so.

The following seven health behaviors are key ones linked to prevention or symptom improvement of anxiety and depression. 

While everything on this list is simple, it’s far from easy. Change is hard. And if you currently have depression or anxiety, it can be especially challenging. That’s why one of the key behaviors is being kind to yourself. 

If moved to do so, choose one area to work on at a time, perhaps an area you feel especially motivated or confident to address, or an area that feels aligned with your most important values. Then take it one step at a time. The funny thing about change is we often don’t know it’s happening, we just keep rowing in the right direction, and usually after a few, or a few thousand, twists and turns, we look back in awe at how far we’ve come. 

1. Sleep 

While 10-18% of adults in the U.S. experience chronic sleep issues, this number jumps to 65-90% of those with depression, and over 50% of those with generalized anxiety disorder. Of those with depression, 65% had sleep issues first. Addressing sleep issues can alleviate symptoms of mental health conditions, and given sleep problems are a risk factor for mental health conditions, can also help protect your mental health. 

There are many resources to help improve your sleep, such as this free app.

2. Self-Compassion

A disposition that tends towards self-critical, or perfectionistic, can be a risk factor for anxiety and depression. This can include feeling like you must be perfect to be accepted, an inability to accept flaws within yourself, intense self-scrutiny, or an unrealistic sense of others’ expectations and your capacity to meet them. 
​
Despite the fear of many who have this characteristic, the antidote to perfectionism isn’t letting it all go, or saying goodbye to standards – it’s self-compassion. According to researcher Kristen Neff, self-compassion has three components: self-kindness vs. self-judgment, common humanity vs. isolation, mindfulness vs. overidentification. How we treat ourselves through the ups and downs of life can have a tremendous impact on health and mental health.

3. Social Connection

From the time we are born, we need social connection in order to thrive. 
A recent study lead by researchers at Harvard sought to understand what could most protect us from depression that is within our control. After analyzing over 100 potential factors, they found that social connection was by far the most important protective factor. 
​
It’s been a lonely year for many. And many are anxious at the prospect of going back to normal. But connection doesn’t mean a big party or bustling office. It can be confiding in one trusted person about how you’re really doing, listening to how someone else is really doing, giving a meaningful thank you, or having a (safe) visit with any family member or friend. If this feels out of reach, try making a short list of people who at any point have given you a sense of belonging. Other studies have shown that just calling positive relationships to mind can have a positive impact on our capacity to tolerate stress."

"​In just 5 minutes you can reset your day in a positive way."

"Women who had Covid while expecting experienced guilt, shame and unhealthy levels of stress."

"Kate Glaser had chalked up her exhaustion to being 39 weeks pregnant and having twin toddlers in the house. She also wondered whether her flulike symptoms were a sign that she was about to go into labor. But when she woke up one morning with a 100.4-degree fever, she called her doctor and got a rapid Covid-19 test.

Two nurses came to deliver her results to her in the waiting room. They were dressed in full gowns, masks, face shields and gloves.

“I knew by the eerie silence and the way they were dressed that I was Covid positive,” she said. “It was an emotional moment; I felt really disappointed and shocked and, as a mom, I felt a lot of guilt. What did I do wrong?”

Glaser, who lives in the Buffalo, N.Y., area, returned home and isolated from her husband and the twins in her bedroom, where she spent hours mentally replaying all her activities leading up to the positive test result. She also made a public post on her Facebook page about her positive status, and what she was feeling — guilt, embarrassment and panic. The post went viral, and Glaser started hearing from women around the world who were pregnant and worried about Covid-19. The majority of the of the 2,300 comments she received were supportive; a few were harshly critical.

“I was going down a rabbit hole of guilt and stress,” Glaser said, adding that for her, as much as the physical symptoms were bad, the mental stress of Covid was much worse.

Prolonged stress can have real consequences on pregnant people even outside of a pandemic and has been tied to low birthweight, changes in neurological development and other health impacts in children. And the pressure associated with a positive Covid-19 test increases these mental health risks.

The anxiety is not without reason. As of November 30, there have been more than 42,000 cases of coronavirus reported in pregnant women in the U.S., resulting in 57 maternal deaths. U.S. health officials have said pregnancy increases the risk of severe disease for mother and child, and being coronavirus-positive in late pregnancy may increase the rate of preterm birth.

Prenatal care and birth plans are also disrupted by a positive test result. “Women are expressing so much fear about being infected, but also about going to the hospital, delivering and being separated from their child,” said Laura Jelliffe-Pawlowski, an epidemiologist who is the primary investigator of HOPE COVID-19, a new study that focuses on the well-being of women who are pregnant during the pandemic.

The study launched in July and will follow more than 200 women around the world, from pregnancy to 18 months postpartum, to understand how Covid-19 and the pandemic response impacts pregnancy and infant health outcomes.

Dr. Jelliffe-Pawlowski and her team have analyzed the data from the first group of women, and they are finding “absolutely incredible” levels of stress and anxiety. “Sixty percent of women are experiencing nervousness and anxiety at levels that impede their everyday functioning,” she said, citing preliminary data. “There are a number of women, particularly lower-income women, expressing how hard it is to choose to stay in a job that puts them at risk versus quitting the job and not having enough food for their baby.”

Nearly 70 percent of the participants reported feeling worried about decreasing family income and more than 22 percent worried about food insecurity (though none had experienced it at the time of the survey). Dr. Jelliffe-Pawlowski worried that women were not necessarily getting the psychological care they needed: “If you can’t feed your family, seeking out mental health care is not your top priority.”

She also said more than 84 percent of women reported moderate to severe anxiety about giving birth during a pandemic. “Many women do not want to get tested because they will be stigmatized or separated from their baby or not allowed to have people in the room to support them,” she said. She added that similar visiting rules often hold true for babies in the NICU after being born preterm during the pandemic: Only one parent can be present in a 24-hour period. “It’s heart-wrenching to see families go through those choices.”

Dr. Jelliffe-Pawlowski is particularly interested in how stress impacts births and long-term outcomes for children as psychological stress is highly associated with preterm birth. After the attacks of September 11, 2001, the risk of preterm births almost doubled for people living near or working at the site of the fallen towers. She’s also concerned about long-term effects of stress and anxiety on maternal bonding during the pandemic.

Margaret Howard, a psychologist at Women & Infants Hospital in Providence and postpartum depression researcher at Brown University thinks it is absurd for pregnant women who test positive for an infectious virus to bear any guilt or stress associated with their diagnosis: “Are moms in a special category where they are expected to not get Covid? What about a sinus infection? Hay fever? Cancer? Why is Covid a moral failing for mothers?”

When Erica Evert, a pregnant mom in northern Virginia, received her postive Covid-19 test result, it didn’t make sense. She was near the end of her pregnancy, and hadn’t left the house in four and a half months, except for ob-gyn appointments to check on the baby.

“My first thought was, is this a false positive? I feel fine. And my second reaction was to start bawling,” said Evert. She was scheduled to have a cesarean section with her second baby and the test was merely a formality — until it was a life-changing event.
​
The hospital gave her a choice: She could deliver the next day and be treated as a Covid-19 patient — separated from her baby with no skin-to-skin contact, per the hospital’s policies. Or she could wait 10 days from the date she received the positive test result and deliver with her regular plan. She had four hours to make a choice she wasn’t expecting. “I kept thinking: am I going to make a decision that results in my child dying?” said Evert."