Depression During Pregnancy

It's not easy being blue — especially when everyone around you thinks you're feeling rosy.

The truth is, pregnancy depression is common — more so than you might think: Nearly 13 percent of women meet the diagnostic criteria for depression during pregnancy, and up to 37 percent say they experience depressive symptoms at some point while expecting, according to a review of several studies.

And it’s no wonder women are even more susceptible to depression (defined as a disorder in which the parts of the brain that control mood, sleep and thinking are not functioning properly, possibly due to a chemical imbalance) when they’re expecting, since pregnancy can affect your mental health. Surging hormones coupled with stress, anxiety and societal pressure to feel a certain way can do a number on any woman’s emotional state while expecting. 

Some factors can put you at greater risk for depression, but it’s an illness that strikes women of all ages at all stages of their lives — and there’s no shame in asking for help.

Although pregnancy depression can be severe, leaving some women feeling so sad and hopeless that they have trouble taking care of themselves and their babies, the good news is that symptoms of depression can be effectively treated. 

Drug-free approaches like talk therapy can be very effective. So are some antidepressants, which research has shown to be more effective and safer during pregnancy than previously believed.

Deciding what treatment is right for you is a highly personal decision, and your doctor can walk you through the details and options specific to you. Read on for more information on the causes and symptoms of depression during pregnancy, and learn ways to cope with the condition.

What are the risk factors for depression in pregnancy?

Pregnancy depression can happen to anyone. But certain women may be at higher risk than others. You could be more prone to experience depression during your pregnancy if:

Recommended Reading

Anxiety During Pregnancy: What’s Normal and What’s Not?

Postpartum Depression (PPD)

The Baby Blues

Anxiety During Pregnancy: What’s Normal and What’s Not?

Postpartum Depression (PPD)

The Baby Blues

• You already struggle with depression or anxiety, or have a family history. If you’ve been diagnosed with depression in the past or depression runs in your family, tell your practitioner, since there’s a greater chance you’ll experience depression during pregnancy.
• You’re dealing with a major stressor.  Caring for an aging parent, grieving over the loss of a loved one, fighting with your partner or being worried about finances are all examples of stress factors that can take an emotional toll on you and trigger depression when you're expecting.
• You’re dealing with a difficult pregnancy. If you had trouble getting pregnant, have had a miscarriage in the past or are experiencing a high-risk pregnancy, you may be worried about losing the baby you’ve tried so hard to conceive. Women under this kind of stress are at greater risk for pregnancy depression.
• Your pregnancy wasn't planned. Depression is more common among moms-to-be who didn’t plan on getting pregnant or didn’t want to.
• You have diabetes. Both preexisting diabetes and gestational diabetes are tied to a higher risk of pregnancy depression.
• You don’t have a supportive partner or other social support. It’s easier to become depressed if you feel like you’re going through your pregnancy alone.
• You’ve been the victim of domestic violence or physical or sexual abuse. That kind of stress along with the accompanying feelings of low self-esteem, helplessness, fear and isolation can all contribute to depression symptoms. If you are in an abusive or violent relationship or other situation, you should seek help immediately.
• You smoke, drink or take drugs. All are tied to a greater chance for pregnancy depression — which is just one more reason you should steer clear of all three when you’re expecting.
• You have a thyroid condition. Levels of thyroid hormone, which regulate how your body uses and stores energy in food, can fluctuate during pregnancy, which can cause symptoms of depression. A simple blood test can tell if a thyroid condition is causing these symptoms.

What causes depression during pregnancy?

No one knows for sure, and depression is far from a guaranteed side effect of pregnancy. But it's a pretty sure bet that those raging hormones play a significant role.

Hormones directly affect the brain chemistry that controls emotions and mood. Those same hormonal fluctuations that wreak premenstrual emotional havoc can lead to prenatal depression.

In fact, research has found that women who suffer from pronounced PMS are at greater risk for depression during pregnancy. 

Genetics may play a role too. Depression tends to run in families. If anyone in your family has a history of depression or any other mood disorder, you’re more susceptible to experiencing it too.

Add in one or more of the risk factors like those mentioned above, and you have all the potential ingredients for a case of depression.

In short, depression during pregnancy is usually the result of a combination of factors, not all of which are fully understood.

What is known is that depression doesn’t happen because a woman did something wrong, and moms-to-be aren’t to blame for these emotional valleys. The important thing is understanding your risk factors, knowing the signs that you could be depressed, and seeking help when you need it.

What are the symptoms of depression during pregnancy?

It’s often difficult to diagnose prenatal depression because some of its warning signs mirror so many "normal" pregnancy symptoms, including: 

• Sleep problems 
• Appetite changes 
• Loss of interest in sex
• Anxiety
• Inability to concentrate
• Mood swings or general emotional instability

If you’re not sure whether your feelings are within a healthy range, it’s best to discuss your symptoms with your doctor to be safe. 

If you have five of the following more serious symptoms of depression for most of the day every day during the same two-week period, you should seek help:

• Sad, hopeless, restless, indifferent or depressed mood
• Crying a lot
• Withdrawal from friends and family
• Loss of interest or pleasure in activities you used to enjoy
• Weight loss
• Weight gain that exceeds your target pregnancy weight gain
• Wanting to eat all the time, or no appetite at all
• Trouble sleeping or sleeping too much
• Fatigue or loss of energy
• Feelings of worthlessness or guilt
• Having trouble thinking, concentrating or making decisions
• Thoughts of harming yourself, death or suicide
• Having headaches, stomach problems or other pains that don’t go away
• Missing prenatal visits or not following medical instructions
• Using harmful substances like tobacco, alcohol or illegal drugs

Can depression during pregnancy affect your baby?

Some women don’t seek treatment for their pregnancy depression out of embarrassment, shame or guilt, or simply because they think their depression symptoms are just “normal” pregnancy symptoms that will go away on their own. 

But studies show that untreated or undertreated depression can lead to preterm delivery, low birth weight, possibly gestational diabetes and, in severe cases, developmental delays in baby.

Over time, these problems can snowball as your baby gets older. Babies and children of mothers who experienced depression during pregnancy are at greater risk for learning delays and emotional issues, including aggression.

There’s also the fact that depression may not end when your pregnancy does. Being depressed when you’re pregnant also puts you at a higher risk of postpartum depression. In fact, research estimates that around a quarter of women with PPD first became depressed while they were pregnant.

So if you think there’s any chance you’re suffering from pregnancy depression, ask for help — for yourself, but also because your baby needs a mother who's healthy both physically and mentally.

Treatments for pregnancy depression

Untreated depression during pregnancy can morph into postpartum depression or postpartum anxiety after your baby is born. The good news is that there are lots of treatment options that can help you feel better, including:

1. Non-drug treatments

For many moms-to-be, non-medication approaches can be enough to get their depression under control — and often, doctors suggest starting with these approaches first.

• Psychotherapy or talk therapy. Meeting with a therapist (either in person or virtually) can help you work through the challenges of going through a big life change and find ways to cope.
• Support groups. Ask your doctor about support groups in your area where you can talk to other pregnant women in similar situations, or look for online groups (try the depression group or the pregnancy depression group on WhatToExpect.com). Building your support network now will be helpful after your baby arrives too.
• Light therapy. Also called phototherapy, it simply involves spending time by a high-intensity bright-light lamp to increase levels of the mood-regulating hormone serotonin in the brain.
• Acupuncture. The ancient practice of acupuncture can trigger the release of feel-good brain chemicals called endorphins — which can help improve your mood as well as ease other pregnancy symptoms like morning sickness or back pain.
• Rest as much as you can. Pregnancy fatigue can intensify the mood swings you may be having, so make sure you’re getting enough rest. Go to bed early, sleep late or take naps when you can.
• Spend time outside. Being in nature Being outside in nature has been proven to reduce stress and depression symptoms. So take a walk in the woods, have a picnic in the park or plan a day at the beach.
• Put chores on hold. You don’t have to set up the nursery, reorganize your closets and stock up on baby supplies all at the same time (really!). So resist the urge to get everything done — and if there are to-dos on your list that absolutely have to be crossed off, ask your partner, family and friends for help.
• Follow a balanced pregnancy diet. Regular snacks and meals can keep your blood sugar up, keeping moods stable. Avoid caffeine, sugar and processed foods, and opt instead for a diet rich in omega-3 fatty acids (try walnuts, fish and enriched eggs), which has been shown to lower the risk of depression during pregnancy.
• Exercise. Regular, frequent physical activity boosts feel-good endorphins and has been shown to help stabilize your moods — some research has even found that regular aerobic exercise is as effective at treating depression as taking an antidepressant. Not sure where to start? Try any of these depression-busting workouts (once you get the okay from your practitioner first, of course).
• Spend time with your family and friends. Make time to visit friends and family and be alone with your partner. It can help you feel closer and boost your mood.
• Avoid big life changes if possible. Avoiding unneeded stress is key to managing depression. So whenever possible, postpone big life changes like moving or starting a new job until you’ve got your symptoms of depression under control. If making a big change is unavoidable, try to arrange support ahead of time.
• Discuss your feelings. If you’re worried, anxious or feeling unsettled about the future, don’t hold it in. Get support from your partner, family, friends, a support group, or a counselor or therapist.

2. Antidepressants

If your symptoms are more severe, your doctor may want to treat your depression more aggressively with antidepressants. Moms-to-be have a few different options to choose from, including:

• Selective serotonin reuptake inhibitors (SSRIs), including fluoxetine, sertraline and citalopram. They’re the most commonly prescribed antidepressants for pregnant women.
• Serotonin and norepinephrine reuptake inhibitors (SNRIs), including duloxetine and venlafaxine.
• Bupropion, which is not considered a first line treatment but can be used if a pregnant woman is not responding to other antidepressants.
• Tricyclic antidepressants (TCAs), such as nortriptyline.

Antidepressants aren’t the right choice for everyone, and it’s important to weigh the benefits and risks with your doctor. (Never take any medication — herbal or otherwise — without consulting your practitioner.)

Research is still inconclusive about the long-term effects of antidepressants during pregnancy, and there’s some evidence that newborns exposed to SSRIs in the womb may experience short-term withdrawal symptoms. 

If you are starting a new medication during pregnancy, discuss your options with your provider. Your practitioner may recommend different options depending on the trimester you're in, as well as whether or not you're planning on breastfeeding.

Still, experts say those risks shouldn’t keep pregnant women from taking medication if they need it, since the risks of untreated depression are often greater than those associated with taking an antidepressant. 

If you were taking antidepressants before you got pregnant, you’ll need to work with both your practitioner and your psychiatrist to determine whether you should continue once you conceive.

Your doctors may want to change your dosage, switch you to a different kind of antidepressant or keep your meds exactly the same to minimize the risk of relapse. Stopping your medication altogether can be dangerous — especially if you have a history of mood disorders. If you're a younger mom, especially 25 or younger, you'll need to have close supervision when starting a new antidepressant medication or changing the dosage.

Whatever treatment or combination of treatments you follow to help manage your depression, it’s important to be good to yourself. Taking care of yourself emotionally as well as physically should be your top priority.

Can you prevent pregnancy depression?

The U.S. Preventive Services Task Force recommends that moms-to-be seek out therapy or counseling to address pregnancy depression preemptively if they have one or more of the following risk factors:

• You’re currently experiencing signs or symptoms of depression.
• You have a history of depression or other mental health conditions.
• You’re partnerless or are a teenager.
• You’re dealing with major stressors like low income or unemployment.
• You’re a victim of domestic abuse.

That said, pregnancy depression can affect any woman — not just those deemed high-risk. Your provider may opt to screen you for depression during your pregnancy. The American College of Obstetricians and Gynecologists (ACOG) recommends screening women at least once for depression and anxiety either shortly before or after birth, so some providers might not screen during pregnancy.

That means that you should still let your provider know if you start to notice signs of possible depression — whether they ask about your mood or not.