Depression during pregnancy

What is depression?

Depression (also called depressive disorder, major depression and clinical depression) is a medical condition that causes feelings of sadness and a loss of interest in things you like to do. It can affect how you feel, think and act and can interfere with your daily life. It needs treatment to get better.

Perinatal depression is depression that happens during pregnancy or in the first year after having a baby. It’s one of the most common medical complications of pregnancy. It affects up to 1 in 7 women (about 15 percent). It includes postpartum depression (also called PPD), which is depression that happens after pregnancy.

Depression is not your fault. And treatment can help you feel better. Untreated perinatal depression can cause problems for you and your baby. If you think you’re depressed, tell your health care provider right away.

What are the signs and symptoms of depression?

Major depression is more than just feeling down for a few days. You may have depression if you have signs or symptoms of depression that last for more than 2 weeks. Signs of a condition are things someone else can see or know about you, like you have a rash or you’re coughing. Symptoms are things you feel yourself that others can’t see, like having a sore throat or feeling dizzy.

Signs and symptoms of depression include:

Changes in your feelings

• Feeling sad, hopeless or overwhelmed
• Feeling restless or moody
• Crying a lot
• Feeling worthless or guilty
• Thinking about death or suicide (killing yourself)

Changes in your everyday life

• Eating more or less than you usually do
• Having trouble remembering things, concentrating or making decisions
• Not being able to sleep or sleeping too much
• Withdrawing from friends and family
• Losing interest in things you usually like to do

Changes in your body

• Having no energy and feeling tired all the time
• Having headaches, stomach problems or other aches and pains that don’t go away

If you’re pregnant and you have any of these signs or symptoms, or if they get worse, call your health care provider. There are things you and your provider can do to help you feel better. If you’re worried about hurting yourself, call emergency services at 911.

Can depression during pregnancy affect you and your baby?

Yes. Depression during pregnancy increases your risk for:

• Not taking care of yourself. For example, if your depression isn’t treated, you may not eat healthy foods and not gain enough weight during pregnancy. You may skip your prenatal care checkups or not follow instructions from your health care provider.
• Smoking, drinking alcohol or using harmful drugs.
• Having PPD after pregnancy. PPD can make it hard for you to care for and bond with your baby.
• Suicide (killing yourself), thinking about suicide or thinking about hurting your baby. These are rare.

Depression during pregnancy increases your baby’s risk for:

• Premature birth. This is birth that happens too early, before 37 weeks of pregnancy.
• Being small for gestational age (also called SGA). This is when a baby doesn’t weigh what he should before birth.
• Having low birthweight (also called LBW). This means your baby is born weighing less than 5 pounds, 8 ounces.
• Being more irritable, less active, less attentive and with fewer facial expressions than babies born to moms who don’t have depression during pregnancy
• Learning, behavior and development problems and mental health conditions later in life

Depression during pregnancy can make it hard for you to get ready for your baby and take care of your baby after birth. This is why it’s important to treat depression as soon as possible. For example, if depression is untreated:

• You may find it hard to get the kind of things you need, like a car seat, crib and medical supplies, to help keep your baby safe and healthy.
• Your baby may not breastfeed long. Depression may make it hard for you and your baby to get used to breastfeeding. Breast milk is the best food for your baby through the first year of life.   
• Your baby may not get medical care he needs. Depression may make it hard for you to take care of your baby if she’s sick. You may not see health problems in your baby that need quick attention and care. It may be hard for you to get your baby regular well-baby care, like vaccinations. Vaccinations help protect your baby from harmful infections.

Early treatment for depression can help you feel better and be ready to care for your baby after birth. If you think you’re depressed, tell your provider and ask about treatment. 

What causes depression?

We’re not exactly sure. It may be a combination of things, like changing chemicals in the brain or changing hormones. Hormones are chemicals made by the body. Some hormones can affect the parts of the brain that control emotions and mood.

Depression also may be caused by genes. Genes are parts of your body’s cells that store instructions for the way your body grows and works. Genes are passed from parents to children. Depression is more common in people whose family members have depression. This is called a family history of depression.

Are you at risk for depression?

Some things make you more likely than others to have depression. These are called risk factors. Having a risk factor doesn’t mean for sure that you’ll have depression. But it may increase your chances. Talk to your health care provider about what you can do to help reduce your risk.

Your health care provider screens (checks) you for depression at your prenatal care checkups. Screening means that your provider asks you questions about your risks, feelings and mood. If the screening shows that you may be depressed or that you’re at risk for depression, your provider can help you get treatment. 

Risk factors for depression during pregnancy include:

• You’ve had major depression or another mental health condition in the past. Or you have a family history of depression or mental health condition. Family history means that someone in your family has had the condition. Even if you’ve been treated for depression and are feeling better, being pregnant can make depression worse or make it come back.
• You’ve been physically or sexually abused. Or you have problems with your partner, including domestic violence (also called intimate partner violence or IPV).
• Your pregnancy is unplanned or unwanted. Or you’re single or pregnant as a teenager.
• You have stress in your life, like being separated from your partner, the death of a loved one or an illness that affects you or a loved one. Or you’re unemployed or have low income, little education or little support from family or friends.
• You have diabetes. Diabetes can be preexisting diabetes (also called pregestational diabetes). This is diabetes you have before pregnancy. Or it can be gestational diabetes. This is a kind of diabetes that some women get during pregnancy.
• You have complications during pregnancy, like being pregnant with multiples, birth defects and pregnancy loss. Multiples is when you’re pregnant with more than one baby. Birth defects are health conditions that are present at birth. They can change the shape or function of one or more parts of the body. Birth defects can cause problems in overall health, how the body develops or how the body works. Pregnancy loss is when your baby dies before birth.
• You smoke, drink alcohol or use harmful drugs.

Can depression during pregnancy be prevented?

The U.S. Preventive Services Task Force says that certain kinds of counseling (also called therapy) can prevent perinatal depression for women at increased risk of depression. Counseling is when you talk about your feelings and concerns with a counselor or therapist. This person helps you understand your feelings, solve problems and cope with things in your everyday life.

The Task Force recommends counseling for women who have one or more of these risk factors:

• Current signs and symptoms of depression
• A history of depression or other mental health condition
• Being pregnant as a teenager or being a single mom
• Having stressful life circumstances, like low income
• Being a victim of IPV

The Task Force recommends two kinds of counseling to prevent depression for women at increased risk:

1. Cognitive behaviorial therapy (also called CBT). CBT helps you manage negative thoughts by changing the way you think and act. Common kinds of CBT include working with a therapist to help you set goals and identify negative thoughts and behaviors so you can begin to think and act differently.
2. Interpersonal therapy (also called IPT). IPT helps you identify and deal with conditions and problems in your personal life, like relationships with your partner and family, situations at work or in your neighborhood, having a medical condition or losing a loved one. Common kinds of IPT include working with a therapist in role-playing, answering open-ended questions (not yes or no questions) and looking closely at how you make decisions and communicate with others.

If you’re at increased risk for depression, your provider can help you get treatment with CBT and IPT. Be honest with your provider about your life, your pregnancy and your feelings so your provider can help you find counselors for treatment.

How is depression treated during pregnancy?

It’s best if a team of providers treats your depression during pregnancy. These providers can work together to make sure you and your baby get the best care. Your providers may be:

• Your prenatal care provider. This is the provider who gives you medical care during pregnancy.
• Your primary care provider. This is your main health care provider who gives you general medical care.
• A mental health provider. This may be a psychiatrist, psychologist, social worker, counselor or a therapist.
• Your baby’s health care provider

Depression can be treated in several ways. You and your providers may decide to use a combination of treatments instead of just one. Treatment can include:

• Counseling, like CBT and IPT
• Support groups. These are groups of people who meet together or go online to share their feelings and experiences about certain topics. Ask your provider or counselor to help you find a support group.
• Medicine. Depression often is treated with medicines called antidepressants. You need a prescription from your provider for these medicines. You may be on one medicine or a combination of medicines. Don’t start or stop taking any medicine for PPD without your provider’s OK.
• Electroconvulsive therapy (also called ECT). In this treatment, electric current is passed through the brain. This treatment is considered safe to use during pregnancy. Providers may recommend ECT to treat severe depression.

How safe are antidepressants during pregnancy?

If you take an antidepressant during pregnancy, there may be some risk of birth defects and other health problems for your baby. In most cases, the risk is low. But if you stop taking an antidepressant during pregnancy, your depression may come back. Don’t start or stop taking any medicine during pregnancy without your provider’s OK.

You and your prenatal care provider and your mental health provider can work together to decide about treatment with antidepressants. Learn as much as you can about your medicine options so you can make the best choice for you and your baby. If you’re taking an antidepressant and planning to get pregnant, talk to your prenatal and mental health providers before you get pregnant.

There are several kinds of antidepressants. Most affect chemicals in the brain called neurotransmitters, but each kind does it in a different way. And each has risks and benefits during pregnancy. Antidepressants that may be used during pregnancy include:

• Serotonin reuptake inhibitors (also called SSRIs). SSRIs are the most commonly prescribed antidepressant medicines. SSRIs that may be used during pregnancy include citalopram (Celexa®), fluoxetine (Prozac®) and sertraline (Zoloft®).
• Serotonin and norepinephrine reuptake inhibitors (also called SNRIs), like duloxetine (Cymbalta®) and venlafaxine (Effexor XR®)
• Tricyclic antidepressants (also called TCAs), like nortriptyline (Pamelor®)
• Buproprion (Wellbutrin®)

The SSRI paroxetine may be related to heart defects in a baby if exposed to the medicine in the first trimester of pregnancy. If you’re pregnant or planning to get pregnant and taking paroxetine, talk to your provider right away about changing medicine.

Some research says that taking certain antidepressants during pregnancy may cause miscarriage, low birthweight, premature birth, birth defects (including heart defects) or a lung condition called persistent pulmonary hypertension (also called PPHN). A study from the Centers for Disease Control and Prevention (CDC) shows that birth defects happen about 2 to 3 times more often in women who take the SSRIs fluoxetine and paroxetine. The study also found that other SSRIs, like sertraline, don’t cause birth defects.

Some research says certain antidepressants may cause a baby to be irritable or have feeding trouble. These studies haven’t been confirmed by more research, so we don’t know for sure if the medicines do cause these kinds of problems. More research is needed.

What do you need to know about St. John’s wort to treat depression?

St. John's wort is an herb (plant) that some people use to treat depression. We don’t know for sure how well it works in pregnant women or if it can cause problems during pregnancy. Herbal products aren’t regulated by the Food and Drug Administration (FDA), so there isn’t much information about how safe it is for pregnant women or rules about how much you can take.

If you’re thinking about taking St. John’s wort or any other herbal product during pregnancy, talk to your provider first. There’s very little information on how herbal products may affect your pregnancy.

More information

• Treating for Two: Safe medication use in pregnancy from the Centers for Disease Control and Prevention (CDC)
• Depression during and after pregnancy: A resource for women, their families and friends from the U.S. Department of Health and Human Services, Health Resources and Services Administration, Office of Maternal and Child Health
• Mental Health America
• Mothertobaby.org. Medications and more during pregnancy and breastfeeding from the Organization of Teratology Information Specialists (OTIS)
• National Alliance on Mental Illness or 800-950-NAMI (6264)
• National Institute of Mental Health
• Substance and Mental Health Services Administration

Last reviewed: March, 2019