Depression doesn't only happen after birth: signs during pregnancy that people around you often miss

When people talk about depression in moms, most think of “postpartum depression” first. But quite a few moms start feeling weighed down while they’re still pregnant, and keep it to themselves, because everyone says “pregnancy should be a happy time.” Then they end up feeling guilty for not feeling that way.

Read this calmly, there’s no need to be alarmed. We just want moms and their families to know which signs you don’t have to keep putting up with, and that you can pick up the phone and tell your doctor. This is common, and it really can be helped.

Can depression really happen during pregnancy?

Quick Answer: Yes. The World Health Organization estimates that about 10% of pregnant women worldwide have a mental health problem, mostly depression.

WHO notes that in developing countries the figure is even higher, about 15.6% during pregnancy. The UK’s NHS explains that some people have depression or anxiety for the first time during pregnancy, and those who’ve had it before may find their symptoms come back.

Put simply: if you’re feeling this way, it’s not because you’re weak or don’t love your baby. It’s a health condition, like many other things that can happen in pregnancy.

Why do people around you miss it?

Quick Answer: Because many symptoms look like normal pregnancy symptoms, such as tiredness, poor sleep and loss of appetite, and because many moms don’t dare to speak up.

It slips past easily for these reasons:

• “Pregnancy is just tiring like this.” Fatigue, poor sleep and loss of appetite all get written off as pregnancy symptoms.
• “Mood swings are normal in pregnancy.” That’s partly true (read Mood swings in pregnancy: is it normal?), but when people say it often, heavy and long-lasting symptoms get brushed off as small too.
• Moms feel guilty for not being as happy as they’re “supposed to be,” so they choose not to tell anyone.
• Well-meaning elders comfort in the wrong way. “Don’t overthink it, the baby will get stressed too” only makes moms less willing to share how they really feel.

Which signs suggest it might be depression?

Quick Answer: If you have several of the signs below nearly every day for more than 2 weeks, tell your antenatal doctor.

Mayo Clinic and Cleveland Clinic summarize the common signs like this:

• Feeling sad, empty or hopeless most of the day
• No longer enjoying things you used to like, not wanting to talk to friends
• Feeling worthless, or doubting whether you can be a good mother (Mayo Clinic lists this as a sign specific to pregnancy)
• Crying often, getting so irritable it surprises even you
• Poor concentration, not being able to make simple decisions
• Not sleeping even when you have the chance, or sleeping a lot but still having no energy
• Severe loss of appetite, or eating unusually much
• Losing interest in antenatal care: not wanting to go to appointments, not wanting to prepare things for the baby
• Severe anxiety, a racing heart, panic for no reason
• Thoughts of harming yourself, or thinking you don’t want to live anymore

The difference Cleveland Clinic stresses is that depression doesn’t go away on its own in a few days. It stays for weeks or months and may keep getting worse.

Who is more likely to have it?

Quick Answer: Anyone can, but people who’ve had depression before, are under a lot of stress, or lack support are more likely to.

Risk factors mentioned by Mayo Clinic and Cleveland Clinic include:

• A past history of depression or anxiety disorder, or a family member who has it
• An unplanned pregnancy
• Lack of support, for example living far from family, or problems in your relationship with your partner
• Stress about money, work, or a difficult life event
• Past fertility problems, a past miscarriage, or a high-risk pregnancy this time
• Having taken antidepressants and stopped them yourself on finding out you’re pregnant
• Chronic insomnia

Matching one of these doesn’t mean you’ll have it. It’s just a good reason to tell your doctor from your first antenatal visit, so your care team can keep an eye out too.

If I think I might have it, what do I do next?

Quick Answer: Start by telling your antenatal doctor or nurse directly. The doctor will assess you and refer you to a psychiatrist or psychologist if needed.

Here’s what you can do right away:

1. Talk to the doctor or nurse at your antenatal appointment. Many hospitals already have a mood screening form. Answer honestly, there’s no need to try to look fine.
2. If your appointment isn’t for a while, call the antenatal clinic. Don’t wait.
3. Bring someone you trust, like your husband, mother or a close friend, who can describe what they’ve noticed.
4. If you’d like to talk to someone first, call the Department of Mental Health hotline 1323, any time, 24 hours a day.

If you’re not sure how to begin, you can open with something simple like: “Lately I’ve been feeling sad almost every day for a few weeks. I’m not sure if that’s normal.”

How is it treated, and is it safe for the baby?

Quick Answer: It can be treated. The main approach is talking therapy. For some people the doctor may also consider medication, and there are some treatments that can be used safely during pregnancy. Let your doctor choose.

• Talking therapy, such as cognitive behavioral therapy (CBT), which the NHS recommends
• Medication. The NHS says that if medication is needed, the doctor will choose the type that is safest for mother and baby, at the lowest dose that works. Never buy medicine and take it yourself.
• If you’re already taking medication and have just found out you’re pregnant, don’t stop it on your own. Talk to your doctor first, because stopping suddenly can bring symptoms back.
• Looking after yourself alongside treatment: get enough sleep (Can’t sleep in late pregnancy: what to do), move gently, eat what you can, and have someone share the workload.

Mayo Clinic explains that if it isn’t looked after, the mother may not eat or sleep well, may not want to go to antenatal appointments, and has a higher chance of postpartum depression. Starting care during pregnancy helps both now and after the birth.

Get help immediately if…

Quick Answer: If you have thoughts of harming yourself or your unborn baby, call 1323 or 1669 right away, or go to the nearest emergency room.

• You have thoughts of wanting to die, or plans to harm yourself
• You have thoughts of harming your unborn baby
• You feel you can’t control yourself, or you hear or see things other people don’t

Numbers to save

Number	When to use it
1323 Mental health hotline, Department of Mental Health	You want to talk, you feel you can’t cope, or you’re worried about someone close to you. Call any time, 24 hours a day.
1669 Emergency medical hotline	An emergency where you need urgent help. Free, 24 hours.
Your hospital’s antenatal clinic	Symptoms aren’t improving, or you want to be seen before your appointment

If you’re a family member worried about someone, don’t wait for them to bring it up. Ask directly and with care, then stay with them until they’ve talked to someone who can help.

You can keep looking after your mind after the birth too. Read more in Guide to the first 3 months after birth

Not feeling happy during pregnancy doesn’t make you a bad mother. Being brave enough to tell someone “I’m not coping” is already taking care of both yourself and your baby.