Although our modern era allows for a more nuanced view, many still assume pregnancy is a time of unqualified joy. As a result, if pregnancy depression strikes, that can be an incredibly isolating experience – and what’s more, many women who experience prenatal depression prefer to postpone any treatment, as it is widely believed that selflessness is good and “the baby should take priority.”
In reality, treating depression during pregnancy is vital to ensure the holistic wellness of both you and your baby. This is equally true whether it’s during your pregnancy that you are feeling depressed for the first time or if you’ve been struggling with your mental health for years.
About depression during pregnancy
Medically termed prenatal depression or antenatal depression, depression during pregnancy is sometimes lumped together with its more famous (and more commonly referred to) cousin, the “baby blues.”
The main difference? The baby blues are usually a short-term (but intense) period of mood swings and sadness that moms may feel immediately after giving birth. Sometimes, the baby blues give way to more lasting postpartum depression, which can develop at any time between birth and the next two years.
Prenatal depression, on the other hand, has the same severe and prolonged symptoms as major depressive disorder. It encompasses people who develop depression for the first time while pregnant, as well as people who have been battling mental health conditions well before their pregnancies.
So, how many women are we talking about? Some estimates indicate that up to 11% of all pregnant women develop depression while pregnant.
Antenatal depression is closely linked to its postpartum version. As a result, some research addresses both together and calls it “perinatal depression.”
Symptoms of depression during pregnancy
Prenatal depression symptoms are generally similar to those of a significant depression that may be experienced by anyone at any time, with symptoms that commonly include:
- Persistent mood swings or low moods
- Feelings of hopelessness, worthlessness, or guilt
- Withdrawing from social activities
- Loss of interest in regular hobbies or activities
- Pervasive fatigue
- Changes in appetite and sleep patterns
- Loss of sex drive or the ability to orgasm
- Problems with concentration, focus, or decision-making
- Thoughts of self-harm or suicide
Any of these symptoms alone wouldn’t be enough to classify someone as “depressed.” To be classified as having depression, you’d need to experience at least five of these symptoms frequently, or nearly every day, for at least two weeks.
Identifying prenatal depression can be trickier than diagnosing “general” depression (or “major depressive disorder” in psych talk). Often, people attribute many signs of depression to “pregnancy hormones,” especially during the first trimester of pregnancy.
Why? Because at this stage, pregnancy symptoms can mimic the pantheon of regular pregnancy symptoms. For example, morning sickness and hormonal changes can easily affect your appetite or make you feel like every day should be a “bed day.”
As pregnancy progresses, weight gain, the so-called “baby brain,” or the added mental load of prepping for a new baby, can all mask anxiety and depression symptoms – or even make existing issues worse.
All in all, diagnosing perinatal depression may require an in-depth chat with a mental health professional. Because that won’t be practical for every expectant mom, the American College of Obstetricians and Gynecologists (ACOG) recommends that all pregnant women be screened for depression at least once during pregnancy.
Pull Quote block
Some estimates indicate that up to 11% of all pregnant women develop depression while pregnant.
Prenatal depression risk factors
People of all ages, genders, and walks of life can experience depression. However, some groups are more likely to develop perinatal depression, including people who have:
- A history of major depression, bipolar disorder, or severe depression.
- A strong family history of depression, anxiety, or other mood disorders.
- A high-risk pregnancy, especially if it comes after previous fertility issues or miscarriages.
- Coexisting health problems such as thyroid disease, diabetes, or an autoimmune disorder.
- Severe stress in other areas of life – such as job insecurity, financial uncertainty, or a recent traumatic life event.
- An unplanned pregnancy, especially if it means the pregnant person is placed in an uncomfortable financial position.
- A lack of social support during pregnancy
- A history of experiencing abuse or domestic violence
These factors also place you at a higher risk of developing postpartum depression (PPD) or severe depression in the long term. If this describes your experience, it’s best to be up-front with your OB/GYN. Early screening and quick referrals can protect you and your baby throughout the pregnancy and beyond.
Can pregnancy depression harm my baby?
During pregnancy, many women see their chronic or ongoing needs – whether a holiday plan or an elective surgery – pushed to the back burner.
But while some procedures or concerns can be safely postponed, the same cannot be said for mental health. Untreated depression during pregnancy has been linked to poorer pregnancy outcomes, mainly:
- Higher rates of preterm delivery and low birth weight
- Postpartum depression
- Problems bonding with the baby after delivery
- Difficulty breastfeeding
In turn, each of these problems can invite further complications down the road. For example, low-birthweight babies have a higher chance of experiencing developmental delays, substance abuse, and mental health issues later in life. PPD can develop into chronic depression, which will impact your daily life – and the lives of your loved ones.
Call (844) 473-6100 or click here to schedule online
Treating prenatal depression
There is some complexity to treating depression during pregnancy, if only because of having to balance a more comprehensive array of needs and concerns. Nowadays, several pharmaceutical and nonpharmaceutical treatment options are deemed safe for pregnancy.
Current research shows that combining different approaches is often the most effective strategy for treating depression. Your main healthcare provider (whether a family doctor or your OB/GYN) can help you decide which methods will be most well-suited to your circumstances, provide you with any needed referrals, or point you to other helpful resources.
Nonpharmaceutical options for depression during pregnancy
For women who are looking to play it safe, the first-line alternatives for treating perinatal depression are nonpharmaceutical interventions. In mild to moderate cases of pregnancy depression, these are often enough to keep the condition in check.
According to research, the most effective options include:
- Psychotherapy (talk therapy) can range from general counseling to more specialized cognitive behavioral therapy (CBT) or interpersonal therapy (IPT).
- Group therapy or the help of a support group.
- Pregnancy-appropriate outdoor exercise programs.
- Light therapy, acupuncture, or other similar alternative therapies.
Antidepressants in pregnancy
Often, both patients and general physicians are wary of prescribing any medication during pregnancy. This usually stems from fears of harming the fetus – with anything from low-birth weight babies to serious congenital defects being touted as a reason. Unfortunately, this often keeps women with all sorts of conditions from getting the treatment they need, which is also dangerous.
In truth, the answer is far from straightforward: we don’t know. Proving that medicine is absolutely safe takes decades of data collection, but we also have no evidence that it isn’t safe in many cases.
However, research does show that there are some antidepressants you can take while pregnant with a reasonable degree of safety so that most practitioners will recommend them first. This list includes most selective serotonin reuptake inhibitors (SSRIs), like fluoxetine (Prozac) or sertraline (Zoloft).
We simply don’t have any conclusive data yet on newer options such as duloxetine (Cymbalta ®) or venlafaxine (Effexor ®).
Meanwhile, amitriptyline is a much older antidepressant that dates back to the 1960s, which means we have a lot more data showing its safety for both mother and baby. And yet, these older medications also tend to have much harsher side effects overall, which is why they’re rarely used or studied in recent years.
On the other hand, we do know enough about a handful of psychiatric medications that are not safe during pregnancy. These include paroxetine (Paxil ®), valproic acid (which is mainly used for bipolar disorder), and benzodiazepines like diazepam (Valium ®) or alprazolam (Xanax ®).
So, how is it best to proceed if you’re dealing with a significant mental illness, such as bipolar disorder, and want to get pregnant? Because stopping medications abruptly may cause unintended harm, if you are considering going off any prescription medications, it would always be best to talk to your doctor ahead of time. Together, you can devise a plan to replace a medication safely.
Are you at risk for perinatal depression? Dr. Rad’s team has your back
Dr. Steve Rad is one of the top-ranked neonatologists and maternal-fetal medicine experts in Los Angeles. In his private practice, he routinely welcomes and assists women with high-risk pregnancies who are trying to balance complex health issues during their journey to motherhood.
Because of his extensive experience with complex cases, he has cultivated a unique sensitivity to the mental well-being of his patients before, during, and after they give birth. We are currently accepting new patients. Call us at (844) 473-6100 or schedule your consultation online.
We are conveniently located for patients throughout Southern California and the Los Angeles area at locations in or near Beverly Hills, Santa Monica, West Los Angeles, West Hollywood, Culver City, Hollywood, Venice, Marina del Rey, Malibu, Manhattan Beach, Newport Beach, Irvine, and Downtown Los Angeles. We also offer in-home prenatal care and have a fly-in program for out-of-town and international patients. Dr. Rad even travels to patients who need him throughout the U.S. and worldwide.
If you can’t make it to Dr. Rad, he also offers virtual consultations worldwide.
Call (844) 473-6100 or click here to schedule online
