When Rebecca Binford was pregnant with her son three years ago, she found herself engulfed by emotional and physical stress, increased pressures at work, extreme anxiety and an unbearable amount of pain. She became so overwhelmed that it was difficult to function normally. \"I was in a total state of despair,\" she says. \"I had very little coping skills at a time when so much was going on in my life and with my body.\" She\'s fine now, but some women don\'t survive depression in pregnancy. Two out of every 100,000 women who are pregnant kill themselves, according to a study published in November by the journal Obstetrics and Gynecology. Authors analyzed the Centers for Disease Control and Prevention\'s National Violent Death Reporting System, which includes reports from 17 states, from 2003 to 2007. The authors found 94 cases of pregnant women who had taken their own lives. While that number isn\'t huge, it\'s higher than the number of pregnant women who die from such causes as hemorrhaging, improper development of the placenta or preeclampsia, a condition of high blood pressure that can occur during pregnancy. Suicide is the second-leading cause of death in the women in the study. The first is homicide. \"This may not be what we want to hear, but it\'s the reality,\" says Dr. Christine Palladino, who authored the study. Palladino, an obstetrician-gynecologist and researcher at Georgia Health Sciences University in Augusta, says the suicide figures should shine a light on the number of pregnant women suffering from depression who, for reasons that are still unclear, may not be getting the proper treatment. Stigma may inhibit women from admitting a problem. Pregnancy is supposed to be a joyous time, which makes women feel ashamed to admit they are suffering. Scant Training Few obstetricians, meanwhile, are trained to recognize depression symptoms in their patients, so they may not know how to help or make appropriate referrals. Palladino and other doctors throughout the country are working within hospitals and clinics to provide proper training to doctors and come up with better screening techniques. Dr. Heather Flynn, an obstetrician and researcher at the University of Michigan in Ann Arbor, has studied the difficulties of treating depression during pregnancy. She says that many obstetrician-gynecologists may not even use detection tools, which mainly consist of questionnaires. If they do use them, she says, there is not a lot of guidance for what to do if a woman tests positive for depression. \"Practitioners don\'t receive a lot of training in psychiatric assessment and they don\'t always have the time and resources to follow up.\" Palladino says she is beginning to research training interventions for ob-gyns that will help them recognize and address depression in pregnant women. She says ideally it should bring together mental health providers, physicians, nurses and social workers. \"There are many factors at play here and the goal is to address the barriers to treatment at each point where we see them,\" Palladino says. \"The good thing about it is that it\'s a captured time. Most women do come for pre-natal care and they often come for repeat visits so we do have a unique opportunity to intervene.\" Equal-Opportunity Illness Palladino calls depression in pregnancy an equal opportunity illness. \"It hits all types of people from every race, age and social class. It is difficult to deal with, but there is a silver lining. We do have ways to intervene and can get these women the help they need.\" The first thing a woman can do is to admit that something is wrong, Palladino says. \"Women often say, \'People expect me to be happy. People are throwing me baby showers. I wanted to get pregnant. I wanted to have this baby. Everyone expects me to be happy.\' But sometimes that might not be the case.\" Depression during pregnancy may be difficult to diagnose because some of the symptoms, such as change in appetite, loss of sleep and mood changes are common characteristics of pregnancy. But doctors say if a woman thinks something is off, she should speak up. \"Depression is never diagnosed on the basis of one symptom,\" says Flynn. \"If all these things cluster together and they persist for more than two weeks and start to interfere with the woman\'s ability to function, then that is when she should speak to her doctor.\" When Amanda Englund, 27, became pregnant four years ago, she felt that she had no one to turn to. \"I think my depression stemmed from feeling completely isolated,\" she says. \"I was 23, and the other women that I was speaking to who were pregnant were in their 30s and were married and very stable emotionally and financially. I just felt like I was totally lost and swimming in this sea of unknown territory.\" Reaching Out Amanda went to prenatal classes and events and sought out others in situations similar to her own. She became friends with a woman her age who was also experiencing symptoms of depression and the two spoke often about what they were going through. She also reached out to a support hotline for pregnant women and moms experiencing depression where she now volunteers. \"Finding that connection is what ultimately helped me get through my depression,\" she says. \"It is important for women to know that they are not alone,\" Palladino says. \"There are other women who suffer from similar circumstances and sharing with one another can help.\" Treatment can include counseling and, in more severe cases, medication. Studies have linked the use of antidepressants during pregnancy to preterm births, fetal heart defects and even autism. However, other studies refute these claims and experts say more research needs to be done to determine actual risks. So how should a woman decide whether antidepressants are right for her? \"It should be done on a case-by-case basis, says obstetrician Dr. Diane Ashton, medical director at the March of Dimes, the health advocacy for babies and mothers based in White Plains, N.Y. \"All decisions need to be made in collaboration with physicians. The risks really need to be weighed versus the benefits of a pregnant woman being on medication.\" Ashton says if a woman is depressed to the point of considering suicide, the risk of not taking medication would outweigh the risk of taking it. If a woman is already taking anti-depressants at the time she becomes pregnant, she should also consult with her doctor, as it may be dangerous stop the medication. A well-balanced diet and a healthy amount of exercise can help improve the wellbeing of pregnant women, just as they do for everyone else. \"If an active woman becomes pregnant, she should continue exercising through her pregnancy as much as her condition allows,\" Ashton says. \"Studies have also shown that yoga and meditation can provide depression relief.\" Some studies have found that the use of omega-3 fatty acids, present in fatty fish like salmon and mackerel and also available as dietary supplements, can help relieve some symptoms of depression like fatigue and mood swings.