What Is Prenatal Depression and How Is It Treated?

What Causes Depression During Pregnancy?

While many people have heard of postpartum depression, which can occur after the baby arrives, depression is also thought to affect about 7% of expectant parents during pregnancy.

Depression is about as common in pregnant women as it is in nonpregnant women. “There isn’t more of a biological risk of becoming depressed during pregnancy than at any other time in life,” says Lauren M. Osborne, M.D., a board-certified psychiatrist and the director of the Johns Hopkins Center for Women's Reproductive Mental Health, in Baltimore.

However, there are plenty of circumstantial risks that tend to be higher in pregnancy, like hormonal changes and emotional stressors, such as changing relationship roles and worry about the future.

These factors can leave some people feeling a loss of control and can affect their overall mood. Personal health history also plays a role.

“Some women come into pregnancy with a history of anxiety or depression, and they are at higher risk of recurrence during pregnancy and postpartum,” says Jessica Vernon, M.D., a board-certified ob-gyn at NYU Langone Health in New York City, where she serves as co-lead of the Perinatal Mental Health Program and a clinical assistant professor in the Department of Obstetrics and Gynecology. “Others may have no history but may have risk factors for developing these disorders during pregnancy.”

Risk Factors of Prenatal Depression

Many factors may play a role in developing depression during pregnancy. “Some are present even before pregnancy, and some develop during pregnancy or delivery,” Vernon says.

Risk factors for prenatal depression include things like:

• Previous history of anxiety, depression, postpartum depression, or other mental health concerns—and stopping any medications to manage them during pregnancy
• Family history of mental illness
• Personal history of chronic health conditions, such as diabetes or heart disease
• Previous history of trauma such as physical abuse, sexual abuse, or domestic violence
• Previous history of infertility
• Previous history of prior pregnancy loss, trauma in prior pregnancy, or poor outcomes
• Previous or current pregnancy-related complications, such as fetal anomalies, gestational diabetes, or preeclampsia
• Having an unplanned or unwanted pregnancy
• Being pregnant with multiples
• Being single, a teenager, or an older first-time parent
• Socioeconomic stressors, like being unemployed or having low income
• Lack of support from loved ones

Also, it’s important to note that pregnant people who experience depression during pregnancy are at an increased risk of developing depression after giving birth, as well.

Signs of Depression During Pregnancy to Watch For

Since pregnancy can come with a certain degree of natural mood changes, separating which emotions are expected during pregnancy from those that are cause for concern can be confusing. Signs of prenatal depression can include the following:

• Low mood that lasts for two weeks or more
• Feelings of inadequacy about parenting
• Inability to enjoy your usual activities
• Suicidal thoughts (this is a medical emergency—immediate help is available 24/7 at the 988 Suicide & Crisis Lifeline. You can get connected by calling 988 or by chatting with counselors online or by dialing 911)

“Everybody has moments of sadness,” Osborne says. “But if feelings of sadness, listlessness, lack of interest, social withdrawal, or increased anxiety impair your ability to function, then that's a signal that there may be depression.”

Understanding that difference can help you know when to ask for help.

The Effects of Prenatal Depression

Left unmanaged, depression during pregnancy can have a serious impact on both your health and your baby’s health, Osborne says. “The way I like to think of it is that there are both direct and indirect effects.”

As far as indirect effects, people who are depressed during pregnancy are:

• Less likely to seek out and adhere to proper prenatal care
• Less likely to make appropriate lifestyle choices, like following a healthy diet and being active
• More likely to drink alcohol, smoke cigarettes, or use illicit substances

One 2020 study found that depression during pregnancy can directly increase the risk of:

• Preeclampsia
• Premature membrane rupture
• Preterm delivery
• Cesarean section delivery
• Intrauterine fetal growth restriction
• Lower birth weight
• Stillbirth

“After delivery, there may be trouble breastfeeding, poor bonding, and emotional and conduct disorders in childhood,” adds Vernon.

7 Ways to Manage Depression During Pregnancy

If you think you may be experiencing prenatal depression, the good news is that there are plenty of steps you can take to manage it. “The most important thing is to recognize it and get into some kind of treatment,” Osborne says. What works best for you may include a combination of the following:

1. Medication

“Anybody with moderate to severe symptoms probably needs medication,” Osborne says. And many antidepressant medications are considered safe for use in pregnancy.

“There are medications that do have some risks—but the risks of severe depression in a mom and the effects on her baby must be weighed against the medication risks,” adds Vernon, who suggests working with a reproductive psychiatrist who specializes in mental health in pregnancy and postpartum. A professional with this expertise can help you find the right treatment plan and make adjustments as needed throughout your pregnancy. Ask your ob-gyn for help finding someone.

“You actually have to increase dosing [with certain medications] to maintain the same concentration of medication in the blood,” Osborne adds.

2. Therapy

“People who have less severe symptoms can often be helped with psychotherapy alone, without medication,” Osborne says. Findings from a 2020 paper published in Frontiers in Psychiatry suggest that undergoing a type of therapy known as cognitive behavioral therapy throughout pregnancy and the postpartum period may help improve the mental health and well‑being of both you and your baby. For more help, try Postpartum Support International.

3. Diet

Although it’s common for good eating habits to be pushed to the back burner when feeling depressed during pregnancy, making the right food choices promotes healthy growth and development for the baby. Try eating more fresh fruits and vegetables, whole grains, low-fat dairy, and lean proteins (as well as taking a prenatal vitamin).

4. Exercise

Staying active can help boost your physical and mental well‑being. A review of studies published in 2021 suggests that exercise can help prevent and reduce prenatal depression and related symptoms. Just be sure to get the green light from your doctor before jumping into action—and don’t overdo it.

5. Sleep

“During pregnancy, there’s a lot of sleep disruption—both during early pregnancy, because of the biological changes that are going on, then in late pregnancy, when people are uncomfortable and getting up to pee more,” Osborne says.

Meanwhile, depression can make it even harder to fall asleep and stay asleep throughout the night. And lack of sleep during pregnancy can lead to complications that affect both you and your baby. Aim to get eight to 10 hours of sleep at night (combined with naps as needed).

6. Mindfulness

Research suggests that mindfulness can help people manage symptoms of depression. Although the benefits of mindfulness for prenatal depression specifically are less clear, it still offers promise (and can help you get that good night’s sleep). Vernon recommends options like meditation and yoga to help you relax and unwind.

7. Support

Connecting with loved ones or joining a support group to share experiences with others who are pregnant can be a valuable source of emotional support when dealing with prenatal depression.

Resources That Can Help

These resources can help you manage symptoms of depression during pregnancy:

• Postpartum Support International: “This is the largest online resource to help you find therapists and prescribers in your area,” Vernon says. “They also have free weekly online support groups.”
• Maternal Health Hotline: Call or text 833-943-5746 (833-9-HELP4MOMS) to connect with a counselor as part of this free resource set up by the U.S. Department of Health and Human Services.

“Anyone with risk factors should be empowered to speak to their care team at the beginning of pregnancy and get set up with support so that they are less likely to develop [prenatal depression],” Vernon says. “Anyone experiencing symptoms should reach out, as well, so that they can get better as quickly as possible.”

You May Also Like:

• How to Manage Anxiety During Pregnancy
• Are Antidepressants Safe During Pregnancy?
• The “Baby Blues” vs. Postpartum Depression: Understanding Postnatal Emotions