Depression in pregnancy
It’s not uncommon for women to experience changing emotions during pregnancy - you may feel moody or tearful or angry from time to time. However, if you feel that you are tired all the time, have lost interest in yourself or your pregnancy, always feel down or anxious or angry, or can’t sleep, then you may have prenatal depression.
Pregnancy is generally seen as a time of cheerfulness, fulfilment and joy. Perhaps because of this, depression in pregnancy can be difficult both for women - who often feel guilty about not feeling happy - and the people around them to accept and recognise.
Antenatal depression can be caused by a hormone imbalance during pregnancy. Other factors that can contribute to antenatal depression are pregnancy sickness and tiredness, anxieties over coping with motherhood, and economic and relationship concerns. Common concerns can include:
- How you feel about going through such a major life-changing event.
- How you view yourself including negative perceptions about physical changes, such as weight gain, swollen breasts, and other discomfort.
- The restrictions to your lifestyle that motherhood might place on you.
- How your partner or family feel about the baby.
- How depression during pregnancy could impact your relationships.
- Difficulties with previous pregnancies.
Although antenatal depression is more likely to occur among women who have a history of depression, it is by no means inevitable. It is important, however, that women with a history of mental health issues tell their midwife and/or GP so they can discuss how this might affect their pregnancy and birth, and plan the right care and support. GPs might be able to seek additional support or refer women to perinatal mental health specialists. Some areas in the UK have specialist midwives.
Antenatal depression can begin at any point during pregnancy and is characterised as having a higher than normal level of worry about the impending birth and parenthood. Symptoms include lack of energy, feeling emotionally detached, tearfulness, chronic anxiety and feeling isolated and guilty.
It may be helpful to think about these recommendations, made by the Royal College of Psychiatrists, during pregnancy:
- Don’t try to be ‘superwoman’. Try to do less and make sure that you don’t get over-tired.
- Find someone you can talk to. If you don’t have a close friend you can turn to, try NCT’s Early Days groups. Your local group can be very supportive both before and after childbirth.
- Go to antenatal classes. If you have a partner, take them with you. If not, take a friend or relative.
- Don't stop (or change) ntidepressant medication during pregnancy without medical advice. Around seven in 10 women who stop antidepressants in pregnancy relapse if they stop their medication. You need to discuss the risks and benefits of continuing treatment in pregnancy and while breastfeeding (see section below).
- Keep in touch with your GP and your health visitor if you have had depression before. Any signs of depression in pregnancy or PND can be recognised early.
- Make sure that you have treatment for depression in pregnancy. This may be a talking therapy or medication.
- Accept offers of help from friends and family.
Postnatal depression (PND) is more likely to occur if you have experienced depression before so you may find it helpful to look at our article here.
There are various antenatal depression treatments that can help if you are feeling low during pregnancy. If you think that you may be depressed or you are experiencing a dramatic change of emotions during pregnancy, it is important that you talk either to your midwife or GP, so that they can help you. Some people respond better to one method rather than another. Talk about it with your GP, or other specialist services and organisations, such as: Mind (in England and Wales), Well Scotland or Niamh (in Northern Ireland). Details for contacting these organisations can be found at the end of this page.
Counselling and therapy
Talking treatments, such as counselling and psychotherapy, offer you the opportunity to look at the underlying factors that have contributed to depression, as well as helping you to change the way you feel.
If a friend or someone you know recommends a therapist, this can be a great way to find someone. If you don't feel that the method of therapy or the therapist isn't working for you, you can always change and try someone else. Private practitioners will charge a fee for their services so this will probably be another factor in your decision.
Whoever you choose, make sure your therapist is registered with an accredited body, such as the British Association for Counselling and Psychotherapy (BACP), United Kingdom Council for Psychotherapy (UKCP) or British Psychoanalytic Council (BPC). You could also contact your Community Mental Health Team.
Your GP may prescribe antidepressants which can help to ease many of the symptoms of moderate or severe antenatal depression. It is generally considered safe to take certain types of antidepressants when pregnant or breastfeeding, though do discuss this with your doctor who will ensure the ones selected for you are compatible.
Peer support in the right environment can be of great benefit to mothers affected by antenatal depression and PND. Speaking to someone who has been through what you’re going through and who has recovered allows mums to see they can get better. However, do check that these groups are properly safeguarded with well-trained staff and volunteers, who have access to clinical supervision and support for themselves.
Experiencing depression – particularly during pregnancy – can feel isolating and confusing but you’re not alone. Try to talk about how you’re feeling and be positive about seeking help: it’s the best thing you can do. With the right help and support, particularly early on, things can get better.
NCT's helpline offers practical and emotional support in all areas of pregnancy, birth and early parenthood: 0300 330 0700. We also offer antenatal courses which are a great way to find out more about birth, labour and life with a new baby. Our #BeyondBabyBlues campaign is encouraging parents to talk more openly about maternal mental health, to avoid the mistake of dismissing potentially serious mental health issues in themselves, friends or family, and to seek help if they need it.
You might find attending one of NCT's Early Days groups helpful as they give you the opportunity to explore different approaches to important parenting issues with a qualified group leader and other new parents in your area.
Make friends with other parents-to-be and new parents in your local area for support and friendship by seeing what NCT activities are happening nearby.
NICE publishes a booklet Mental health problems during pregnancy and after giving birth covering antenatal and postnatal depression.
#PNDHour is an online peer support group that runs every Wednesday at 8pm via the Twitter account @PNDandMe. Anyone can join in to discuss topics about antenatal and postnatal depression (and other perinatal mental health illnesses), such as self-care, medication and seeking help. It’s run by a mum called Rosey who also blogs about her own experiences with antenatal and postnatal depression, as well as raising awareness of perinatal mental illness, at PND and me.
We are grateful to Dr Andrew Mayers, a psychologist specialising in child and family mental health (particularly perinatal mental illness) and sleep (especially children), for his help in reviewing the information on this page.