Depression during pregnancy affects one out of every five women, making it one of the most common pregnancy complications.1 Many people do not fully understand how to recognize or address perinatal depression and therefore a large portion of affected women never receive treatment. Most importantly, perinatal depression is treatable and it is possible to find relief with the right interventions.
Signs of Depression During Pregnancy
Feeling depressed during pregnancy can at times cause confusion because the symptoms of pregnancy and depression have some strong similarities. For example, changes in mood, sleep patterns, and appetite are usually present in both healthy pregnant women and those who are feeling depressed. Thus it can be helpful to focus on understanding the severity, intensity, duration, and onset of all symptoms to determine whether or not you’re experiencing depression during your pregnancy.
Some common symptoms that may present as depression during pregnancy:
- Feeling overwhelmed or like it is hard to cope
- Inability to care for oneself or family
- Irritability
- Increased somatic symptoms
- Common thought “this just doesn’t feel like me”
Any combination of these symptoms can present while other women may also feel excessively sad and low on energy leading them to find it difficult to attend prenatal healthcare appointments.
The American College of Obstetricians and Gynecologists recommends that health care providers screen for depression and other perinatal mood and anxiety disorders using a standardized tool at least once during pregnancy. Recent studies indicate that 10% to 15% of women experience clinically significant depressive symptoms during pregnancy.2
It is possible that these numbers are higher due to the large number of unreported cases. Although it can bring about a sense of hopelessness, depression is treatable with interventions from a trained professional.
Symptoms of Depression While Pregnant
Depression during, and after pregnancy, is more common than you might think. Studies have shown that 1 in 5 women were diagnosed with postpartum depression in the first year and of those, over 26% of the episodes began before pregnancy with a chronic pattern, over 33% of the episodes onset during pregnancy, and about 40% of the episodes began during the postpartum period.1
Symptoms of perinatal depression or with peripartum onset can start anytime during pregnancy, or within the first year postpartum.3
The presentation can differ but some of the most common symptoms of perinatal depression include:
- Depressed mood most of the day, nearly every day
- Feelings of anger, irritability, or rage
- Lack of interest in the pregnancy or baby
- Crying and sadness
- Appetite and sleep disturbances
- Loss of interest or pleasure in things that are usually enjoyable
- Feelings of guilt, shame, or hopelessness
- Thoughts of harming the baby or oneself
Is My Depression Affecting the Baby?
Exposures in pregnancy, whether it be to depression or to medication, carry some risk. During pregnancy, the mother’s internal environment plays a big part in the development of her baby. When a mother is experiencing high levels of stress regularly, there is an increase in cortisol production. Increased cortisol production in pregnancy has been linked to increased risk of early miscarriage.9
Studies have found that pregnant women with depression and their babies typically do better if they receive treatment as compared with attempting to deal with untreated depression. Working with a doctor that is comfortable with assessing treatment needs during pregnancy allows for appropriate treatments and better outcomes.
Some, but not all, of the substantially dangerous outcomes for untreated depression in the perinatal period include:4
- Substance abuse
- Functional impairment
- Increased risk of postnatal depression
- Poor pregnancy outcomes including loss
Risk Factors for Perinatal Depression
It is important to be aware of the risk factors for depression in pregnancy and the postpartum period.
Research has shown that the following factors can increase the risk for depression:
- A personal or familial history of depression, anxiety, or postpartum depression
- Premenstrual Dysphoric Disorder (PMDD)
- Inadequate support in caring for the baby
- Unplanned pregnancy
- Financial stress
- Undergoing fertility treatments
- Marital stress and/or domestic violence
- Complications in the pregnancy
- A major recent life event: personal loss, moving, loss of job or income
- Previous loss of pregnancy for any reason
- Toxic relationships
- Mothers of multiples
- Parents whose infants are in Neonatal Intensive Care Unit (NICU)
- Past or current thyroid imbalance
- Type 1, type 2, or gestational diabetes
Treatment of Depression While Pregnant
There is a saying: “When a baby is born, so is a mother.” Becoming a parent can be an incredible experience and usually brings about great joy, but it can also be a time of extraordinary physical and emotional transitions that can be intense at times. Sometimes the expectations of positive emotions can further the confusion for new moms during this critical period.
When an expectant, or new mother is faced with a diagnosis of depression, treatment is needed to prevent worsening of symptoms. Below are some treatment options and alternative modalities to address symptoms of depression in pregnancy.
Therapy
Some common evidence based therapy options for depression in pregnancy and the postpartum period include Cognitive Behavioral Therapy (CBT) and Interpersonal Therapy (IPT).
A few examples of common treatment goals associated with these types of therapies include:
- Processing the change in identity as you enter into new parenthood
- Grief and loss work
- Checking expectations of pregnancy and parenthood
- Development of communication
- Conflict resolution skills
These models of treatment address the underlying reasons for distress as well as the foundational thoughts that can make depressive symptoms worse and more difficult to manage.
Lifestyle Changes
Participating in peer support either on the phone, virtually, or in person is one lifestyle change that can help address the symptoms of depression. Although it can feel difficult to take that first step and enter into a community of other people who are going through similar experiences, the benefits of peer support, as well as psycho-educational group therapies are considered evidence based approaches to treatment.
Medication
Making the decision to take antidepressant medication during pregnancy or the postpartum period is not to be taken lightly for new and expectant mothers. Finding a prescriber who is up to date on the implications of prescribing during the perinatal period is vitally important due to the unique role of treating both the mother and the baby simultaneously. When it comes to medications, there are often concerns regarding the implications on the health of both the mother and the baby.5
Many antidepressant medications such as Selective Serotonin Reuptake Inhibitors (SSRIs) and Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs) have been studied in pregnancy and have not been linked to a higher chance for birth defects. Studies in some antidepressants have shown that when taken during the third trimester, there may be effects on the newborn after birth. The baby may exhibit symptoms of being jittery, irritable, or have difficulties with feeding, sleeping, breathing, and heart rate. In most cases, these newborn symptoms last a few days or less and are not considered to be harmful.
It is important to note that if you are currently prescribed medication and become pregnant, it is highly recommended to contact your prescriber to discuss your options. In many cases the benefits of staying on medication outweigh the risks of discontinuing it and the possibility of a relapse in symptoms. Listed below are resources which discuss medication interactions and recommendations in the perinatal period.
How to Get Help for Depression While Pregnant
Healthcare providers around the world are working hard to normalize the process of reaching out and receiving help for perinatal mental health disorders. Reaching out to your doctor, OBGYN, midwife, or therapist is a great first step in getting the help that you need for depression during pregnancy or after birth.
Many women suffer in silence with depression in pregnancy for a number of reasons. Some of these barriers to getting help may include cultural factors, misinformation, fear of judgment, and personal pressure to “appear strong” and be able to do it on their own. It is common for women experiencing perinatal mood and anxiety disorders to experience intrusive or scary thoughts which can result in confusion and embarrassment. It is important to keep in mind that seeking help from a professional does not indicate that you are weak, instead, it is a sign that you are taking care to keep yourself and your baby safe and healthy.
It is always a good idea to speak with a professional who is trained in perinatal mental health if you are having thoughts of harm to yourself or your baby.
How to Get Help for a Loved One
Oftentimes, pregnant women will feel added pressure to be happy due to societal expectations. Depression can impact people in all stages of life, even during the times that are expected to be joyous. If you think that a loved one is feeling depressed there are some things that you can do to help. First, trust your instincts. Don’t be afraid to ask the person if they are having a difficult time or feeling down.
Many times people think that bringing up the subjects of depression or suicide will worsen the symptoms, or remind the person of how poorly they are feeling. The truth is that many times they are already feeling isolated, alone, or too embarrassed to be honest and are in need of extra encouragement to share the burden.
One of the most helpful ways to assist someone who is depressed is to listen to them, asking them open ended questions about how they are feeling and what they are experiencing. Your loved one has the ability to get better and your support of treatment can make a world of difference.
Ways to Manage Depression Symptoms While Pregnant
When managing perinatal depressive symptoms it is important to follow your healthcare provider’s treatment plan regarding taking medications (if prescribed), attending appointments, and staying in close contact with your support system.
Some self-care techniques that can help in the moment include:
- Avoiding strict schedules to decrease stress during pregnancy
- Resting when your baby sleeps, or whenever you are able to
- Setting limits with guests and visitors
- Delegating household chores/responsibilities to family members or friends who are willing to help
- Spending less time on social media and avoid comparing yourself to others
- Being patient and kind with yourself – It takes time to feel relief!
Some other helpful actions include:
Meet With a Therapist
Therapy can provide a safe space for you to share about the thoughts and symptoms that you are experiencing without judgement. Many women who are feeling depressed during pregnancy also try to cover up this reality because they are embarrassed. When you meet with a therapist, you may be asked to complete an assessment tool.
One widely used assessment is called the Edinburgh Postnatal Depression Scale (EPDS). This tool is designed specifically for use in peripartum populations and it is well validated during pregnancy and postpartum to assess for depression.6 However, it is important to note screenings alone do not treat depression, they are simply tools used to help establish a course of treatment with your provider.
Get Involved With a Social Support Group
Social supports include support groups and/or targeted therapy groups. These can help with empathy, practical solutions, and specific information to assist with personal needs. This resource can truly be the heart of a treatment plan. Social support groups strive to create an environment that helps women feel connected, as if they are not alone, and promote a sense of hope. Groups can be found both online, and in person depending on your community resources.
Get Some Rest
Most people know that rest is very important during pregnancy however sleep can be disrupted when symptoms of depression get in the way. Some basic sleep hygiene tips are to avoid caffeine, set a consistent bedtime, create a ritual before bed that relaxes you, avoid using electronics at least 30 minutes before the intended bedtime, and be gentle with your expectations as you adjust to a new sleep routine. If you are having trouble sleeping, speak with your doctor or therapist about ways to improve your chances of getting a good night’s sleep.
Start an Exercise Routine & Eat a Nutritious Diet
Exercise has many great benefits for physical and mental wellbeing. Some benefits include improvements to sleep, reduction in symptoms of depression, decrease in stress, and strengthening your mind/body connection. During pregnancy, it is important to consult with your treatment team regarding the right exercise regimen for you and the baby given your specific abilities and situation.
Staying well hydrated and eating a well balanced diet can also promote mental wellness. Omega-3 polyunsaturated fatty acids have been shown to offer health benefits to pregnant and nursing mothers. Speak with your doctor about other ways to stay mentally and physically healthy during pregnancy and the postpartum period.
Explore Complementary & Alternative Interventions
Many times women who are pregnant or postpartum prefer to use alternative treatments for depression because they are holistic, give a sense of control over the process, and eliminate some fears of using conventional medical interventions.
Some examples of these alternative treatment modalities include:
- Prenatal yoga
- Prenatal/postnatal massage
- Meditation
- Acupuncture
- Stress reduction techniques such as progressive muscle relaxation, biofeedback, guided imagery, and mindfulness practices
Light therapy is another intervention gaining traction and may be preferred by women who are interested in non-medical treatments. Many herbal remedies, supplements, or other nontraditional therapies have not been studied enough to be deemed safe during a pregnancy. It is always a good idea to explore these options with your doctor.
Perinatal Depression Statistics
Consider the following statistics about Perinatal Depression:
- Perinatal Depression around the time of pregnancy, affects 1 in 5 women, making it one of the most common complications of pregnancy.1
- 21% or 1 in 5 women had postpartum depression in the first year.1
- Of those 21%:
- 26.5% of the episodes began before pregnancy with a more chronic pattern.
- 33.4% of the episodes had their onset during pregnancy.
- 40.1% of the episodes began during the postpartum period.
- 10% to 15% of women experience clinically significant depressive symptoms during pregnancy. 2
- Recent data suggests that untreated postpartum depression, rather than treatment with antidepressants in pregnancy, results in adverse perinatal outcome.7
- A large National Institute of Health trial found that women who discontinued their antidepressant therapy relapsed significantly more frequently compared with women who maintained their antidepressant use throughout pregnancy. In that study, 68% of women who discontinued their medication had major depressive relapses compared with only 26% of women who maintained their medication, and those who discontinued their medication were 3 times more likely to be hospitalized and experience further complications.8
Next Steps
Postpartum Depression is not the same as the baby blues. The baby blues are categorized by symptoms of tearfulness, mood swings, and exhaustion. The mother typically does not exhibit changes in self-esteem and she will seem happy most of the time. Baby blues last anywhere from 2 days to 2 weeks after birth and usually peaks 3-5 days after delivery.
If you notice that you are feeling disconnected from yourself or the baby, depressed most of the day, nearly every day, or other changes that are not typical and are disruptive to your life, it is best to reach out for support rather than trying to wait it out, or solve it on your own. Untreated depression in the perinatal period can result in a strain on relationships and hinder embracing new roles. There is also a chance your baby’s psychological and emotional development will be impacted if your depression is left untreated. It is important for both you and your baby to be healthy and supported.
Depression in pregnancy and the postpartum period is a real illness and it is very much treatable. Many women suffer in silence and it is crucial not to let misinformation, uncertainty, shame, financial difficulties, distance to resources, or denial get in the way of getting the help you need. Reach out to your partner, family, friends, doctor, therapist, or anyone that can help you get the attention that you need. Opening up yourself to receiving help takes a lot of courage and with the right interventions, you can recover, and feel like yourself again.
For Further Reading
- Postpartum Support International (PSI): Provides support, local resources, and information for perinatal mood and anxiety disorders.
- PSI Helpline: 1800-944-4773 (4PPD)
- The Postpartum Stress Center Premier treatment and professional training center for prenatal and postpartum depression and anxiety.
- MothertoBaby: Information about medications during pregnancy and breastfeeding.
- MGH Center for Women’s Mental Health: Reproductive Psychiatry Resource and Information Center.
