Causes And Treatments For Depression During Pregnancy

According to the American College of Obstetricians and Gynecologists, approximately one out of every 10 women experiences symptoms of depression during pregnancy. This is often referred to as antepartum depression or antenatal unipolar depression, and it affects approximately 7% of women during pregnancy. Some people may think that symptoms of a depressive disorder in a pregnant person are related to hormones and are a natural part of the changes in mood that can occur during pregnancy. While feelings of depression and anxiety are common mental health challenges in people expecting a new child, these symptoms may also be an indicator of serious psychiatric conditions. In this article, we’ll explore the causes and treatments for pregnancy depression to help you identify if you or someone you care for needs help.

It’s important to note that while both mental health conditions fall under the classification of “perinatal depression,” antepartum depression and postpartum depression are not the exact same mood disorder. The best way to distinguish between these conditions is to determine when symptoms began to manifest: if they happened during pregnancy, it's likely that a person is experiencing antepartum depression; if they occur after pregnancy, they are likely to be signs of postpartum depression.

Causes of antepartum depression

Depression is a mood disorder characterized by changes in physical health, feelings, thoughts, and behavior that affect a person’s ability to accomplish daily tasks and enjoy their overall quality of life. Depressive symptoms—which may include low mood, loss of interest, lack of motivation, and fatigue—can affect not only daily life but also personal and work relationships.

However, changes in hormones may not be the only risk factors.

A pregnant person may be experiencing difficult life situations that make it challenging to manage the stress of a pregnancy effectively. The birth of a new child on the horizon can make other challenges, such as finances or relationships, seem overwhelming. Lastly, the changes that occur within a pregnant woman’s body can exacerbate any other external stressors.

While there is often not a single identifiable cause of depression in pregnancy, there are some common risk factors. These include:

• Personal or family history of depression
• Anxiety and/or life stress
• A recent traumatic life event, such as the death of a loved one
• Relationship problems
• Lack of support from friends or family members
• Domestic violence*
• Financial problems
• Smoking
• Single status

Any of the above factors can lead to severe depression even in people who are not pregnant. However, pregnancy can exacerbate each of these risk factors and increase the risk of developing a depressive disorder.

How do you know when sadness has crossed the line into perinatal or unipolar major depression? There are several signs of depression that can indicate the presence of a disorder. According to the Centers for Disease Control and Prevention, you might look for the following symptoms:

• Excessive worry and anxiety
• Feelings of worthlessness or low self-esteem
• Loss of interest in activities that you once enjoyed
• Appetite problems
• Trouble focusing or making decisions

You may be tempted to ignore these signs of depression and think that they are simply part of being pregnant, but they likely are not. To determine if you have symptoms of clinical depression, you can reach out to a medical or mental health provider. If you don’t feel well enough to leave home, you can call your doctor or contact an online counselor. 

Risks of antepartum depression

So can depression during pregnancy affect the health of an unborn child? Well, like many forms of untreated depression, untreated antepartum depression can pose some significant risks to you and your baby. When you are depressed, you may be less likely to take care of yourself. Many women who are pregnant and experience depression can make poor nutritional choices, either not eating enough healthy foods or choosing unhealthy ones. They may also be more likely to smoke or to consume alcohol. In the worst-case scenario, a pregnant person with untreated depression may even have suicidal thoughts or behaviors, a mortal risk to their fetus and themselves.

Depression during pregnancy has been linked to premature birth and low birth weight. Pregnant women who experience depression also have an increased risk of developing pregnancy-induced hypertension, or pre-eclampsia, a condition that can be dangerous for both mother and child.

The newborn children of pregnant people experiencing depression may be adversely affected, especially if they are born prematurely. There is evidence that the effects of depression during pregnancy can last for a child's entire lifespan. A study from the British Journal of Psychiatry found a direct link between pregnancy during depression and children developing mood disorders later in life. Children born to mothers with depression were 1.5 times as likely to experience depression at the age of 18. This trend may be partly because of the proven genetic component of depression. However, it has also been found that the effects depression has on the brain can be passed along through the placenta, directly impacting child health and brain development.

Additionally, antepartum depression may lead to depression after the birth of the child. According to the American College of Obstetricians and Gynecologists, the presence of depression during pregnancy increases one’s risk of developing postpartum depression. This form of depression is more severe than the “baby blues”, which are feelings of sadness, guilt, and anxiety that many caregivers experience following the birth of a child. 

If you are currently pregnant and living with depression, this information is not meant to add to any challenging emotions you are experiencing. You are not alone, and reaching out for support from friends, family, or a professional therapist may help with what you’re experiencing.

Treating depression without medication

Many pregnant people are concerned that treating their depressive disorder with medications is unhealthy for their fetus. For this reason, many ask for behavioral interventions to treat their depressive disorder. In these cases, there are several options you can try to help you manage your symptoms.

Psychotherapy

Different kinds of talk therapy can be successful in treating and preventing antepartum depression. This is supported by organizations like the United States Preventive Services Task Force (USPSTF), which found evidence that counseling interventions are effective in preventing various forms of pregnancy-related depression. If you already have a therapist, you can tell them if you are experiencing symptoms of depression. If you don’t have a therapist, consider finding one to help you manage depressive symptoms. Even if you are not feeling depressed but are simply experiencing stress and anxiety, talking to a professional may be helpful. They can guide you through different strategies for stress management and provide you with resources that aim to build resilience.

If you are experiencing added stress due to relationship problems, you can try relationship or couples therapy. Several non-pharmacological therapeutic interventions can provide strategies to cope with what you’re experiencing at this time.

Organizations and support groups

Many organizations have dedicated energy and resources to addressing pregnancy and mental health challenges, including the U.S. Department of Health and Human Services. You can also look for organizations in your local area that focus on antepartum depression or emergency services for those experiencing pregnancy. In addition, there are also many support groups for depression, both in person and online. Research shows that social support is closely connected to mental wellness.Talking about your feelings in a non-judgmental group setting might give you some perspective and improve your self-esteem. You may also meet people who understand what you are experiencing during your pregnancy.

Exercise

Before you practice any new form of physical activity, you might consult with health care providers to ensure it is safe during pregnancy.

Research suggests that exercise can improve symptoms of depression during pregnancy. When you exercise, your brain releases feel-good endorphins that may elevate your mood. Moderate physical activity (such as brisk walks or aerobic, strength, or balance exercises) can help you build resilience for stress, lower your anxiety, and help prepare your body for birth.

Acupuncture

In 2010, the Stanford School of Medicine found that acupuncture was a highly effective way to treat depression during pregnancy. In the study, researchers recruited 150 pregnant women whose symptoms met the criteria for depressive disorder. Those who received eight weeks of acupuncture therapy reported that they experienced a significant reduction of depression symptoms. Acupuncture releases endorphins that function as natural painkillers and calm the stress response.

Antidepressant medications

Any of these methods, or some combination of them, may relieve symptoms of mild to moderate depression. However, if your depression is severe, you may find that your healthcare provider or psychiatrist wants to prescribe antidepressant medication for relief. If they don’t, but you want more information, you may want to bring up medication during prenatal care checkups. If the topic of medication does arise, your prenatal care provider can explain the benefits and risks of antidepressant medication during pregnancy.

The benefits and risks of antidepressants during pregnancy

Any medication that you take during pregnancy will cross the placenta to reach your unborn baby. The Mayo Clinic states the following regarding the risks of antidepressants during pregnancy: 

“A decision to use antidepressants during pregnancy, in addition to counseling, is based on the balance between risks and benefits. The biggest concern is typically the risk of birth defects from exposure to antidepressants. Overall, the risk of birth defects and other problems for babies of mothers who take antidepressants during pregnancy is very low.

However, some antidepressants are associated with a higher risk of complications for your baby. Talking to your health care provider about your symptoms and medication options can help you make an informed decision.”

Most medical and mental health care professionals aim to try as many alternative methods as possible before prescribing an antidepressant during pregnancy. However, if none of those methods are working, your doctor may prescribe the lowest possible effective dose of an antidepressant. It can take some time to figure out what dosage will be effective in treating your depression while minimizing the risk to your baby.

If you become pregnant while taking antidepressants

If you are already taking medication for depression when you become pregnant, you may be tempted to reduce your dosage or even stop taking the medication altogether. You can contact your health care or prenatal care provider before making any decisions regarding your medications.

This decision can be complex, and there are many factors to consider, such as the severity of your symptoms. While stopping your medication may seem like the obvious choice, depression can affect your unborn baby. It is possible that the benefits of continuing to take your medication outweigh any potential risks.

Reaching out for help with depression symptoms

Pregnancy can be a stressful time when many worries and feelings arise. You may have experienced bouts of anxiety or some of the symptoms mentioned above. If so, consider looking for a therapist as soon as possible. Several therapeutic interventions have the potential to help you. For example, cognitive behavioral therapy (CBT), interpersonal therapy, and mindfulness-based cognitive behavioral therapy (MCBT) are three options that may help you alter negative thought processes that can contribute to depression. 

Antepartum depression can make it challenging to travel to an office for therapy. In these cases, online therapy may be a convenient alternative to in-person therapy, and research shows it’s effective for depression and anxiety. With an online therapy platform like BetterHelp, you can participate in therapy via audio or video chat. Also, if you experience depression symptoms in between sessions, you can contact your therapist 24/7 via in-app messaging, and they’ll get back to you as soon as they can.