By Brain & Behavior Research Foundation NARSAD Young Investigator Grantee Katrina Johnson, Ph.D. and graduate student Julia Schechter, M.A. Both are Emory University researchers.
While pregnancy is often viewed as a period of great joy and excitement, it can also be a time of heightened risk for the development of or reoccurrence of a psychiatric disorder. Women are twice as likely as men to be diagnosed with a mood or anxiety disorder, and they are most at risk during their childbearing years. The risk for developing symptoms of depression and anxiety increases during major life transitions, and becoming pregnant is a significant life change. Some evidence suggests that the risk of experiencing depression may be highest during the first trimester when women are adjusting to pregnancy. Thus, while postpartum depression gets more attention, the reality is that many women experience significant mood and anxiety symptoms during pregnancy as well.
Anxiety and mood disorders such as depression during pregnancy can affect both the mother and the developing fetus. Untreated prenatal depression and anxiety have been linked to higher rates of birth complications, higher levels of infant irritability and mild delays in infant development. There may also be lasting effects on child behavior. Many women suffering from psychiatric illness face difficult decisions regarding treatment options during pregnancy and postpartum. Research to date has provided inconsistent and incomplete information, with some studies highlighting the negative effects of the illness itself while others raising concerns about the impact of treatment on infant and child outcomes.
As part of ongoing, longitudinal research, Dr. Katrina Johnson and her colleagues at Emory University have interviewed many women struggling with psychiatric illness before, during and after their pregnancies, to find out more about their concerns and decision-making process. Excerpts from these interviews follow:
“The internet research I did was helpful, but what really helped was talking with my psychiatrist. He was very up front with me. He treated me like a peer ‘this is what we know, this is what we don’t know, this is what we are looking out for.’"
“I am taking a medication that affects my brain, so it is scary to think that it could affect my baby’s brain."
“I knew I couldn’t get depressed when I was pregnant because I tend to get suicidally depressed. My psychiatrist told me I had a 99% chance of postpartum depression. I needed to function."
"I told my psychiatrist that I was more worried about being on the medications than off of them. He agreed to monitor me during my pregnancy off of the meds, and I was okay. But the big thing for me was a few months after the baby was born, I became very, very depressed. It caught me by surprise."
Although each woman's thoughts and feelings are unique, we do know that depression is a major public health concern: not only is it a leading cause of disability worldwide (according to the World Health Organization), but it also can pass from mother to child in a continuing cycle. We need more research to identify the most effective interventions at the most appropriate time(s).
Funded by the Brain and Behavior Research Foundation, Dr. Johnson and her colleagues, including NARSAD Grantee Patricia Brennan, Ph.D., are aiming to better understand the impact of mood disorders and their treatment during pregnancy on fetal brain development. Pregnant women are seen multiple times to assess their levels of mood symptoms, anxiety, stress and sleep habits. Shortly after birth, the baby undergoes a brief MRI (magnetic resonance imaging) scan while they are sleeping. Brain connectivity within and between areas of the brain is measured, focusing on areas that play an important role in emotional regulation. The hope is that research like this may help reduce the risk of negative outcomes in the children of mothers with mood disorders and in the mothers themselves.