Anyone that has been pregnant or has known someone pregnant can say that it is both a beautiful and terrifying experience. For women encountering their first pregnancy, there are many unknowns about the process and how it changes the female mind and body. Not everyone is aware that depression and pregnancy can be related. In fact, for many women, depression can happen during their pregnancy. As it stands, there is not very much information about why depression occurs during pregnancy in certain women, or if it can be prevented.
It is important to note that any woman can become depressed over the course of their pregnancy, even women that have never had depression and have no family history of depression. Pregnancy causes both physical and mental stress for most women due to fluctuating hormones and rapid lifestyle changes. Even women that have had normal pregnancies before can still develop depression during later pregnancies. Having an understanding of how to recognize depression during pregnancy, how this condition specifically affects both mother and baby and how it can be treated is critical.
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Prevalence of Depression During Pregnancy
How common is depression during pregnancy? According to the Centers for Disease Control and Prevention, approximately 1 in 9 women experience postpartum depression symptoms. Additionally, the rate of depression in pregnant women increased sevenfold from 2000 to 2015. This relatively high rate of depression in pregnant women demonstrates just how common the condition is during pregnancy.
Teen Pregnancy and Depression
What about teen pregnancy and depression? Teen pregnancy is often stigmatized and associated with accidental pregnancies. A study conducted in 2018 found that pregnant teenagers had higher rates of depression relative to other teenagers and pregnant adult women. However, teenage depression while pregnant was not due to childbearing, but rather other factors. For instance, teenage mothers who reported depression during pregnancy often reported being depressed prior to becoming pregnant. These results suggest that psychologically distressed teens may be at a higher risk for teen pregnancy.
Signs & Symptoms of Depression While Pregnant
How can a pregnant mother recognize depression symptoms in herself? How can relatives or friends recognize depression in their pregnant loved one? Family and friends should make sure to monitor their loved one for signs of depression while pregnant. Depression and pregnancy symptoms may be similar to a person who normally experiences depression, or the signs may differ slightly.
It is important to remember that hormonal fluctuations during pregnancy are normal and healthy. Crying and occasional emotional outbursts happen in pregnant mothers without depression. Pregnancy is not only physically taxing, but can be emotionally taxing as well. It is important to be able to differentiate between the normal emotional fluctuations of pregnancy and pregnancy depression symptoms because the latter should be addressed by a medical professional.
What are the physical symptoms of depression during pregnancy? Some women will exhibit almost all physical signs of depression, while others will only experience a few. The severity of each symptom also lies on a spectrum from less severe to more severe. Examples of physical symptoms of depression during pregnancy include:
- Feeling constantly tired or experiencing an abnormal loss of energy
- Issues with concentrating, memory and decision-making
- Changes in sleep
- Changes in appetite
- Body aches and pains that do not seem to get better over time
Sometimes, it may be more difficult to observe the emotional symptoms of depression during pregnancy. Some women may try to hide the fact that they are persistently feeling down. Others may think that the way they feel is how everyone feels while pregnant. There can also be extreme guilt associated with feelings of depression since pregnancy is supposed to be a joyous and happy time. However, the reality is that for some women, stress, genetics, pregnancy complications and other underlying issues can make pregnancy difficult.
Unfortunately, mood swings are to be expected for almost all pregnant women due to the hormonal and physical changes associated with pregnancy. It is important to remember that some emotional symptoms may be temporary, and most women feel sad, depressed or down on at least one occasion during their pregnancy. It is easy to feel overwhelmed and certainly common for women to cry during pregnancy.
However, if negative emotional symptoms seem to persist or last for longer than a few days, it is critical to see a medical professional and discuss these feelings. Depression — whether a woman is pregnant or not — is a treatable condition. Some examples of emotional depression symptoms while pregnant include feeling:
- Persistently overwhelmed, anxious, upset or empty
- Hopeless or pessimistic about life or pregnancy
- Guilty, worthless or helpless
- Unworthy of motherhood
- Out of control
- Irritable or restless
- Suicidal or attempting suicide
Can Pregnancy Cause Depression?
Answering conclusively if pregnancy causes depression requires extensive research involving many study participants who have experienced depression before, during and after pregnancy. This type of research is difficult to conduct and receive adequate funding. Thus, the direct causes of depression during pregnancy are not completely clear.
Perinatal Depression vs. Postpartum Depression
What is the difference between perinatal depression versus postpartum depression? Perinatal depression symptoms are virtually the same as postpartum depression except for the time of onset. Perinatal depression is defined as depression that manifests either during pregnancy or within four weeks after giving birth. In contrast, most women’s health providers would classify postpartum depression as occurring any time in the first year after birth, though the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) criteria are more specific. Thus, women should be mindful of when depression symptoms start. However, depression will likely be treated in the same way regardless of whether it is diagnosed as perinatal or postpartum.
Risk Factors for Depression While Pregnant
Currently, the causes of depression during pregnancy are not well understood, but likely involve a combination of psychological, genetic and environmental risk factors, as is the case with most other mental health conditions. Nevertheless, there are several risk factors for developing depression while pregnant. Some of these include:
- High stress levels
- Family history or past history of depression
- Lack of social support
- Problems at home
- Accidental pregnancy
- Low income or socioeconomic status
- Substance abuse
- Never before being pregnant
- Lack of adequate women’s health care
Dangers of Depression During Pregnancy
What are the dangers associated with depression during pregnancy? In answering this question, two lives — both that of the mother and the unborn baby — must be taken into account. There are clear dangers posed for both parties if depression is recognized too late, not addressed or not managed effectively with proper medical care and support.
There are several dangers and risks associated with depression during pregnancy, specifically for the expecting mother. Some of these risks include:
- Increased impulsivity
- Decreased social interaction
- Trouble thinking clearly
- Emotional disturbances
- Higher risk of developing postpartum depression
- Higher risk for committing suicide while pregnant
- Increased hospital admissions
- Preeclampsia, a condition involving pregnancy-induced dangerously high blood pressure
- Pregnancy complications
- Increased engagement in higher risk behaviors, including substance abuse
Risks to the Unborn Baby
Currently, there are not many risks associated with a pregnant woman taking antidepressants or selective serotonin reuptake inhibitors (SSRIs) to treat her depression. There is some evidence to suggest that certain uncommonly prescribed SSRIs may cause birth defects, but these cases are extremely rare. Commonly prescribed antidepressants rarely cause serious birth defects.
Unrelated to medication, there is some evidence to suggest that mothers who were depressed during pregnancy had more lethargic and irritable babies. Additionally, these children went on to develop cognitive and emotional difficulties. Therefore it is critical that a mother receives support and some form of treatment for depression during pregnancy not only for herself but for her baby’s well-being.
Preventing Depression During Pregnancy
Unfortunately, there is little evidence to suggest that screening for depression during pregnancy affects patient outcomes. Besides eliminating life stressors that a woman has control over, there may be no singular way to prevent depression during pregnancy. However, if a woman feels any symptoms of depression or just feels “off,” she should still not hesitate to make an appointment with her health care provider, psychiatrist or psychologist. There is absolutely no shame in asking for help.
It is important to note that if a woman was prescribed antidepressants before her pregnancy, she should not stop taking her medication without the consent and approval of a licensed medical professional. There could be negative side effects associated with suddenly stopping antidepressants, including insomnia, anxiety, headaches, dizziness and nausea.
Treating Depression During Pregnancy
What are the typical treatments for depression during pregnancy? Generally, there are two main approaches to treating depression: pharmacologic and nonpharmacologic. Although the risks of taking antidepressants are small, some women may opt for a nonpharmacologic treatment approach. Some common nonpharmacologic approaches include:
- Patient education
- Psychotherapy (talk therapy)
- Cognitive behavioral therapy
- Nutrition and lifestyle modification
- Stress management techniques
- Practicing proper sleep hygiene
- Bright light therapy (for seasonal depression)
Pharmacologic approaches typically involve the use of antidepressants or SSRIs. Only a medical professional can assess the safety and efficacy of using these medications during pregnancy. Generally speaking, most of the commonly prescribed medications for treating depression are safe during pregnancy. Some common medications include:
Support for Pregnancy-Related Depression
How can a woman receive help with depression during pregnancy? First, it is important that a woman has friends, family or other sources of positive social support during and after pregnancy. Without a support system, individuals can feel isolated, lost and desperate. Isolation can cause and exacerbate depressive symptoms. There are various forms of help a woman can receive during this difficult time, including a support system, therapy or even medication, such as antidepressants for depression.
Beyond friends, family and acquaintances, there are other forms of support available for women experiencing depression during pregnancy. Simply searching for “pregnancy support groups” will lead to many resources based on a person’s geographical location. Hospitals and women’s health clinics can also be a great reference for finding nearby pregnancy support groups. In many cases, having support from individuals who have gone through similar periods of depression during their pregnancy can be comforting.
Key Points: Understanding Depression and Pregnancy
Some important points to remember about depression during pregnancy are:
- Depression during pregnancy is not uncommon
- Depression during pregnancy can happen to anyone, including women with no history of depression
- Depression during pregnancy is treatable
- Many commonly prescribed antidepressants are safe to take while pregnant
Centers for Disease Control and Prevention. “Depression During and After Pregnancy.” May 15, 2019. Accessed July 12, 2019.
Centers for Disease Control and Prevention. “Key Findings—A Closer Look at the Link Between Specific SSRIs and Birth Defects.” March 20, 2018. Accessed July 12, 2019.
Chan, Justin et al. “Risks of untreated depression in pregnancy.” Can Fam Physician, March 2014. Accessed July 12, 2019.
Collingwood, Jane. “Depression and Teenage Pregnancy.” PsychCentral, October 8, 2018. Accessed July 12, 2019.
Haight, Sarah et al. “Recorded Diagnoses of Depression During Delivery Hospitalizations in the United States, 2000–2015.” Obstetrics & Gynecology, June 2019. Accessed July 22, 2019.
Harvard Health. “Depression during pregnancy and after.” March 21, 2017. Accessed July 12, 2019.
Lancaster, Christie et al. “Risk factors for depressive symptoms during pregnancy: a systematic review.” Am J Obstet Gynecol., January 2010. Accessed July 12, 2019.
The Mayo Clinic. “Depression during pregnancy: You’re not alone.” November 25, 2016. Accessed July 12, 2019.
Stuart-Parrigon, Kaela and Stuart, Scott. “Perinatal Depression: An Update and Overview.” Curr Psychiatry Rep., September 2014. Accessed July 12, 2019.