Prenatal Depression: Signs, Symptoms, and Support During Pregnancy

Pregnancy is often portrayed as a time of joy and anticipation, but for many expecting parents, it can also bring unexpected emotional challenges. While postpartum depression has gained significant attention in recent years, prenatal depression—depression that occurs during pregnancy—remains less discussed despite affecting a substantial number of pregnant individuals.

Prenatal depression, also called antenatal depression or perinatal depression, is a mood disorder characterized by persistent feelings of sadness, anxiety, and loss of interest in daily activities during pregnancy. Understanding this condition is essential for ensuring the health and wellbeing of both parent and baby.

Prenatal depression is a clinical mood disorder that occurs during pregnancy. It goes beyond the typical mood swings or temporary feelings of worry that many pregnant people experience. This condition involves persistent symptoms that can significantly impact your daily functioning, relationships, and ability to care for yourself during pregnancy.

Unlike the “baby blues” or occasional worries about becoming a parent, prenatal depression is a serious medical condition that requires professional attention and treatment. It’s not a sign of weakness, and it’s not something you can simply “snap out of” through willpower alone.

Research indicates that approximately 7% to 9% of pregnant individuals in the United States and other high-income countries experience prenatal depression. In low- and middle-income countries, these rates may be even higher due to various socioeconomic factors.

Despite how common this condition is, many cases go undiagnosed. Healthcare providers may be less likely to identify depression in pregnant patients compared to those who aren’t expecting. Additionally, prenatal depression is often diagnosed less frequently than postpartum depression, even though it can be equally serious and impactful.

The prevalence of prenatal depression appears to be fairly consistent across all three trimesters of pregnancy, meaning you can develop symptoms at any point during your pregnancy journey.

Several factors contribute to the underdiagnosis of prenatal depression:

Overlapping Symptoms

Many symptoms of depression mirror normal pregnancy experiences. Changes in sleep patterns, energy levels, appetite, and libido are common during pregnancy, making it easy for both pregnant individuals and healthcare providers to attribute these signs to pregnancy rather than recognizing them as potential indicators of depression.

Focus on Physical Health

Prenatal care appointments often prioritize physical health monitoring—blood pressure checks, weight measurements, and fetal development assessments. While these are certainly important, the emphasis on physical health can sometimes overshadow mental health concerns.

Stigma and Cultural Barriers

In many communities, mental health conditions carry a stigma that can prevent pregnant individuals from openly discussing their emotional struggles. Some may feel ashamed or worry about being judged as incapable of handling pregnancy. Cultural beliefs about mental health can also lead people to dismiss or minimize depression symptoms.

Reluctance to Speak Up

Some pregnant people hesitate to share their feelings because they believe they should be happy during pregnancy. They may feel guilty about not experiencing the joy they think they’re supposed to feel, which can prevent them from seeking help.

While prenatal depression can affect anyone, certain factors may increase your risk of developing this condition:

• Personal or family history of depression: If you’ve experienced depression in the past or have family members who have, you may be at higher risk.
• Anxiety disorders: Existing anxiety can increase vulnerability to depression during pregnancy.
• High stress levels: Major life stressors, financial difficulties, relationship problems, or work-related stress can contribute to prenatal depression.
• Lack of social support: Limited support from family, friends, or partners can increase your risk.
• Unplanned pregnancy: An unexpected pregnancy, especially in challenging circumstances, may increase depression risk.
• History of trauma or abuse: Past experiences with intimate partner violence, childhood abuse, or other trauma can heighten vulnerability.
• Pregnancy complications: Medical issues during pregnancy, such as gestational diabetes or high blood pressure, can add stress and increase depression risk.
• Severe morning sickness: Persistent nausea and vomiting (hyperemesis gravidarum) that lasts throughout pregnancy can contribute to depression.
• History of premenstrual syndrome (PMS) or premenstrual dysphoric disorder (PMDD): Hormonal sensitivity may play a role in prenatal depression.
• Discontinuing antidepressant medication: Some people stop taking prescribed depression medication when they become pregnant, which can trigger a recurrence of symptoms.
• Sleep problems: Chronic insomnia or poor sleep quality can increase depression risk.
• Young maternal age: Younger pregnant individuals may face unique challenges that increase their vulnerability.

Identifying prenatal depression can be challenging because some symptoms overlap with normal pregnancy experiences. However, certain warning signs may indicate depression rather than typical pregnancy changes:

Pregnancy-Specific Warning Signs

• Excessive anxiety or worry about your baby’s health and wellbeing
• Persistent doubts about your ability to be a good parent or low self-esteem
• Lack of interest in or emotional connection to your pregnancy
• Not responding to reassurance or support from loved ones or healthcare providers
• Neglecting prenatal care appointments or not following medical recommendations
• Engaging in harmful behaviors such as smoking, drinking alcohol, or using illicit drugs
• Poor nutrition and inadequate weight gain due to lack of appetite or inability to care for yourself

General Depression Symptoms

If you experience any of the following symptoms for two weeks or longer, it’s important to speak with your healthcare provider:

• Persistent sad, empty, or hopeless mood: Feeling down most of the day, nearly every day
• Loss of interest or pleasure: No longer enjoying activities that once brought you happiness
• Feelings of guilt or worthlessness: Excessive self-criticism or believing you’re inadequate
• Sleep disturbances: Insomnia or sleeping much more than usual (beyond typical pregnancy fatigue)
• Changes in appetite and weight: Eating significantly more or less than appropriate for pregnancy
• Fatigue or loss of energy: Feeling exhausted beyond normal pregnancy tiredness
• Difficulty concentrating: Trouble focusing, making decisions, or remembering things
• Physical agitation or slowed movements: Feeling restless or unusually sluggish
• Thoughts of death or suicide: If you have any thoughts of harming yourself, call 911 or the National Suicide Prevention Lifeline at 988 immediately

Seeking treatment for prenatal depression is crucial for several important reasons:

Effects on Maternal Health

When prenatal depression goes untreated, pregnant individuals may struggle to engage in proper self-care. This can include:

• Skipping prenatal appointments or inadequate prenatal care
• Poor nutrition and failure to maintain a healthy diet
• Lack of energy to exercise or engage in beneficial activities
• Increased risk of pregnancy complications
• Higher likelihood of developing postpartum depression

Effects on Baby’s Development

Maternal depression during pregnancy can potentially affect fetal development and infant outcomes:

• Increased risk of preterm birth
• Low birth weight
• Potential developmental delays
• Difficulty with bonding after delivery
• Increased stress hormones that may affect the baby

Long-Term Family Impact

Untreated prenatal depression can affect family dynamics and relationships, making it harder to adjust to parenthood and potentially impacting the parent-child relationship in the months and years following birth.

The American College of Obstetricians and Gynecologists (ACOG) recommends that healthcare providers screen for depression and anxiety at least once during pregnancy. Typically, screening occurs during the first prenatal visit and again during the third trimester.

What Screening Involves

Depression screening during pregnancy usually involves answering questions about your mood and emotional state. Your healthcare provider may:

• Use a standardized questionnaire where your answers are scored to assess depression severity
• Ask specific questions about whether you’ve felt down, depressed, or hopeless recently
• Inquire about loss of interest or pleasure in activities
• Discuss any anxiety symptoms you may be experiencing

The Importance of Screening

Even though not every pregnant person who screens positive for depression has immediate access to comprehensive treatment resources, research shows that screening itself offers benefits:

• Reduces stigma around mental health during pregnancy
• Increases self-awareness about depression and anxiety risks
• Opens the door for important conversations about mental health
• May lower overall depression rates through early identification

Important: Don’t wait for a scheduled screening if you think you might have depression. Contact your healthcare provider as soon as you recognize concerning symptoms and ask about next steps.

Effective treatments are available for prenatal depression, and seeking help is one of the best things you can do for yourself and your baby. Treatment options depend on the severity of your symptoms and may include:

Psychotherapy

Talk therapy, particularly cognitive-behavioral therapy (CBT) and interpersonal therapy (IPT), has proven effective for treating prenatal depression. These approaches help you:

• Identify and change negative thought patterns
• Develop coping strategies for stress and anxiety
• Improve communication and relationships
• Address past trauma or ongoing stressors
• Build problem-solving skills

Medication

For some individuals, medication may be necessary to manage prenatal depression effectively. If you’re considering or currently taking medication for depression during pregnancy:

• Always consult with your healthcare provider before starting, stopping, or changing any medication
• Discuss the potential risks and benefits with your doctor
• Never discontinue prescribed medication without medical guidance
• Work closely with your healthcare team to find the safest and most effective treatment plan

The decision to use medication during pregnancy should be made carefully with your healthcare provider, weighing the risks of untreated depression against any potential medication risks.

Lifestyle Modifications and Support

In addition to professional treatment, certain lifestyle changes may help manage depression symptoms:

• Regular physical activity (with your doctor’s approval)
• Maintaining a consistent sleep schedule as much as possible
• Eating nutritious, balanced meals
• Building and maintaining social connections
• Joining pregnancy support groups
• Practicing stress-reduction techniques like prenatal yoga or meditation
• Limiting major life changes when possible
• Asking for and accepting help from loved ones

Complementary Approaches

Some people find additional relief through complementary approaches such as:

• Acupuncture
• Massage therapy
• Light therapy
• Omega-3 fatty acid supplementation (discuss with your doctor first)

These should complement, not replace, evidence-based treatments recommended by your healthcare provider.

If you’re experiencing symptoms of prenatal depression, taking the first step to get help can feel overwhelming, but it’s crucial for your wellbeing and your baby’s health.

Steps to Take

1. Talk to your healthcare provider: Your obstetrician, midwife, or primary care doctor can evaluate your symptoms and recommend appropriate treatment or referrals.
2. Contact a mental health specialist: Ask for a referral to a therapist or psychiatrist who specializes in perinatal mental health.
3. Reach out to support organizations: Groups like Postpartum Support International (which also addresses prenatal depression) offer resources, helplines, and support groups.
4. Call a crisis line if needed: If you’re in crisis, call 988 (Suicide and Crisis Lifeline) or text “HELLO” to 741741 (Crisis Text Line).
5. Involve your support system: Share your feelings with trusted family members or friends who can provide emotional support and practical help.

Questions to Ask Your Healthcare Provider

• What treatment options are available for prenatal depression?
• Can you refer me to a mental health specialist experienced in treating pregnant individuals?
• What are the risks and benefits of different treatment approaches?
• How will treatment affect my pregnancy and baby?
• What can I do at home to manage my symptoms?
• How often should we reassess my treatment plan?

If someone you care about is experiencing prenatal depression, your support can make a significant difference in their recovery:

• Listen without judgment: Allow them to express their feelings without dismissing or minimizing their experience.
• Offer practical help: Assist with household tasks, meal preparation, or attending appointments.
• Encourage professional treatment: Gently support them in seeking help from healthcare providers.
• Educate yourself: Learn about prenatal depression to better understand what they’re experiencing.
• Be patient: Recovery takes time, and symptoms may not improve immediately.
• Take care of yourself: Supporting someone with depression can be emotionally taxing; make sure you maintain your own wellbeing.
• Watch for crisis signs: If they express thoughts of self-harm, take it seriously and seek immediate help.

Prenatal depression is a real and serious condition, but it’s also treatable. With appropriate care and support, most people with prenatal depression can recover and go on to have healthy pregnancies and form strong bonds with their babies.

Remember that experiencing depression during pregnancy doesn’t make you a bad parent or mean that you don’t love your baby. It’s a medical condition that requires treatment, just like gestational diabetes or high blood pressure during pregnancy.

By recognizing the signs of prenatal depression, seeking help early, and following through with treatment, you’re taking important steps to protect both your health and your baby’s wellbeing. You’re not alone in this experience, and support is available.

If you’re struggling with prenatal depression, reach out to your healthcare provider today. Taking care of your mental health during pregnancy is one of the most important things you can do for yourself and your growing baby.