How to manage depression during pregnancy

It's normal to feel down from time to time. But if you're depressed, you experience feelings of sadness or hopelessness that last for weeks or even months. Pregnancy depression can impact your ability to care for yourself and your baby.

Feeling this way is hard any time, but it can be especially difficult to cope when you're pregnant. There's an expectation that pregnancy is supposed to be a joyful time, so it can be hard to admit it if that's not the way you're feeling.

Know that depression is an illness, not a choice. And it's surprisingly common: About 1 in 10 women experience depression during pregnancy.

Even if you're diagnosed with severe clinical depression, there are many effective treatments. The earlier you're able to start treatment, the more effective it will be. So don't hesitate to ask for help. Your emotional health is just as important as your physical health.

What causes depression during pregnancy?

While experts don't fully understand what causes depression during pregnancy, it's likely due to a mix of emotional, physical, and environmental factors. Preparing for a baby brings about lots of big changes, many of which feel out of your control – including concerns about giving birth, being a good parent, and the loss of your former life. Hormonal changes can also impact a woman's odds of developing pregnancy depression.

While women who have already been diagnosed with depression and anxiety are more likely to be diagnosed with pregnancy depression, many women are diagnosed with the disorder for the first time while they're expecting.

Symptoms of depression in pregnancy

Some symptoms of depression, such as fatigue or trouble sleeping, are normal during pregnancy. But you may have prenatal depression when you have a sense of sadness or hopelessness, lose interest or pleasure in things that you used to enjoy, or aren't able to function in your daily life, and these symptoms last for weeks.

You may be depressed if you've experienced any of the following symptoms for at least two weeks:

• Losing interest in daily activities, or having a sense that nothing is enjoyable or fun anymore
• Feeling "blue," sad, or "empty" for most of the day, every day
• Having low self-esteem, such as thinking that you won't be a good parent
• Crying all the time
• Feeling extremely irritated or agitated
• Feeling anxious about your baby
• Finding it hard to concentrate or make decisions
• Having low energy or extreme fatigue that doesn't improve with rest
• Experiencing changes in your patterns of eating or sleeping, such as wanting to eat or sleep all the time or not being able to eat or sleep at all
• Having overwhelming feelings of guilt, worthlessness, or hopelessness
• Feeling that life isn't worth living

Research suggests these symptoms may be more likely to happen in the first and third trimesters.

It's also common for women to develop the first signs of postpartum depression (PPD), or depression that develops in the year after giving birth, during pregnancy. In fact, an estimated half of women with PPD first notice symptoms of depression during pregnancy.

If you think you might be depressed, talk to your provider. Only a medical or mental health professional can diagnose depression.

To get some insight into your state of mind, you can also take our Pregnancy Depression Quiz.

If you're having thoughts of hurting yourself, call the National Suicide Prevention LifelineOpens a new window at 988, or text the Crisis Text LineOpens a new window (text HELLO to 741741).

Risk factors for depression during pregnancy

Anyone can have depression at any point in life. But about twice as many women as men are diagnosed with depression, possibly due in part to hormonal fluctuations related to menstruation, pregnancy, and childbirth.

Pregnancy depression has been linked to several risk factors, including:

Personal history of depression or anxiety

If you've struggled with depression or anxiety in the past – like during an earlier pregnancy or after the birth of a previous child – you're more likely to become depressed now that you're pregnant.

If you're struggling with anxiety during pregnancy, this also increases the risk of being diagnosed with prenatal depression.

Family history of depression

If depression runs in your family, you have a higher risk of the condition, and you're more likely to get it at a younger age.

Women whose partners have been diagnosed with depression or another mental disorder are also more likely to experience prenatal depression.

Stress

Coping with stressful events, such as financial problems, the end of a relationship, the death of a close friend or family member, or a job loss can trigger depression during pregnancy.

Smoking, drinking, or using drugs that haven't been prescribed to you by a doctor to alleviate stress increases the risk of pregnancy depression along with health complications for your baby.

Lack of support

If you're having your baby on your own, or if you feel isolated or receive little support from friends or family, you have a higher risk of depression. Having relationship problems or an unsupportive partner can also increase your risk of depression.

Pregnancy complications

Having pregnancy complications increases the risk of pregnancy depression.

Previously going through a pregnancy loss or traumatic birth also increases the risk of experiencing depression during a subsequent pregnancy.

Certain illnesses

Pregnancy is already physically demanding, which can make managing a chronic illness such as high blood pressure or type 2 diabetes more challenging. In addition, having preexisting diabetes or gestational diabetes while pregnant increases the risk of pregnancy depression.

Unplanned pregnancy

Finding out you're pregnant when you weren't planning to be can be extremely stressful and increases the risk of depression.

Domestic violence or a history of abuse

It's very common for domestic violence and emotional abuse to get worse when a woman is pregnant. If this happens to you, it's crucial that you speak to someone to make sure you and your baby stay safe. Talk to your provider about how to change your situation. You can also call the National Domestic Violence HotlineOpens a new window at 800-799-SAFE (7233) or text START to 88788.

Women who have a history of physical or sexual abuse are also more likely to experience depression during pregnancy. If you've struggled with abuse in the past, it's important to seek help from a mental healthcare professional. If you aren't already seeing a therapist, ask your primary care doctor or ob-gyn for a referral.

Will having depression during pregnancy affect my baby?

If pregnancy depression goes untreated, it can make it harder for you to take care of yourself. You may be less likely to eat healthy or sleep, and you may be more likely to smoke or use alcohol or other substances. This, in turn, can impact not only your own health and well-being but your baby's.

Untreated depression during pregnancy has been linked to a higher likelihood of a baby being born early or having a low birth weight (and other health complications). Research also suggests that babies born to women with depression are more likely to be irritable and may cry more than babies born to moms who aren't depressed. Later in life, children may be at greater risk of emotional, developmental, and behavioral problems.

Treatment options for pregnancy depression

Depression is one of the most common pregnancy complications. At your prenatal visits, it's likely your provider will ask you about your mood and how you're feeling. If they don't, be sure to bring it up.

Talking about mental health issues can be hard, and it's easy to think you're the only one who feels this way. But your provider likely sees many other women going through a similar experience. Remind yourself that they're there to help, not judge.

There are two main treatment options available to help you manage pregnancy depression, which may be used alone or in combination: psychotherapy and medication.

Psychotherapy

Talk therapy can help you to recognize and address potential causes for depression during pregnancy. Sessions may be one-on-one or take place with your partner or in a group setting.

Several different psychotherapy methods are used during pregnancy, including:

• Cognitive behavioral therapy (CBT), which helps you to identify and change unhelpful ways of thinking and behavior patterns. CBT has been shown to improve quality of life and to be an effective treatment for both depression and anxiety disorders.
• Psychodynamic therapy, which helps you to understand the causes for emotional suffering through self-reflection in order to change problematic patterns in your life.
• Interpersonal therapy, which may be particularly effective during pregnancy, as it teaches you how to cope with the many life changes that come with being a new parent.

Medication

It's natural to feel concerned about taking medication while you're pregnant. Your provider will weigh the benefits and risks of medication for you and your baby and explain them so you can make an informed decision about your treatment.

The risks involved with taking an antidepressant during pregnancy are small and vary depending on the medication, the dose, and how long you take it. Most research suggests that selective serotonin reuptake inhibitors (SSRIs) are safe to take during pregnancy.

If you take antidepressants in your third trimester, your baby may experience withdrawal at birth. This will likely be mild and short-lived but can include breathing problems, jitteriness and irritability, low blood sugar (hypoglycemia), or trouble feeding.

If you were taking medication for depression or any other mental health condition before you became pregnant, don't stop taking it without talking to your provider first. Stopping suddenly could be risky for you and your baby. If you're concerned the medication isn't safe during pregnancy, talk to your doctor about finding the option that's best for you and your baby.

Are there other ways I can manage my depression during pregnancy?

Coping with the physical, hormonal, and emotional changes of pregnancy is hard when you have depression. The best approach is to talk to your provider and find a treatment plan that works well for you. The following tips can also help you to manage depression during pregnancy.

Care for yourself. Put self-care at the top of your to-do list. Make time to read a book, have breakfast in bed, take a bath, or go for long walks around the neighborhood.

Spend time with other people. Nurture your relationship with your partner, friends, and family.

Join a support group. Connect with other moms, especially those who are also struggling with depression during pregnancy. Ask your doctor for local resources, or find a support group near you. You can also get online support in the BabyCenter Community

Stay active. Aim to fit in some physical activity every day – whether it's taking a prenatal yoga class, hitting the gym, or going for a walk around the block (just be sure you have your provider's okay before starting a new exercise program). Research suggests even small amounts of physical activity can ease symptoms of depression and anxiety by releasing feel-good brain chemicals and taking your mind off of worries.

Eat well. Focus on consuming lots of fresh foods, especially fruits, vegetables, low-fat meat and poultry, fish, and whole grains. Try to minimize processed and sugary foods.

Prioritize rest. While pregnancy can make it harder than ever to get a good night's rest, sleep is critical for your health and well-being. Not getting enough can increase the risk of experiencing both anxiety and depression. Try to go to bed early when possible, establish a soothing bedtime routine, and invest in a comfy pregnancy pillow.

Set realistic priorities. Resist the urge to tackle too many chores before the baby comes. You may think you need to clean the house or do a lot of extra work before you go on maternity leave, but you don't.

Ask for help. Don't hesitate to ask your partner, family, or friends for help with the tasks that need to get done.

How to find help and why it's so important

If you're feeling very low, you may find that it's hard to get to your prenatal appointments – and that means you won't get the care you and your baby need. This can be the start of a downward spiral, which may also increase your risk of being diagnosed with PPD once your baby is born. That's why it's so important to reach out for help as soon as possible, as difficult as that may be.

If you're unable to handle your daily responsibilities, or if you have thoughts of harming yourself, call your provider immediately. They can provide a referral to a mental health specialist. Your health insurer can also provide a list of providers who accept your insurance plan. 

Once you have a few mental health provider options, call and ask basic questions, such as about their education and experience and what you can expect from sessions. Get a sense of whether you feel comfortable working with this person – and if not, don't hesitate to shop around.

Mental healthcare is expensive, costing $150 per hour or more without insurance. If you're struggling to afford counseling, ask a provider whether they offer their services on a sliding scale (that means they'll adjust their charges based on your income). You may also be able to access affordable or even free care at a federally funded health centerOpens a new window near you or from a grad student at the behavioral health department of a local college or university.

Don't try to handle the challenges of depression and pregnancy alone. Seeking help doesn't mean you're weak. It shows that you're willing to do what's necessary to keep you and your baby safe and healthy. Following an individualized treatment plan – whether it's talk therapy, medication, or some combination of both – is the best way to stay healthy during your pregnancy and beyond.