Depression During Pregnancy

Depression during pregnancy, also called antepartum depression, is a mood disorder in which strong feelings of sadness persist for a long time and interfere with daily life. Mood disorders are biological illnesses involving changes in brain chemistry.

During pregnancy, hormone levels change and can affect the chemicals in your brain, which are directly related to depression. Depression causes you to feel strong negative feelings, such as sadness, hopelessness, and lack of interest, that interfere with daily life and last for prolonged periods of time – for weeks or even months. Even if you were diagnosed with depression prior to becoming pregnant, and had your symptoms under control, the hormonal shifts that come with pregnancy could trigger a relapse.

Often, depression is not properly diagnosed during pregnancy, because it is believed to just be a hormonal imbalance. While it can be triggered by hormonal changes during pregnancy, depression is an illness that can be treated and managed.  If left untreated, depressing can pose potential risks to both the mother and child. Untreated depression can lead to poor nutrition, drinking, smoking, and suicidal behavior, which can then cause complications with the child, like premature birth, low birth weight, and developmental problems. Babies who are born to depressed mothers may be less active, more agitated and show less attention than babies born to moms who are not depressed.

It is important to seek help and speak with your doctor if you experience signs or symptoms of depression during your pregnancy.

How Often Does Depression During Pregnancy Happen?

Between 14 and 23 percent of women will struggle with symptoms of depression during their pregnancy. About 1 in 4 women have depression at some point in their lifetime. About 1 in 7 women are treated for depression within the year before pregnancy and the year after pregnancy.

However, these numbers could be even higher, as many people who struggle with depression are reluctant to admit it or reach out for help.

What Are Some Symptoms of Depression During Pregnancy?

Some symptoms of depression, like fatigue or trouble sleeping, can be normal during pregnancy. However, if they are accompanied by negative feelings that inhibit you from being able to function in daily life, you may have depression. You may have depression if you have experienced any of the following symptoms for two weeks or more:

• Persistent sadness
• Difficulty concentrating, remembering things or making decisions
• Not being able to sleep or sleeping too much
• Loss of interest in activities that you usually enjoy
• Recurring thoughts of death, suicide, or hopelessness
• Withdrawing from friends and family
• Feelings of guilt or worthlessness
• Change in eating habits
• Frequent crying
• Feeling extremely irritated or agitated
• Feeling anxious
• Having headaches, stomach problems or other aches and pains that don’t go away 
• Having low energy or extreme fatigue that doesn't improve with rest

What Are Some Causes of Depression During Pregnancy?

Some women who experience antepartum depression have a history of major depression prior to pregnancy. However, many women have their first experience of depression while they're pregnant. Antepartum depression is thought to be caused by a combination of hormonal changes and psychological disturbances associated with pregnancy. Physical changes, such as changes in body and changes in sleep and eating habits, while normal aspects of pregnancy, can also contribute to the development of antepartum depression. Risk factors for antepartum depression include:

• Personal or family history of depression
• Stressful life events, like the death or illness of a loved one
• Lack of a partner or social support during pregnancy
• Relationship problems, including domestic violence
• History of abuse or trauma
• Financial stress, including poverty
• Substance abuse, including smoking or drinking alcohol
• Previous pregnancy losses or abortions
• Anxiety about pregnancy complications
• Unplanned pregnancy

How Can Depression During Pregnancy Be Treated?

If you think you are struggling with antepartum depression, the first and most important step you can take is seeking help. Speak with your doctor about your symptoms and issues. He or she will be able to recommend treatment that would be best suited to you and your child. Treatment methods for depression during pregnancy may include:

• Counseling or therapy: You will discuss your thoughts and feelings with a counselor or therapist, who will help you understand your feelings and cope with your issues. You may learn to practice specific techniques such as cognitive behavioral therapy and interpersonal psychotherapy.
• Support groups: These are groups of people going through similar circumstances who meet in person or talk online to share their feelings and experiences about specific topics.
• Medication: Depression is often treated with antidepressants. Your doctor may prescribe you one or a combination of antidepressants. Your doctor should discuss the benefits and risks of taking antidepressants while pregnant, and which antidepressants would be safest for you to use, so you can make an informed decision about your treatment and if medication is the best option. If you were taking an antidepressant before you became pregnant, or began taking them while pregnant, do not stop taking them without first talking to your provider. Stopping medication can be harmful to your baby, and may make your depression worsen, leading to other potential health risks. 
• Brain stimulation therapies: Electroconvulsive therapy is a brain stimulation therapy considered safe to use during pregnancy. Electric current is passed through the brain to produce a seizure and change the brain’s chemistry to relieve depression symptoms. Your doctor may recommend electroconvulsive therapy if you have severe depression, or if medication is deemed to be too risky to take during pregnancy.

Making changes at home may also help you manage your depression symptoms. Speak with your partner, family, or friends about your issues and ask for support. Allow yourself to relax, slow down, cut down on chores and tasks, and put your health and well-being first. Taking care of yourself is vital to taking care of your unborn baby. Some other changes that may help manage depression symptoms include:

• Exercise: Exercise is a natural way to increase serotonin levels and decrease cortisol levels. Speak with your doctor to find the best workouts that would be safe and appropriate for you. Exercise classes designed for pregnant women may be available to you.
• Eat a healthy diet:  Many foods have been shown to affect mood, the ability to handle stress, and focus. Caffeine, sugar, processed carbohydrates, artificial additives and lack of protein can negatively affect your mental and physical health.  Ask to speak with a registered dietitian to determine an individualized healthy eating plan that would most benefit you.
• Get enough sleep: A lack of sleep can greatly affect the body’s and mind’s ability to handle stress and cope with day-to-day challenges. Although depression can affect your ability to sleep, try to establish a sleep schedule so you go to sleep and get up at the same time each day.

When Should I See My Doctor for Depression During Pregnancy?

If you have any symptoms of depression, call your doctor to set up an appointment to discuss your issues and treatment options. If you find yourself having frequent or obsessive thoughts about harming yourself or your unborn baby, contact your doctor or emergency services immediately.

It's important to call your doctor as soon as possible if your depression symptoms exhibit any of these features:

• Remain after two weeks
• Are worsening over time
• Make it hard for you to care for yourself
• Make it hard to complete everyday tasks
• Include thoughts of harming yourself or your unborn baby

If your depression is severe or worsens over time, it is critical to seek help from a mental health specialist. Seeking help is the best step you can take to ensure that you and your child stay safe and healthy.

Learn more about Multidisciplinary Obstetric Medicine Service (MOMS) at Brown University Health