Postpartum depression is a common mood disorder that is sometimes very serious and develops after the birth of a baby. Prenatal depression — a similar mood disorder that occurs during pregnancy — is also common but not as well known. Learn more about prenatal depression, how to tell the difference between this condition and others, and what to do if you need help.
What Is Prenatal Depression?
When depression happens during pregnancy, it’s called prenatal depression. If you have prenatal depression, you may feel too sad, and those feelings may not go away. But the symptoms don’t look the same for everyone who goes through this condition.
Prenatal depression can be hard to diagnose for two reasons. First, pregnancy is idealized in the media and in real life. Many women feel guilty for feeling anything negative during pregnancy. Second, depression is sometimes hard to separate from “normal” pregnancy symptoms such as fatigue, mood swings, and appetite changes.
Some symptoms of depression, such as feeling tired, overlap with normal pregnancy issues. Talk to your doctor to figure out why you’re feeling off, and get help for prenatal depression if you have the following symptoms:
- Feeling overwhelmed, unhappy, or apathetic
- Having trouble concentrating
- Not experiencing joy or wanting to do what normally interests you
- Having low energy
- Having thoughts of harming yourself or ending your life
“I’ve heard patients say, and providers say, too, ‘Well, this is a very happy time. You should be happy. You shouldn’t be having these symptoms,’” says Ewurama Sackey, a child, adult, and reproductive/perinatal psychiatrist and Director of Women’s Behavioral Health in the Psychiatry and Behavioral Health Institute at Allegheny Health Network. “And so when people experience it, they think, ‘Oh, there’s something wrong with me. I’m alone in experiencing this.’ . . . It makes people feel very isolated.”
Sackey adds, “What we try to tell our patients is that you can have many feelings at the same time. You can be happy that a baby is coming, but also you can be feeling not great at the same time. And so it’s important to understand it is OK that you are experiencing these feelings. We want you to get help, and we don’t want you to suffer in silence.”
How common is it?
Prenatal depression is common. Estimates vary, but one is that it affects about 10% of pregnant people.
A review of multiple studies found that the average rate of depression during pregnancy was 17%. Among serious complications of pregnancy, depression is one of the most common. Pregnancy may be the first time you experience depression or anxiety.
“Perinatal depression” is a term that includes both prenatal depression and postpartum depression, which begins after childbirth. This term recognizes that depression that’s connected to having a baby often begins during pregnancy.
Who Gets Prenatal Depression?
Depression is one of the most common mental health issues for adults. Around 15% of women go through depression at some point, and it’s common to have mood changes during and after pregnancy.
You’re more likely to have prenatal depression if you have one or more of these risk factors:
- You or your family members have a history of depression, anxiety disorders, panic disorder, or obsessive-compulsive disorder.
- You’re going through stressful life events. Everyone feels stress, but if you’re dealing with high-stress situations while pregnant — such as a conflict-ridden marriage, job loss, or a health problem in the family — you’re at higher risk for prenatal depression.
- You don’t have much social support. If you don’t have a partner, family, or friends who support you during your pregnancy, you’re more likely to have prenatal depression.
- You’ve gone through intimate partner violence or abuse.
- Your socioeconomic status is low, meaning you have less access to financial, health, and other resources.
- You didn’t plan the pregnancy. Unexpected or unwanted pregnancy can lead to prenatal depression.
- The fetus has a health problem or special needs.
- You’re dealing with a health condition during pregnancy, such as gestational diabetes. This condition and other chronic medical conditions can put you at risk for prenatal depression.
“A lot of our patients who do come to us — they’ve experienced depression before,” Sackey says. “That is one of the risk factors. You’ve had depression or anxiety prior to pregnancy, and so you know what it feels like.”
What Causes Prenatal Depression?
Prenatal depression may be caused by many factors. During pregnancy, rapid changes in sex, stress, and thyroid hormones can affect your mood and may lead to to depression, research suggests. An imbalance in the chemical levels in your brain can cause depression.
“Everyone experiences these fluctuations, but some people are a little more susceptible to changes in hormones,” Sackey says. “It’s thought to be hereditary or genetic — they are just a little more sensitive to those changes, and with those changes, then they can have depressive symptoms.”
Many people go through these symptoms in the last couple of weeks of pregnancy, Sackey says, “where there’s a sharp incline in estrogen and progesterone, and then right after giving birth, there’s a sharp decline in some people,” although symptoms can occur throughout the pregnancy.
A history of mood disorders may be a cause of prenatal depression, and other risk factors may add to it, too. Anxiety or worries about changes to your body, financial or parenting concerns, and other issues also may play into prenatal depression.
Prenatal Depression Symptoms
Feeling sad or anxious sometimes is normal, whether you’re pregnant or not. But with prenatal depression, these feelings can last weeks or months and can get worse. Symptoms of prenatal depression include:
- Intense anxiety and worries
- Excessive crying or mood swings
- Loss of interest in activities you used to enjoy
- Fatigue, sleeping more than usual, or trouble sleeping
- Problems with concentration, memory, or decision-making
- Changes in appetite and unexplained weight loss or gain (not related to your pregnancy)
- Not enough weight gain because you’re not getting enough nutrition
- Lack of interest in your pregnancy
- Smoking, drinking alcohol, or using illicit drugs
- Thoughts of harming yourself or the fetus
If you have thoughts of harming yourself or the fetus or of suicide, call the 988 Suicide & Crisis Lifeline. By calling or texting 988 or using the online chat, you can reach a counselor who can provide support.
Some of these symptoms overlap with depression symptoms for anyone. But with prenatal depression, you may feel especially weakened due to the many changes to your body and hormones caused by pregnancy.
How it differs from a major depressive episode that happens outside of pregnancy is that “it’s a little more related to the pregnancy,” Sackey says. For example, you might have thoughts such as “I’m not going to be a great mom. This child would be better off with someone else. I have thoughts of harming myself or my baby,” she says.
If you have prenatal depression, you may have many of these symptoms at once. They may get more or less harmful.
Prenatal Depression Treatment
If you think that you have prenatal depression, it’s important to ask your doctor for a checkup as soon as possible. Sometimes, people don’t seek treatment for prenatal depression because they think it’s a normal part of pregnancy, but getting treatment is essential.
In deciding when to seek help, knowing how long you’ve been feeling the symptoms and how strong they are can help. “How much are they impairing your functionality? Are you unable to work? Are you unable to interact with people in your family very well? Are you isolating yourself? Are you not able to leave your home?” Sackey says. “Even if it’s not the worst depressive symptoms you’ve had, once you start to feel a lower mood, it’s important to talk to your doctor, because you can also, then, help to prevent some symptoms.”
Prenatal depression is probably more common than you think, and there are many prenatal depression treatments available that are safe for you and your baby.
Prenatal depression medication
Many people who aren’t pregnant take antidepressant medication to ease symptoms of depression. It’s possible to safely treat depression with certain medications during pregnancy, but they should be prescribed based on your current condition, your medical history, and your baby’s health risks. Some antidepressants, such as paroxetine, have been found to cause heart problems in babies, while others, such as sertraline, are generally considered safe.
“It’s important, if you are on medications before pregnancy, to stay on those medications or discuss with your doctor the risk of having untreated depression or anxiety versus the potential risks for medications. And usually, the risks of being without medication are much greater than the risks of medication,” Sackey says.
You may wish to avoid medication during pregnancy, but it’s still important to address your depression. Be sure to discuss this with your health care provider. They’ll also warn you about certain antidepressant herbs, such as St. John’s wort, that may not be safe during pregnancy.
Therapy for prenatal depression
Various types of therapy or mental health counseling can treat prenatal depression, and they don’t carry physical risks for you or your baby. In psychotherapy, or talk therapy, you can talk through your emotions with a therapist and find ways to manage your mood changes.
Cognitive behavioral therapy (CBT) is one type of psychotherapy that helps you get new thinking patterns and react to challenging situations in a more positive way. Another type is interpersonal therapy (IPT), which helps you understand how your emotions affect your relationships, improve your relationships with others, and lean on loved ones for support.
Another option for treating prenatal depression is couples or family therapy, where you and your partner or family members meet with a therapist. Group therapy, where you meet with one or more therapists and a group of people who are dealing with similar issues, can be helpful as well.
Does Prenatal Depression Go Away on Its Own?
Prenatal depression is unlikely to go away on its own without treatment. It’s important for your and your baby’s health to get treatment if you have prenatal depression.
It’s normal to feel sad or anxious during pregnancy sometimes. But these feelings typically last a few days. If you have signs of depression that last two weeks, talk with your OB/GYN.
If you notice anything that feels off during pregnancy, talk it over with your provider. Your symptoms could be caused by pregnancy hormones, or they could point to something more serious. The faster you reach out for help, the sooner you’ll begin feeling better.
What Are the Risks of Prenatal Depression?
You may already know that postpartum depression puts new mothers and their babies at risk. Women with postpartum depression might avoid their new babies, stay in bed, or struggle with unwanted anger.
Prenatal depression is similar in that it can affect your ability to take care of yourself during pregnancy. During this time, your baby relies on you for nourishment. If your depression affects your ability to take your prenatal vitamins, eat a healthy diet, or attend medical checkups, your baby’s health is put at risk. Research has found a link between prenatal depression and negative birth outcomes, including low birth weight.
Prenatal depression can be mild or severe. At the mild end of this disorder, you might feel anxious and hopeless about the future (or your pregnancy itself). At the severe end, prenatal depression might cause panic, insomnia, self-harm, and rage.
Avoiding treatment might seem like the easier option, but you could be putting your own health as well as your unborn baby’s health at risk if you ignore this mood disorder. Speak with your doctor, nurse-midwife, or mental health counselor as soon as possible to learn more about your condition and its treatment options.
“We really want you to understand that dealing with your depression is really going to help you, not just in the pregnancy period, but also in the postpartum period, when you’re bonding with your baby. The longer you go without treating it, the worse it can become,” Sackey says.
Can I Prevent Prenatal Depression?
Prenatal depression involves many factors that are out of your control, such as life stress, medical status, and hormonal shifts. It’s not possible to prevent all cases of prenatal depression.
But if you’ve gone through depression before, continuing the treatment that worked for you is important in preventing prenatal depression — and getting enough sleep is helpful, too, Sackey says. Experts recommend both CBT and IPT to help prevent depression during pregnancy.
“I think it’s really important to talk about things as early as possible,” especially if you have some risk factors for prenatal depression, says Sackey. If you talk to your family and your support system about prenatal depression symptoms, they might be able to identify them in you, she says. They can also help you develop a plan for “OK, if this happens, what can we do? How can we reach out and get these services? Where can we go?”
Living With Prenatal Depression
If you have prenatal depression, here are some things that may help you through it, along with the treatment your health care provider prescribes.
Staying active
Physical activity can help boost your mood, so regular exercise during pregnancy is important. Be sure to get your doctor’s OK before beginning a workout program and to use caution if you have risk factors such as preterm labor, previous pregnancy issues, or problems with your placenta. Walking each day may be a good place to start if your doctor says it’s OK.
Also, make sure you’re getting out of the house and interacting with other people, such as your partner, friends, and family, because this can affect your mood.
Healthy eating and sleeping habits
Eat a healthy diet to ensure that you’re getting the nutrition you and your baby need during pregnancy. You can talk with your health care provider about your diet, and USDA's MyPlate guidelines may be helpful, too.
Other important practices during your pregnancy include:
Taking prenatal vitamins
Staying hydrated
Getting enough sleep
Getting support from others
Along with support from your friends, family, or partner, you might consider joining a support group for pregnant people. These may be virtual groups or local, in-person groups where you can connect with others who may be going through similar experiences.
Your local hospital may be able to recommend local groups. The National Maternal Mental Health Hotline can connect you with local support groups and organizations. Through this free, confidential hotline, you can also talk to a counselor and get referrals for health care providers. You can call or text 1-833-TLC-MAMA, 24 hours a day.
Stress-reducing practices
Practices such as meditation, mindfulness meditation, breathing exercises, and yoga may help lessen your stress and anxiety and boost your mood. Massage therapy may also help lower depression during pregnancy.
Along with treatment, these practices may help you feel better and less stressed — and help you manage your prenatal depression.
Takeaways
Prenatal depression is common during pregnancy, although many people may dismiss symptoms as a normal part of hormone fluctuations and other changes during pregnancy. If you have depression, treatment is important, and both medication and therapy can treat prenatal depression. Some healthy habits, such as eating well and getting some exercise, can help boost your mood during pregnancy and may help prevent prenatal depression as well. Ensuring that you have the support you need, including treatment and social support, is important if you have depression during pregnancy.
Prenatal Depression FAQs
What are the triggers of prenatal depression?
Prenatal depression can be caused by many things, including hormone changes during your pregnancy and a history of mood disorders.
Does prenatal depression affect babies?
Yes, prenatal depression can affect babies. Research has found that babies born to people with prenatal depression have a higher risk of negative birth outcomes, such as low birth weight.
When should I tell my OB/GYN about depression?
You should talk to your OB/GYN if you have symptoms of depression — such as sadness or anxiety — that persist for more than two weeks. But if these feelings are really intense, it might be a good idea to check in with your health care provider sooner. And if you have thoughts of self-harm, call the 988 Suicide & Crisis Lifeline or get emergency medical attention right away.
Is pregnancy rage a thing?
Prenatal anger and pregnancy rage are valid, and they refer to feeling frustrated or moody during pregnancy. Sometimes, the symptoms of prenatal depression include feeling irritable or angry.
