Pregnant and Depressed: What You Need to Know
You may have heard of postpartum depression (when you get depressed after pregnancy), but we don’t really hear much about how to handle being pregnant if you came to it already depressed.
Stats show that a lot of us are depressed, pregnant or not – about 280 million people in the world have depression, and one in seven 10-19-year-olds experiences a mental disorder. If you’re pregnant or wanting to be, how are you supposed to navigate pregnancy with existing depression?
Societally, many women and other pregnant people have been told that our needs should always come after our child’s or fetus’ –just look at the US’s restrictive abortion laws, the lack of postnatal care for many new parents (especially BIPOC and economically disadvantaged folks), and the high global maternal death rates.
But, your needs matter. Your health matters. In fact, a pregnancy isn’t healthy unless you are, too!
So let’s take a deep dive into some considerations for pregnancy, birth, and early parenting if you have depression to ensure your needs are being met, too.
Antidepressant Medications and Pregnancy
Many people with depression take antidepressant medication to manage their symptoms. A lot of healthcare providers, however, tell pregnant folks to wean off their antidepressant medication before getting pregnant. The problem is, weaning off is not always possible, safe, wanted, or healthy for either the pregnant person, or the fetus, or both. In fact, scientific and medical communities have not even reached a consensus on whether taking antidepressants during pregnancy is okay or not.
Lots of folks with depression take SSRIs (selective serotonin reuptake inhibitors), a common type of antidepressant medication. The main concern with taking SSRIs during pregnancy is some conflicting evidence on whether SSRIs can increase the risk of certain birth defects. Many studies have been published on the topic, and some point to an increased risk for serious health conditions like persistent pulmonary hypertension, cardiac defects, skull deformations, and stomach defects, just to name a few. Other studies have found no long-term negative health impacts on the fetus at all. Some studies have reviewed how being exposed to an SSRI during pregnancy may cause the baby to experience some withdrawal symptoms after birth, such as jitteriness, irritability, and difficulty feeding or breathing; however, these symptoms can occur in all babies (regardless of parental SSRI use) and tend to go away after about one month.
Some folks take MAOIs (monoamine oxidase inhibitors), which were the first antidepressants available. Even less research exists on the safety of using MAOIs in pregnancy, and most sites suggest that they are generally not recommended during pregnancy because we simply don’t know the impact they would have on the fetus. If you’re taking an MAOI, it’s best to discuss the health risks with your healthcare provider.
Other studies have focused on the impact of untreated depression on both pregnant person and fetus.
Pregnant folks with depression are less likely to get good prenatal care, more likely to engage in unhealthy behaviors during pregnancy like smoking and substance abuse, and more likely to experience postpartum depression after the birth. Untreated depression often means that the pregnant person has increased levels of the stress hormone, cortisol, in their body that can be passed to the developing fetus, not to mention having a negative impact on the pregnant person themselves. Being exposed to this hormone may increase premature births or cause low birth weight of the new baby. Reviewing the research on your own and with a healthcare professional is the best way to begin the process of making your own decision about SSRIs during pregnancy.
If you decide you want to try weaning off antidepressants, know that the process can be challenging and is best done under the guidance of a healthcare professional. The process needs to be gradual or you can suffer some not-fun withdrawal symptoms, like dizziness, nausea, insomnia, or flu-like symptoms. Weaning off can feel a bit like an emotional roller coaster as your body learns to readjust without the drug, and it’s normal to feel emotionally drained and a little overwhelmed. Pay attention to how you’re feeling, reacting, and processing as you reduce your medication, and make sure you have developed coping strategies that work for you to help you handle the changes. These could include a number of different things, including seeing a therapist, attending a support group for pregnant people with depression, regularly exercising, getting out in nature, tapping into your network of supportive friends and/or family, and praying. As a bare minimum, writing down a list of activities that make you feel good and/or distract you can be helpful to draw on when you’re feeling down. Also, don’t be afraid to ask your doctor to slow down your weaning process so you can take your time (if that’s a possibility).
If you try weaning off and you realize it just isn’t working, it’s okay! First, take a deep breath and remind yourself that you are super resilient and awesome just how you are–whether that’s on medication or not. Depression is serious, and you deserve to feel as good as you can while growing a human bean inside you. Ask your doctor if you can see a perinatal psychologist, who is trained specifically in managing mental health concerns during pregnancy. Also talk with your doctor about which antidepressants may be an option for you during pregnancy.
Pregnancy Grief is Real
We often think of pregnancy as being a super happy time, full of excitement and maybe some unfortunate morning sickness. We’ve been taught to believe this from a young age, but these attitudes were born from a movement that saw women solely as birthing machines and were often popularized by people who had never been pregnant themselves. The reality is that pregnancy is often a time full of really mixed emotions, including, perhaps surprisingly, grief. Preparing yourself ahead of time to experience some amount of grief, and other strong emotions, can be helpful if you’ve had depression in the past.
When you’re pregnant, your body is changing a TON. Some folks experience grief as they see their body change, growing larger and weighing more in a society that privileges thinness. Some folks grieve that their bodies don’t show a baby bump and that they barely look pregnant for a long time. Some people grieve that their bodies will never be the same as pre-delivery and have a hard time adjusting to a new body with stretch marks and added weight. For trans and gender non-conforming folks, body dysmorphia (experiencing a distorted image of your body that only allows you to focus on the perceived defects or flaws) can be especially tough during pregnancy. Pregnancy can happen as long as you have the necessary body parts, but narrow societal expectations of what bodies are considered acceptable for pregnancy, pregnancy and childbirth resources usually only for cisgender women, and a lack of visbility of pregnant trans and non-binary individuals in media and life in general can make it seem like pregnancy is only for women. Being pregnant as a trans or otherwise gender nonconforming person and having your body change in ways that might not always feel affirming can potentially trigger anxiety or depression so getting support is important.
Big life transitions can also trigger depression or anxiety, and pregnancy and parenting are definitely big life changes. You may not feel up to participating in your normal activities because you feel sick or you’re not as mobile. You may be experiencing a loss of a support network if you don’t have a community that supports your pregnancy. Your routines will be disrupted as you see doctors, prepare your home for a baby, and then begin to care for an infant. Preparing yourself for how you want to emotionally navigate these life transitions is especially important for folks who have experienced depression in the past.
There is also potential to experience grief if you miscarry (when a pregnancy ends on its own before twenty weeks). Miscarriages are very common and can be emotionally difficult, especially if you wanted the pregnancy to come to term. Some may experience their miscarriage with relief, but often there can still be feelings of grief and a sense of loss. Navigating this grief is not often talked about but can trigger depression or other mental health conditions if you don’t address it. Check out our article on miscarriage to learn more about getting support.
These are just a few examples of how grief may show up in the pregnancy journey; you may not have strong feelings about any or all of these examples, but it’s important to consider how you will handle your big feelings as they come up in your unique situation and to have a plan in place.
Caring for a new baby can be overwhelming and often is a huge shift in lifestyle. Many folks experience what is commonly called the “baby blues” within the first few days after the birth in which they experience anxiety, overwhelm, sadness, loneliness, and/or frustration. These symptoms often go away within the first few weeks postpartum (after birth). If they don’t, that may be a sign that you’re experiencing a postpartum mood disorder.
Postpartum depression (PPD) is just one of several postpartum mood disorders. There are also anxiety and panic disorders, obsessive compulsive disorder, psychosis, bipolar disorder, and several more that can show up during or after pregnancy.PPD is the most common, affecting anywhere between 10 and 16% of new mothers (The Doula Book; Our Bodies, Ourselves: Pregnancy and Birth).
PPD is different from more typical baby blues because the symptoms don’t go away after a few days or weeks. You may experience excessive anxiety, frequent crying, feelings of hopelessness, guilt, or worthlessness, irritability or mood swings, lack of motivation or not wanting to do things that you made you happy, or even suicidal thoughts. Many of these symptoms are common in the first few weeks and months (except for suicidal thoughts–if you are thinking about suicide, call a suicide hotline or reach out to a healthcare professional immediately), but if the symptoms are preventing you from going about your daily life, it’s time to get some help.
PPD can be caused by a number of different factors. People who have experienced depression in the past or have a family history of mental illness may have a greater chance of experiencing PPD, but having a new baby is a huge, emotional transition that can trigger PPD in anyone (including fathers, adoptive parents, and supporting partners!). The disruption of eating and sleeping schedules, your sex life, and your social life can be challenging. Many parents are also grappling with wanting to be a perfect parent. The hard reality that parenthood is messy and hard and never perfect. Hormone levels also change drastically in the days and weeks following birth, which can cause mood swings and lead to PPD. Additionally, some parents are still processing trauma from the birth, or maybe the birth of this child triggered some past trauma from experiencing a miscarriage, stillbirth, or challenging relationship with one’s own parents growing up. In reality, there is not a single cause of PPD – but there is help available.
If you think you’re experiencing PPD, begin by asking for help. It’s totally okay to ask friends, family members, partners, or anyone you trust to help out, maybe by cooking dinner one night, taking a feeding or two, or just being available to process. Raising a child literally takes a village so it makes sense that you are feeling overwhelmed.
Sometimes more medical and professional help are needed, and that’s also okay. Finding a therapist who specializes in postpartum mood disorders can be incredibly helpful. Joining a support group for new parents can also provide a healthy outlet for processing. (Check out the online support groups at Postpartum Support International and Postpartum Progress.) Some folks may need medication so talk to your healthcare provider to discuss options. Studies have shown that SSRIs (antidepressants) are relatively safe for breast- and chestfeeding, and harmful complications due to exposure of these medications to babies are very rare. Be sure to discuss these health and safety concerns with your healthcare provider before deciding on a medication.
You Are Not Alone
Just remember that if you’re experiencing depression during pregnancy, postpartum depression, another postpartum mood disorder, or just general frustration and emotional overwhelm before or after the birth of your child, you are not alone. It can be challenging to grapple with these feelings, especially when new parents are so often expected to feel super happy to have a new baby, but all your feelings are valid, even the tough ones. Find your people to support you, don’t be afraid to ask for help, and know that you are doing an incredible job.