It's not easy being blue — especially when everyone around you thinks you're feeling rosy. The truth is, pregnancy depression is common, effecting between 14 and 23 percent of expecting women. And it’s no wonder women are even more susceptible to depression when they’re expecting: Surging hormones coupled with stress, anxiety and societal pressure to feel a certain way can do a number on any woman’s emotional state during pregnancy. 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 the symptoms of depression can be effectively treated with the right help. Drug-free approaches like talk therapy can help. So can some antidepressants, which recent 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 causes prenatal depression
No one knows for sure what causes depression during pregnancy, but it's a pretty sure bet that those raging hormones play a significant role. Here’s a closer look at some of the factors that can put an expectant mom at risk:
- Hormones: 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.
- A history of depression: If you’ve been diagnosed with depression in the past, tell your practitioner, since there’s a greater chance you’ll experience depression while you’re expecting.
- Genetics: 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.
- Stressful life events: 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.
- 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 depression.
- Being young: Young women are more susceptible to depression during pregnancy.
- Being the victim of abuse: Feelings of low self-esteem, helplessness and isolation can all contribute to depression symptoms.
- 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.
Symptoms of pregnancy depression
It’s often difficult to diagnose prenatal depression because its symptoms mirror so many "normal" pregnancy symptoms: sleep and appetite changes, loss of interest in sex, anxiety, inability to concentrate and general emotional instability. What's not normal is to feel consistently sad, hopeless or generally uninterested in life — especially if those feelings are keeping you from eating properly, sleeping regularly or otherwise taking good care of yourself. 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.
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If you have any of the following symptoms of depression for most of the day every day during the same two-week period, you should seek help:
- Sad, restless 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 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
Some women don’t seek treatment for their pregnancy depression out of embarrassment, shame, 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. What’s more, depression may not end when your pregnancy does. Being depressed when you’re pregnant also puts you at a higher risk of postpartum depression. 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 in both body and mind.
Treatments for pregnancy depression
The good news is you can treat depression during pregnancy. Most doctors suggest starting with nondrug approaches including psychotherapy (talk therapy), light therapy (exposure to high-intensity lamps that increase levels of the mood-regulating hormone serotonin in the brain), acupuncture and meditation.
Antidepressants during pregnancy
If your symptoms are more severe, your doctor may want to treat your depression more aggressively with antidepressants. 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. Still, experts say those risks shouldn’t keep pregnant women from taking medication, since the risks of untreated depression are often greater than 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 if 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.
Don't take any medication — herbal or otherwise — without consulting your practitioner. You and your doctor need to carefully weigh the possible benefits against the possible risks to decide the treatment that’s right for you.
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. This list of suggestions is a good place to start:
- Rest as much as you can. Fatigue can intensify normal pregnancy mood swings, so make sure you’re getting enough rest. Go to bed early, sleep late or take naps when you can.
- Spend time outdoors. Being 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 get done, ask your partner, family and friends for help.
- Eat 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 OK from your practitioner first, of course).
- Spend time with your family and friends. Make time to visit friends and be alone with your partner, whether it’s dinner out or just for a night of movies and popcorn. Intimacy of any kind — from simple cuddling to handholding — 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 and friends.
- Join a support group. 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.
From the What to Expect editorial team and Heidi Murkoff, author of What to Expect When You're Expecting. Health information on this site is based on peer-reviewed medical journals and highly respected health organizations and institutions including ACOG (American College of Obstetricians and Gynecologists), CDC (Centers for Disease Control and Prevention) and AAP (American Academy of Pediatrics), as well as the What to Expect books by Heidi Murkoff.
- What to Expect When You're Expecting, 5th edition, Heidi Murkoff and Sharon Mazel.
- American College of Obstetricians and Gynecologists, Depression, June 2012.
- American College of Obstetricians and Gynecologists, Depression and Postpartum Depression: Resource Overview, 2017.
- National Institutes of Health, National Library of Medicine, Examination of Premenstrual Symptoms as a Risk Factor for Depression in Postpartum Women, June 2013.
- National Institutes of Health, National Library of Medicine, A Meta-Analysis of Depression During Pregnancy and the Risk of Preterm Birth, Low Birth Weight and Intrauterine Growth Restriction, January 2011.
- Centers for Disease Control and Prevention, What Is Depression?, April 2018.
- EverydayHealth.com, 6 Depression Symptoms You Shouldn't Ignore, May 2017.
- WhatToExpect.com, Is Anxiety Medication Safe to Take During Pregnancy?, September 2017.
- WhatToExpect.com, No Link Found Between Taking Antidepressants During Pregnancy and Autism, April 2017.
- WhatToExpect.com, Antidepressants and Pregnancy, August 2018.
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