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Depression During Pregnancy: How to Spot the Signs

depressed pregnant woman
Arefa Cassoobhoy, MD, MPH - Blogs
By Arefa Cassoobhoy, MD, MPHBoard-certified internistMay 06, 2019

Depression happens - even during pregnancy.

While most women are aware that depession can surface after giving birth (postpartum depression), I rarely hear anyone talk about depression during pregnancy.

It’s surprisingly common. An estimated 12% of women experience depression during pregnancy. And while 50% of the women have a history of depression before they’re pregnant, 50% are experiencing symptoms of depression for the first time while they are pregnant.

I can tell you, depression during pregnancy surprised me. I was supposed to be happy – I had my dream life: a satisfying job treating patients, a happy marriage, a healthy daughter, and a baby boy on the way.

But I wasn’t happy. I thought it was due to being on bedrest for my high risk pregnancy (and it certainly contributed), so I dismissed my feelings and worked at keeping my spirits up in front of family and friends. But aside from engaging with my daughter and husband for short pockets of time, I didn’t feel like talking to anyone. I didn’t feel like doing anything. I just laid there doing nothing. I couldn’t focus on television shows or read a book, and it didn’t even occur to me to consider a bedrest-friendly project like knitting or making a photobook.

I felt like I was sinking in a dark hole, kind of like the tunnel vision just before you faint. I started having thoughts about running away. I was going to wait until the baby was born and then I would disappear. I didn’t think I was needed, and I didn’t think anybody would miss me.

But then in a moment of mental clarity, I thought, If a woman came to my office telling me this story, I’d immediately start evaluating her for depression and offer to help her. And that’s when I finally opened up. That evening I told my husband what I was thinking and feeling and then got professional help.

I look back at that period in my life and realize how subtle but real my symptoms were. And how important it was that I recognized them myself and then reached out for help. 

I’m one of the lucky ones. Research shows over half of women with major depression during their pregnancy are not diagnosed. And of the women diagnosed, only 50% get treatment.

The symptoms of depression during pregnancy are similar to those of depression in general, but they can be easily missed. Red flags like fluctuations in sleep, appetite, and energy can be easily confused with normal changes related to pregnancy. Some women are more at risk than others; for these women, all of the physical and emotional stressors of impending motherhood can trigger depression.

Risk factors for depression during pregnancy include:

  1. History of depression in the past
  2. Anxiety
  3. Problems related to the pregnancy
  4. History of partner violence or any abuse in the past
  5. Poor social support
  6. Stressful life events or situations
  7. Obesity

The changes in mood or thinking that could be symptoms of depression during pregnancy are:

  1. Feeling unhappy, sad, hopeless or frustrated, annoyed and irritable
  2. Losing interest in activities you used to enjoy
  3. Feeling worthless, inadequate, guilty or like a failure
  4. Having trouble focusing, making decisions, and completing tasks
  5. Thinking about death or suicide

If you’re having any of these symptoms, it’s important to reach out to others – even if you think what you’re experiencing is just part of the normal ups and downs during pregnancy, and especially if the symptoms persist for 2 weeks or longer. And if you’re thinking about death or suicide you must seek help now (If you are in crisis, call 800 273 TALK or text 741 741).

Talk to your obstetrician about diagnosis and treatment. Find a mental health clinician that provides specialized treatment for women during pregnancy. Talk therapy is often the first treatment offered. What type you choose depends on what your doctor recommends and what’s convenient and available to you. Usually you can expect 6 to 10 sessions.

  1. Cognitive - behavioral therapy (CBT) may be recommended if your symptoms are primarily anxiety related. CBT can help you reframe thoughts and behaviors that are dysfunctional or problematic.
  2. Interpersonal psychotherapy may be recommended if your depression is related to stressors in your life including relationships and your own changing circumstances. This type of talk therapy helps you work through life transitions and conflicts with others.
  3. Supportive psychotherapy is also an option and focuses on self-esteem building skills to better address stressful relationships and situations.

Medication is also a treatment to consider with your obstetrician and psychiatrist. Other options that might be helpful for depression during pregnancy include clinician guided self-help, exercises like yoga, family/couples therapy, massage, acupuncture, bright light therapy, and support groups.

The first step is to acknowledge that there might be a problem and let others know. It made all the difference for me.

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About the Author
Arefa Cassoobhoy, MD, MPH

Arefa Cassoobhoy, MD, MPH is a board-certified internal medicine doctor and a WebMD Medical Editor. She is on the team that makes sure all WebMD content is medically correct, current and understandable. She sees patients at the Women’s Wellness Clinic at the Atlanta Veterans Affairs Medical Center.

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