Depression during pregnancy

Feeling sad while pregnant for weeks at a time is prenatal depression. It is common, it is treatable, and it is not a failure of love.

What it is

Prenatal depression, also called antenatal depression, is depression that starts or returns during pregnancy. If you feel sad while pregnant most days, and it has gone on for two weeks or more, this may be what is happening.

About 1 in 10 pregnant women has depression. Some counts put it closer to 1 in 7. It is at least as common in pregnancy as it is after birth, but it gets missed more. Tiredness, poor sleep, and appetite changes look like pregnancy, so nobody asks.

It is not caused by not wanting the baby. Hormone shifts, a past history of depression, stress, loss, and lack of support all play a part. Many mothers who get it were thrilled to be pregnant.

What's typical

Low mood that does not lift for two weeks is the first sign. Others are losing interest in things you used to like, crying often, guilt, feeling numb, and trouble deciding small things. Sleep and appetite change more than pregnancy alone explains. Some mothers feel it most in the first trimester. Others feel it build in the third. With help, most mothers feel better within weeks to a few months. Without help, it often continues after the baby comes.

What's known

ACOG recommends screening for depression at least once in pregnancy, usually with a short questionnaire called the EPDS. The U.S. Preventive Services Task Force found that counseling for women at risk lowers the chance of depression. Talk therapy, especially CBT and interpersonal therapy, is the first option for most. Some providers prescribe medication during pregnancy; several have decades of safety data, and your provider can go over the trade-offs. Untreated depression carries its own risks for mother and baby, so doing nothing is not the safe choice. Across many cultures, a pregnant woman is kept close by other women. The reason given is that she should never carry the waiting alone.

What helps

Tell one person the truth about how you feel. A partner, a friend, your mother, your provider.
Keep a loose routine: get up, get dressed, step outside once a day.
Eat something every few hours, even when you have no appetite. Low blood sugar deepens the dip.
Say yes to help with the things that have piled up.
Ask your provider for the EPDS screen by name. It takes five minutes.
Find a perinatal therapist. Many see pregnant women within a week or two and take Medi-Cal.

When to call someone

Nowthoughts of hurting yourself, or feeling the baby would be better off without you. Call or text 988. The National Maternal Mental Health Hotline is 1-833-852-6262.
Todayyou cannot get out of bed, have not eaten or slept in days, or feel hopeless.
At your next visitsad more days than not for two weeks. Ask for the screen and a referral.

Who helps

Perinatal therapistOB-GYNMidwifePerinatal psychiatrist

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Sources

American College of Obstetricians and Gynecologists — Clinical practice guideline on treatment and management of mental health conditions during pregnancy and postpartum
U.S. Preventive Services Task Force — Perinatal depression: preventive interventions recommendation statement
Postpartum Support International — Depression during pregnancy and postpartum
NHS — Mental health in pregnancy

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