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SADFACES: Diagnosing Depression And Anxiety During Pregnancy

For all the joy and milestones that can comewith pregnancy, the hormonal and physical changes you’ll experience can makeyou tired, emotional, and sometimes a little down.

Many “normal” symptoms of pregnancy overlapwith symptoms of depression and anxiety – conditions that can complicate any pregnancyand caring for a newborn.

Crossover symptoms can make it tough forpatients and doctors to recognize these conditions during pregnancy and in thefirst weeks after delivery. At the same time, the rate at which women werediagnosed with depression during pregnancy increased sevenfold between 2000 and 2015,according to the Centers for Disease Control and Prevention.

Left untreated, depression and anxiety can getworse during pregnancy. But how is a woman to know whether her symptoms are“normal” or something more serious?

In ourOb/Gyn practice, we screen patients for anxiety and depression twice: at the first prenatal visit and at the six-week checkup. Some programs screen only atthe six-week (postpartum) visit, but we feel it’s important to establish mentalhealth care early, if needed. 

What does SADFACES stand for?

SADFACES represents a range of symptoms to help us determine whether a patient might be suffering from anxietyor depression. SADFACES includes:

  • Sleep disturbances, such as sleeping too muchor too little
  • Anhedonia, which means lack of interest inactivities and hobbies you once enjoyed
  • Depressed mood
  • Fatigue or loss of energy
  • Appetite disturbances, such as overeating ornot feeling hungry
  • Concentration difficulties, includingindecisiveness, feeling jittery, and racing thoughts
  • Esteem diminished or guilt without a specificreason
  • Suicidal or recurrent thoughts of death

Symptoms of depression can be physical, withclassic symptoms including sleep disturbances, fatigue or loss of energy, orappetite disturbances. But cognitive symptoms such as lack of interest inactivities, depressed mood, difficulty concentrating, or guilt are also signsof depression.

However, some physical symptoms are considered“normal” during pregnancy and the postpartum period. For example, earlypregnancy can cause fatigue and morningsickness, which can affect the appetite. And new moms who are wakingup to feed their babies every few hours, trying to keep up with householdresponsibilities, and perhaps caring for older children are bound to feel tiredor lack energy.

Cognitive symptoms are more closely associated with anxiety and depression, andperhaps are a good way to differentiate depression from normal pregnancy orpostpartum changes. Feeling jittery, guilty, or in a low mood for no apparentreason are classic depression symptoms that can easily beoverlooked or dismissed during pregnancy and the postpartum period. However,physical symptoms are still important in helping us determine the severity of awoman’s condition.

It’s important to be honest with your doctorduring your screening. We will never judge you for your responses. Thesediscussions help us recognize symptoms of anxiety and depression early so wecan formulate an effective care plan, which might include counseling,medication, or a combination of both.

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