Pregnancy Depression: A Complete Guide
Pregnancy is supposed to be one of the happiest times of one’s life. If that’s true, then why do 14-23% of women struggle with pregnancy depression? What is pregnancy depression? What are its symptoms throughout each trimester? What are the causes of pregnancy depression? What are the risk factors and treatment of pregnancy depression? How does pregnancy depression affect the baby, brain, and hormones? How is it related to anxiety?
Pregnancy depression- 14-25% of pregnant women struggle with anxiety and depression
Depression affects 1 in 4 women during their lifetimes. According to the ACOG (The American Congress of Obstetricians and Gynecologists), between 14-25% of pregnant women struggle with depression. However, sadly, too often women who are suffering from pregnancy depression are deemed to just have a hormonal imbalance.
Like all mood disorders, depression during pregnancy (antepartum) and after pregnancy (postpartum) is considered a biological illness that is linked to changes in brain chemistry. The hormone changes that happen during pregnancy can affect the brain’s chemicals that are directly associated with and control anxiety and depression. When these hormones negatively affect the parts of the brain involved with moods, depression can result.
Symptoms of pregnancy depression
The symptoms of pregnancy depression are often the following for two weeks or more:
- Sleeping badly (either too little or too much)
- Constant sadness
- A complete lack of energy
- Feeling guilty
- Difficulty concentrating
- Feeling worthless
- Crying for no reason
- Change in eating habits
- Recurring thoughts of suicide
- Recurring thoughts of death
- Loss of interest in activities that they often enjoy
Some women, about 13%, suffer from postpartum pregnancy depression, too, after they give birth. Furthermore, 10% of fathers also experience postpartum depression! Common symptoms include:
- Feeling extremely sad
- Feeling like you can’t or are unable to care for the baby
- Having trouble making decisions
- Panic attacks and extreme anxiety
- Feeling hopeless
- Not feeling in control
Pregnancy depression: first trimester
Everyone has a different experience of being pregnant. However, when it comes to the different trimesters and dealing with depression, it’s important to keep an eye on it. During the first trimester (the day of the last menstrual period-12 weeks), knowing that you are suffering from depression (not just pregnancy hormones like some women think) is vital. This type of depression is known as prenatal depression or antenatal depression.
One study has found that untreated depression leads to postpartum depression once the baby is born. The study looked at 73 women postpartum who had been depressed during pregnancy. 21 of them, 28,7% to be exact, had been treated for depression- 52 had been untreated. Not one woman in the treated group was found to suffer from postpartum depression. However, 92% (48 individuals) of the untreated group were considered to suffer from depressive disorder postpartum. The study chalked this up to untreated depression during the first trimester.
Dr. Shaila Misri, a psychologist at the British Columbia’s Women’s Health Centre states that women can show signs as early as 2 weeks into the pregnancy of severe depression such as not sleeping, panic attacks, loss of interest, and crying spells.
Pregnancy depression: second trimester
The second trimester (between 12-24 weeks) is easier than the first and third because there is more of a hormonal balance and most women will have adjusted to having a baby’s movements inside them. Due to the overall easiness of the second trimester, if a woman feels any emotional or physical symptoms, they are easier to diagnose, such as depression. Sadly, there is much more research put into postpartum depression than antenatal depression (while the baby is still a fetus in the womb).
Pregnancy depression: third trimester
The symptoms felt in the first trimester are similar to those during the third trimester (24-40 weeks) due to the fact that these two trimesters are when women feel the most uncomfortable and have the most hormonal changes. Hormones are able to keep the pregnancy going until the placenta takes over the job, hormones try to prepare for labor, regulate glands, and produce milk. However, once the placenta takes over, hormone levels change dramatically and a woman may begin to feel rapid mood swings and mood changes including depression. There are notably more feelings of being weepy, angry, irritable, anxious, and agitated during the first and third trimesters compared to the second trimester.
Causes of pregnancy depression
The main cause of pregnancy depression is being predisposed genetically to depression. 1/3 of women who went through depression in their teens and young adulthood will go through a spout of depression while pregnant. However, depression can also be onset by the mix of hormones that come about during pregnancy. When a woman has constantly changing levels of hormones in her body, her brain begins to get the wrong signals and depression can result. Nutritional imbalances are also known to cause issues with mood, hormones, and subsequent depression.
Risk factors for suffering from pregnancy depression
Women are at a higher risk to suffer from pregnancy depression if they have:
- Relationship problems
- Tried infertility treatments. Women who have been infertile and who become pregnant are at a greater risk of depression due to the fluctuations in their hormone levels that happen while they were trying to get pregnant. That’s in addition to the normal hormones that come with being pregnant.
- A history of abuse or trauma
- Had a miscarriage or previous pregnancy loss
- Unwanted pregnancy. Women are more vulnerable to depression when the pregnancy is unwanted.
- Gestational diabetes, also known as gestational diabetes mellitus (GDM), has been scientifically found to increase the risk of postpartum depression. It makes sense considering that depression often goes along with type II diabetes.
- A family history of depression
- Had previous pregnancies with depression. Over ½ of women who were depressed after prior pregnancies will feel depressed during their next pregnancy.
- Complications within the current pregnancy
- Stressful life events. Some women feel such stress at the thought of becoming a mother, or the financial stress of parenting, that they feel depressed and/or anxious about it to a negative degree.
How does pregnancy depression affect the baby
Pregnancy depression that is left untreated can have negative effects on the baby and the mother. Not only can untreated depression lead to smoking, drinking, poor nutrition, and suicidal behavior- all things that have an incredibly negative effect of a fetus (check out this study here on the negative effect of smoking while pregnant). Not only can it have a negative effect on the baby, but it also can lead to premature birth, developmental problems, and an underweight baby. It’s not easy when suffering from pregnancy depression to take care of oneself, little on a growing child inside of you.
Babies who are born to depressed mothers have been shown to be less active, have lower attention spans, and be more easily agitated than babies who are born to non-depressed mothers.
A study done in Kings College in London found that babies born to depressed mothers can have notable biological changes, considerate inflammation, and more reactive to stress. These results were found by taking 100 women (around 50% suffered from clinically diagnosed Major Depressive Disorder, the other 50% were considered healthy and used as the control group), following their pregnancies, and following the babies a year after birth. During pregnancy, the researchers took saliva and blood samples to assess the depressive states of the women. The women who suffered from major depressive disorder (MDD) showed higher levels of cortisol (the stress hormone) in their saliva and increased amounts of inflammatory biomarkers in their blood. Furthermore, on average, the depressed women gave birth eight days earlier than the control group. After birth, each baby was given a neonatal behavioral assessment which looks at and measures responses to external stimuli and alertness. Babies who came from mothers who suffered from pregnancy depression showed poorer results than the other babies. During the next year, it was found that the babies who were exposed to higher levels of inflammation during pregnancy (due to the mother) had higher cortisol responses to stress. The researchers concluded that the biological and behavioral changes in the babies aren’t due to a mother’s postpartum depression, but due specifically to the depression, the mother feels during the pregnancy- antepartum.
Another study suggests that the development of schizophrenia can be linked to stresses that happened during pregnancy. These stresses change and adapt the expression of certain genes and the probability of the genes showing up once the baby is born. The study focused greatly on the genetic activity that modified and regulated within the placenta.
How does pregnancy depression affect the brain
Depression starts in the brain. With the mix of hormones, the stress of becoming a mother, and everything else going on in life, it makes sense that our amygdala, the powerhouse of emotions in our brain, gets a bit overloaded. Some researchers have reported that pregnancy depression alters the amygdala in a newborn. This can have negative effects such as leaving the child with slower language development and cognitive impairment.
How does pregnancy depression affect the hormones
A long time ago, doctors thought that all of the hormones that rush through a woman’s body during pregnancy shield her from harmful things such as anxiety and depression. However, we now know that the opposite is true and that hormones are huge- especially when a woman is pregnant. Studies have shown that reproductive hormones go wild during pregnancy and that wildness has the possibility to lead to postpartum depression.
Cortisol, the stress hormone, and neurotransmitter, is natural but shouldn’t be had in prolonged doses nor should it wind up in the wrong place within the body. However, pregnant women are pumped with cortisol which causes them anxiety and depression. That cortisol then crosses the placental barrier and ends up at the fetus.
Pregnancy depression and anxiety
Around 70% of mothers experienced anxiety and/or depression at some point during pregnancy. Women who are hormonally sensitive and who are predisposed to anxiety and depression during menstruation, puberty, while using birth control pills and fertility drugs are prone to depression and anxiety during pregnancy, too. Untreated anxiety (and depression) during pregnancy are linked to studies of preterm birth, smaller newborns, neonatal complications, miscarriage, and preeclampsia. Pregnancy depression often comes with anxiety and OCD symptoms. Anxiety in women who are pregnant is known to be associated with impaired and lessened blood flow (something essential to a growing fetus) in the uterine artery which is the artery that feeds the placenta (and subsequently keeps the baby active and in existence).
One study found that kids whose mothers felt extremely anxious while they were 19 weeks pregnant had reduced gray matter between ages 6 and 9. Another study found that kids whose mothers felt anxious while pregnant had a higher probability of feeling anxious at age 4 and a raised level of cortisol in their teens and adolescent years compared to kids whose mothers didn’t experience anxiety while pregnant.
Treatment for pregnancy depression
Luckily, there are treatments that work to help alleviate pregnancy depression. The common treatment options include using support groups, psychotherapy (talk therapy), light therapy, and medications. Women who suffer from mild to moderate depression should try using therapies before using medication.
There is a big debate about whether or not taking medication to treat depression is safe for a baby- short-term and long-term. Some studies have found that using antidepressants during pregnancy lead to baby malformations, a higher risk of autism, an increased probability of the child being diagnosed with a mental disorder later in life, and a child’s cognitive development. It’s important to keep in mind that any medication taken while pregnancy (even just a simple ibuprofen) will reach the placenta and thus reach the baby. With all the risks involved and lack of further research, the best thing to do is try to treat the depression with psychotherapy and avoid medication.
There are some natural ways to try and treat depression, too.
- Try getting a good night’s sleep. Lack of sleep has been proven to mess with mental health. Try going to bed and getting up at the same time daily.
- Acupuncture. Studies have found that using acupuncture on pregnant depressed women has alleviated the depression symptoms noticeably.
- Eat a balanced diet. Different foods have been linked to mood swings and changes in mental clarity. Fuel the body with foods that help the mom and the baby feel better, and avoid caffeine and sugar. Eat lots of Omega-3 fatty acids such as salmon, avocado, or taking daily fish oil supplements!
- Exercising is important to decrease cortisol (the stress hormone) levels and increase serotonin (‘’the happy hormone’’) levels.
- Herbal remedies. Talk to an herbalist about whether or not herbs such as SAM-e, magnesium, 5-HTP, St. John’s Wort, flower remedies, or vitamin B6 would be useful. However, these herbal remedies cannot be taken with laboratory-made antidepressants.
Have you suffered from pregnancy depression? Let us know what you think in the comments below!
Anna is a freelance writer who is passionate about translation, psychology, and how the world works.