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Depression During Pregnancy: The Path to Healing
Pregnancy can be a time of great joy and excitement, but also immense change and stress. For 10 to 20% of women in the United States, these changes can contribute to depression during pregnancy. The risk of depression rises during pregnancy and in the months following birth. With mental health support and treatment, this can be a rewarding and healing time.
What is depression?
Around 280 million people worldwide struggle with depression—a condition that’s twice as common in women due to factors such as hormonal fluctuations and stress. Depression symptoms may include persistent feelings of sadness, hopelessness, and loss of interest in previously enjoyable activities. It can also include physical symptoms like changes in sleep, appetite, and energy levels, as well as concentration and decision-making that can significantly impact daily life. Like other mental health disorders, depression impacts people differently but, most importantly, it is a treatable condition.
Causes of depression during pregnancy
There’s typically not just one cause of depression. “Depression during pregnancy, much like depression in other phases of our lives, can be influenced by various factors,” said Graciete Lo, PhD, a clinical quality manager at Lyra Health. “These influences can include things like hormonal changes, genetic predispositions, past traumas, social support, and personal history.”
Risk factors are characteristics, experiences, or conditions that heighten the likelihood of developing a health issue. Risk factors for depression during pregnancy include:
Genetics
A family history of depression can increase your risk of depression. It doesn’t guarantee you’ll have that condition, but it’s important to pay attention to your mental health and take care of your emotions as best as possible should that condition develop over time.
Previous mental health issues
A history of depression in previous pregnancies or prior episodes of depression
Hormonal changes
Sensitivity to hormonal changes such as mood disturbances from the use of birth control in the past or during adolescence as well as from endocrine disorders like thyroid issues. Pregnancy itself involves substantial hormonal and neurochemical fluctuations, which can contribute to mood disorders.
Age
Depression can occur at any age, but some stages of life carry special risks. Teenagers and younger mothers may experience depression during pregnancy due to the emotional and financial challenges of parenthood at an early stage of life. Meanwhile, older mothers may face anxiety or depression related to concerns about pregnancy complications, birth risks, and the demands of parenting later in life.
Lack of support
Factors such as lacking social support, living alone, distance from family and friends, changes in relationships, poor nutrition, and cultural barriers can all contribute to prenatal depression.
Miscarriages or infertility
A history of pregnancy loss or infertility can also impact emotional well-being during pregnancy. Even in a celebrated pregnancy, past experiences of loss or fertility struggles can evoke complex emotions.
Relationship conflicts
Conflicts with partners can contribute to prenatal depression, especially paired with the heightened emotional vulnerability, responsibilities, changes, and stress that can accompany pregnancy.
Feelings about the pregnancy
Your emotional state before becoming pregnant and expectations about pregnancy can influence your depression risk. Whether the pregnancy was planned or a surprise as well as if it’s seen as joyous or stressful can affect emotions.
Health care access
Several factors can make it tough to access mental health care, let alone diagnose and treat depression while pregnant, including socioeconomic disparities, cultural beliefs, and care preferences. Structural racism and institutional barriers in the health care system can hinder BIPOC women’s access to critical medical care and support. Depending on whether a woman seeks care from traditional healers, midwives, or Western medicine practitioners, the approach to addressing depression during pregnancy may vary.
“These risk factors can apply to both the pregnancy and postpartum periods as they share many similarities,” said Dr. Lo. “There’s also growing attention to identifying and addressing various symptoms and conditions during pregnancy such as bipolar disorder, which may have gone undiagnosed before pregnancy but becomes apparent during or after the pregnancy.”
What are the signs of depression during pregnancy?
It’s important to look out for potential signs of depression during pregnancy because they can have a significant impact on both the mother and developing child. Signs of depression during pregnancy are similar to those in other periods of life and may include:
- Persistent feelings of sadness
- Sleep disturbances
- Appetite changes
- Increased irritability
- Overwhelming exhaustion
- Heightened nervousness
- Feeling out of control
- Recurring anxious thoughts
- Frequent crying spells
- Apathy or disinterest in activities
The symptoms above warrant checking in with a mental health professional. Severe symptoms that require immediate attention include:
- Thoughts of self-harm or suicide
- Thoughts of harm to the baby
- Paranoia or hallucinations
- Extreme and harmful beliefs related to the pregnancy or the baby
“Involving partners and family is essential, as individuals experiencing these symptoms might not be fully aware of their condition,” said Dr. Lo. “Medical providers should also be attentive to these signs so they’re not dismissed as normal ‘pregnancy jitters’ or ‘the baby blues.’”
How does depression affect pregnancy?
Depression during pregnancy can have far-reaching consequences. Apathy and exhaustion may discourage expecting mothers from attending prenatal doctor’s appointments or social activities, which can worsen their depression.
“Depression may also interfere with the mother’s ability to bond with her baby during pregnancy, which could affect the early attachment process after birth, impacting the baby’s emotional and psychological development,” said Dr. Lo.
Pregnant people with depression may lose their appetite, causing insufficient nourishment for both themselves and the baby. On the other hand, their appetite may grow, leading to excessive weight gain. This can potentially lead to complications, especially in cases of gestational diabetes or other preexisting medical conditions that require proper nutrition. Poor nutrition may also affect how the baby grows, causing the baby to be too small (low birthweight) or too big (macrosomia). These conditions are linked to a higher likelihood of chronic diseases in childhood and later in life.
Additionally, depression during pregnancy can impact other mental health conditions. For example, disrupted sleep patterns (a symptom of depression) can potentially trigger manic episodes in people with bipolar disorder, as adequate sleep is crucial in managing the condition. Pregnancy depression is also the main cause of substance use during pregnancy, which can harm both the mother’s health and the baby’s development. Finally, suicide is a leading cause of maternal death during pregnancy and up to a year after birth.
Treatment for depression during pregnancy
“Treatment for prenatal depression can be approached from three primary angles—psychotherapy, social support, and medication,” said Dr. Lo. “A combination of these is often most helpful. It’s essential for pregnant women who are depressed to work closely with their health care providers to determine the most suitable treatment based on their unique circumstances.”
Psychotherapy
Psychotherapy is often the first step in treating depression while pregnant. Cognitive behavioral therapy (CBT) and interpersonal psychotherapy (IPT) are evidence-based approaches that can be helpful. IPT, especially, focuses on how relationships impact depression and how depression affects relationships. It explores the changes in roles and dynamics that can happen during pregnancy and helps women adapt to these transitions.
Medication
Many mothers feel hesitant about taking medication while pregnant, but it’s important to consult an OB/GYN or a prescriber who specializes in prenatal care. These professionals can discuss the potential risks and benefits of medication during pregnancy. Like other medical conditions, pregnancy depression may require treatment and some medications, like SSRIs (e.g., Zoloft and Prozac), have been used for years with a low risk to both mothers and babies.
Social support
Social support can involve talking with friends, fellow pregnant moms, or people who’ve experienced similar challenges. Formal support groups for pregnant people and families are available and can be found through OB/GYN offices or local associations.
Support for depression during pregnancy
If you’re experiencing depression while pregnant, know that you aren’t alone in this struggle. Many people have faced similar challenges and have come out the other side stronger than ever. Whether it’s therapy, medication, lifestyle changes, or a combination of these approaches, there are treatment options to help you manage depression during pregnancy. Seeking help is a courageous step toward ensuring both your well-being and the health of your baby.
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