Anywhere from 14 to 23 percent of pregnant women experience depression (known as antepartum depression), while an estimated 5 to 25 percent experience depression after they give birth (known as postpartum depression).
Depression is a mental illness marked by strong negative emotions — including sadness, loss of interest, and hopelessness — that interfere with daily life for a prolonged period.
There are multiple types of depression, including:
- Major depression (severe depressive symptoms last for at least two weeks)
- Persistent depressive disorder (low-level depressive symptoms that last for at least two years)
- Seasonal affective disorder (depression during the winter or fall due to lack of sunlight)
Although a lot of attention has been paid to postpartum depression, public-health experts are becoming increasingly focused on the high incidence of antepartum depression — debunking the myth that pregnancy is always a blissful period in a woman’s life.
The mismatch between cultural expectations and personal experience can make it even more difficult for pregnant women to cope with depression and seek help.
As a first step in addressing this problem, the U.S. Preventive Services Task Force now recommends that both pregnant women and new mothers be screened for depression.
What Are the Risk Factors for Antepartum Depression?
Some women who struggle with antepartum depression have a history of major depression.
Experiencing an episode of major depression puts you at higher risk for more depressive episodes in the future.
On the other hand, many women have their first experience of depression while they’re pregnant.
Antepartum depression is generally thought to be caused by a combination of hormonal changes and psychological disturbances associated with pregnancy.
Other changes during pregnancy, such as bodily changes and alterations in sleep and eating habits, can contribute to the development of antepartum depression.
In addition to a history of depression, other risk factors for antepartum depression include:
- Maternal anxiety
- Life stress
- Lack of social support
- Unintended pregnancy
- Medicaid insurance
- Domestic violence
- Lower income
- Lower education
- Single status
- Poor relationship quality
What Are the Signs and Symptoms of Antepartum Depression?
Depression during pregnancy can have the same symptoms that define major depression in the general population. These can include:
- Persistent feelings of sadness or emptiness
- Loss of interest in activities or hobbies that were once enjoyable
- Feeling hopeless, worthless, helpless, or guilty
- Frequently feeling irritated, anxious, frustrated, or angry
However, it’s important to note that a number of symptoms of major depression are similar to the changes that many pregnant women typically experience:
- Fatigue and decreased energy
- Sleep disturbances
- Changes in appetite and eating habits
This overlap can make it very difficult to identify pregnant women who need help.
Complications of Depression During Pregnancy
Depressed pregnant women are more likely to develop pregnancy complications such as preeclampsia (high blood pressure during pregnancy) than pregnant women who are not depressed.
Women with antepartum depression are also at higher risk for developing postpartum depression.
Left untreated, antepartum depression poses a health risk to the pregnant woman as well as the infant by increasing the risk of:
- Complications with pregnancy or delivery
- Delivering a low-birth-weight baby
- Prematurely giving birth
A study of more than 7,000 pregnant women, published in the May 2016 issue of the journal Obstetrics & Gynecology, linked antepartum depression to an 82 percent increased risk of extremely premature birth and a 28 percent increased risk of low birth weight.
The researchers did not observe this increased risk in pregnant women who were treated with antidepressants.
How Is Depression During Pregnancy Treated?
Antepartum depression can be successfully treated using standard treatments for major depression. These treatments include:
- Counseling or therapy, including specific techniques such as cognitive behavioral therapy (CBT) and interpersonal psychotherapy
- Brain stimulation therapies, such as electroconvulsive therapy (ECT), in which a low-level electrical current is passed through the brain — although a review of case studies, published in the Archives of Women’s Mental Health, recommends using ECT only as a last resort
Prescription antidepressants offer benefits to both the mother and her child that need to be balanced carefully against their risks.
Although research findings have been mixed, the U.S. Preventive Services Task Force review of the scientific evidence suggests that antidepressant use during pregnancy could be associated with a small increase in the risk of serious harm to infants. (3) Pregnant women should discuss the pros and cons of treatment with a particular antidepressant medication with their doctors.
While some pregnant women experience such severe depression that antidepressants are essential, for women with milder forms of depression, counseling or therapy can be an effective option.
In reviewing studies of nondrug treatments, the U.S. Preventive Services Task Force found that cognitive-behavioral therapy (CBT) — which aims to help people uncover unhealthy or negative patterns of thought and belief and replace those patterns with positive ones — had the strongest evidence of helping pregnant and postpartum women with depression.
Interpersonal psychotherapy — which focuses on exploring a person’s relationships, identifying problems in those relationships, and improving interpersonal skills — was also shown to be effective in treating depression.
Lifestyle changes such as eating a balanced diet, getting regular exercise, and sleeping at least seven to eight hours per night can also help women struggling with depression.
Researchers are devoting more time to finding out whether mindfulness practices, such as meditation and yoga, can help relieve antepartum depression. One pilot study found that mindfulness-based cognitive behavioral therapy prevented relapses in pregnant women who had experienced depression in the past.