While postnatal depression is becoming more talked about, its pregnancy equivalent can be dangerous but is still relatively unknown. Here’s an overview.
Hands up if you’re pregnant and veering between utter joy, anger and emotional bouts of tears? Well, that’s completely normal; pregnancy is an emotional time.
But for some women, those standard pregnancy symptoms can be something more. We might be more used to hearing mention of postnatal depression. But around 12% of women actually experience antenatal or prenatal depression – depression that occurs during pregnancy.
Signs and symptoms of antenatal or prenatal depression
Antenatal depression can happen at any point during pregnancy. Look out for:
- Unusual amount of worry about giving birth and parenthood.
- Lack of energy and disturbed sleep.
- Losing interest in yourself or your pregnancy.
- Feeling emotionally detached, teary, angry or irritable.
- Chronic anxiety.
- No interest in sex.
- Poor concentration.
- Sense of hopelessness about the future.
Bear in mind that you won’t necessarily experience all of these symptoms. And some of them (e.g. reduced sex drive) are common in all pregnancies too.
This can make antenatal depression hard to spot but if you’re at all worried, flag it up to your GP or midwife (Tommy’s, 2013).
What causes antenatal depression?
Antenatal depression can be caused by a hormonal imbalance. Although, because all women experience hormonal changes when they’re pregnant, that’s unlikely to be the only cause (MIND, 2016).
Other things that may play a part are:
- previous miscarriages or difficult birth experiences
- history of depression
- isolation, poor support, stressful living conditions or major life events
- unplanned pregnancy
- difficult childhood experiences and poor self-esteem
- struggling with a pressure to ‘do things right’.
(Boots Family Trust Alliance, 2013; Tommy’s, 2015; MIND, 2016; O’Mahen and Ramchandani, 2016; NHS, 2018)
Getting help for antenatal depression
You might feel confused and isolated if you go through antenatal depression but the key thing is not to keep it to yourself. Instead, speak to your midwife as soon as possible.
Many women don’t open up about their depression in pregnancy because they’re embarrassed or worried about what people will think (Boots Alliance Trust, 2013; NICE, 2014).
But spotting it early is key to getting better and to avoiding any potential impact of the depression on your developing baby (Royal College of Psychiatrists, 2015; Ayers and Delicate, 2016).
Some self-help methods that can help are:
- Reducing sources of stress as much as you can – although we know that can be a tricky thing to do.
- Boosting your wellbeing using pregnancy yoga, mindfulness, meditation, relaxation techniques, hypnobirthing classes or books and eating healthily.
- Talking to friends and family, and accepting offers of help.
- Avoiding caffeine, alcohol and smoking as this can make you feel worse and they carry health warnings during pregnancy anyway.
- Going to antenatal classes for support.
- Getting outside and doing some moderate exercise whenever you can.
- Not stopping or changing antidepressant medication during pregnancy without medical advice. Around seven in 10 pregnant women relapse if they stop their medication. Discuss the risks and benefits of continuing treatment in pregnancy and while breastfeeding with your GP.
- Avoiding St John’s wort: it’s not known whether it’s safe in pregnancy.
- Attending peer support groups – they involve speaking to someone who’s been through what you’re going through. Check that groups are properly safeguarded with well-trained staff and volunteers, who have access to clinical supervision and support for themselves.
- Contacting your community mental health team or self-referring for psychological therapies using The Improving Access To Psychological Therapies (IAPT) programme. IAPT and national equivalents are in place throughout the UK so you can self-refer on the phone.
(Boots Alliance Trust, 2013; Tommy’s, 2013)
Treatment for antenatal depression
Treatment can include:
- Counselling and talking therapies: therapists look at what’s contributing to your depression and try to help you change the way you feel. Make sure they are registered with an accredited body, like the British Association for Counselling and Psychotherapy (BACP) or the United Kingdom Council for Psychotherapy (UKCP) or British Psychoanalytic Council (BPC)
- Medication: antidepressants can help to ease symptoms. Women who have a history of depression or haven’t responded to therapy are more likely to be offered medication. Selective serotonin reuptake inhibitors (SSRIs), or tricyclic anti-depressants (TCAs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) do have some rare risks associated with them. But they are generally considered safe in pregnancy.
- Combination of both: different people respond to different treatment so talk about your options with your GP.
- Contact organisations like MIND (in England and Wales), Well Scotland or Inspire in Northern Ireland.
(NICE, 2014; NHS, 2018; RCPSYCH, 2015)
When you speak to your midwife about antenatal depression, they should ask about your mental health history (RCOG, 2011; NICE, 2014). If they don’t, it’s important you fill them in.
If you’re planning to get pregnant (or are newly pregnant) and have a history of mental health issues, tell your midwife and/or GP too. Then they can discuss with you how to get the right support and care from the beginning.
This page was last reviewed in May 2018
Our support line offers practical and emotional support with feeding your baby and general enquiries for parents, members and volunteers: 0300 330 0700.
We also offer antenatal courses which are a great way to find out more about labour and life with a new baby.
We encourage 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.
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.
Ayers S, Delicate A. (2016) Recognising and acting on perinatal mental health. Perspective. 32. Available from: https://www.nct.org.uk/sites/default/files/related_documents/Ayers%20and%20Delicate%20Recognising%20and%20acting%20on%20perinatal%20mental%20health.pdf [Accessed 1st October 2018]
Boots Family Trust Alliance. (2013) Perinatal mental health: experiences of women and health professionals. Available from: http://www.bftalliance.co.uk/the-report/ [Accessed 1st October 2018]
MIND. (2018) Postnatal depression and perinatal mental health. Available from:
https://www.mind.org.uk/information-support/types-of-mental-health-problems/postnatal-depression-and-perinatal-mental-health/postnatal-and-antenatal-depression/#.Wv0ttVKWyt8 [Accessed 1st October 2018]
NHS. (2018) Mental health problems and pregnancy. Available from: https://www.nhs.uk/conditions/pregnancy-and-baby/mental-health-problems-pregnant/ [Accessed 1st October 2018]
NICE. (2014) Antenatal and postnatal mental health: clinical management and service guidance. Available from: https://www.nice.org.uk/guidance/cg192/resources/antenatal-and-postnatal-mental-health-clinical-management-and-service-guidance-pdf-35109869806789 [Accessed 1st October 2018]
O’Mahen H, Ramchandani P. (2016) The ACORN study – finding ways of helping with high levels of anxiety in pregnancy. Introducing a new group-based intervention (CALM) for pregnant women. Perspective. Available from: https://www.nct.org.uk/sites/default/files/related_documents/Perspective-September-2016_0.pdf [Accessed 1st October 2018]
RCOG. (2011) Management of women with mental health issues during pregnancy and the postnatal period. Good Practice No. 14. Available from: https://www.rcog.org.uk/globalassets/documents/guidelines/managementwomenmentalhealthgoodpractice14.pdf [Accessed 1st October 2018]
RCPSYCH. (2015) Perinatal mental health services: recommendations for the provision of services for childbearing women. Available from: https://www.maternalmentalhealth.org.uk/wp-content/uploads/2015/09/RCPsych-Perinatal-mental-health-services-recommendations.pdf [Accessed 1st October 2018]
Tommy’s. (2015) Depression in pregnancy. Available from: https://www.tommys.org/pregnancy-information/im-pregnant/mental-wellbeing/specific-mental-health-conditions/depression-pregnancy [Accessed 1st October 2018]