Recognizing Prenatal Depression Early: Warning Signs During Pregnancy

You're 22 weeks along, sitting in the car outside your OB's office, and you've just checked "a few days" on the mood questionnaire when the honest answer was "nearly every day." Everyone keeps asking if you're excited. You wanted this baby. You still want this baby. So why do you feel so flat and heavy and far away from it all?

I hear some version of this from pregnant moms often, usually with a lot of guilt attached. As a psychologist and a mom, I want you to know that depression during pregnancy is real, it's common, and it is not a sign that you'll be a bad mom or that you don't love this baby. It's a health problem that happens to show up at a time when everyone expects you to glow. And the earlier it's recognized, the easier it is to treat.

What is prenatal depression?

Prenatal depression (sometimes called antenatal depression) is depression that starts or continues during pregnancy. Most people have heard of postpartum depression. Fewer know that depression during pregnancy is about as common, and it gets missed more often, because so many of its signs get chalked up to hormones, nausea, or ordinary pregnancy tiredness.

It matters for another reason too. Depression during pregnancy is one of the strongest predictors of depression after birth. Treating it now is one of the best things you can do for the months after your baby arrives. I wrote more about whether postpartum depression can be prevented here.

Warning signs of depression during pregnancy

Pregnancy itself changes your sleep, appetite, energy, and mood, so the question is how intense these are, how long they've lasted, and whether they're getting in the way of your life. Talk to someone if, for two weeks or more, you notice:

• Sadness, emptiness, or numbness most of the day, most days. A heaviness that doesn't lift, day after day.
• Losing interest in things you used to enjoy, including things you were looking forward to about the baby.
• Guilt or worthlessness. "This baby deserves better." "I'm already failing."
• Exhaustion that goes beyond pregnancy tired. You can't get going at all.
• Sleep that's off for reasons other than your body. Lying awake when you're physically comfortable, or wanting to sleep all day to escape.
• Appetite changes that aren't about nausea.
• Trouble concentrating or making even small decisions.
• Feeling disconnected from the pregnancy, or not wanting to think about the baby at all.
• Irritability or anger that feels out of character.
• Thoughts that you'd be better off dead or that everyone would be better off without you. That one doesn't need to wait two weeks. Tell someone today.

Anxiety often comes along with it: constant worry about the baby's health or the birth, panic, trouble sleeping because your mind won't stop, or scary unwanted thoughts. If that sounds more like you, it's just as treatable. Here is more on intrusive thoughts and how they're treated.

Who is more likely to have prenatal depression

Anyone can get depressed during pregnancy, but it is more likely if you have:

• A history of depression or anxiety, especially during or after a past pregnancy
• A family history of depression or other mood problems
• Little support, or a lot of strain in your relationship
• A lot of stress at once, such as money worries, a move, or a job change
• A hard road to this pregnancy, like infertility treatment or a past loss
• Pregnancy complications or a high-risk pregnancy
• A history of trauma
• Mixed feelings about being pregnant, or a pregnancy that wasn't planned

Thyroid problems can also cause symptoms that look like depression, so it's worth asking your doctor to check if you haven't had labs recently. If you had postpartum depression after a past baby, here is how I help moms plan for the next pregnancy.

Getting screened for prenatal depression

Many OBs and midwives give a short mood questionnaire at some point in pregnancy, often one called the Edinburgh scale. It only works if you answer honestly, and I know how hard that is when you're worried about what it says about you. A high score doesn't mean anything bad about you as a mom. It means you get help sooner.

If no one has asked, you can bring it up yourself. Something as simple as "I haven't felt like myself for a few weeks, and I'm worried it's depression" is enough to start the conversation. Here is how to talk to your OB about it.

Treatment for depression during pregnancy

The most common fear I hear is "Is it safe to treat this while I'm pregnant?" Depression that goes untreated during pregnancy carries real risks of its own, for you and for the baby, so leaving it untreated carries risk too. You have good options.

Therapy

For many moms, especially with mild to moderate depression, therapy is the first step, and often it is enough. I use a few approaches, usually together, and none of them is better than the others:

• Cognitive behavioral therapy (CBT) helps you catch the harsh, hopeless thoughts depression feeds you and check them against the facts. Those thoughts are symptoms of depression. It also helps you start doing the things depression has pulled you away from.
• Interpersonal therapy (IPT) focuses on the role change you're in the middle of and the relationships that are shifting or strained because of it.
• Psychodynamic work helps when pregnancy has brought up older things: how you were raised, old losses, patterns you don't want to pass on.

We usually meet weekly for the first eight to twelve weeks, then less often as you feel better. Most moms notice real change within the first several weeks. Video sessions help a lot when you're exhausted or on modified activity. Here is what to expect in a first session.

Medication

For moderate to severe depression, or when therapy alone isn't enough, medication may be part of the plan. Whether to take a medication during pregnancy, and which one, is a decision to make with your OB or a psychiatrist who knows perinatal care. They can walk you through the specific risks and benefits for you. I don't prescribe, but I'm happy to work alongside them. For reliable information on medications in pregnancy, MotherToBaby is a free service that answers questions from pregnant and breastfeeding moms.

If you were already taking an antidepressant when you got pregnant, please don't stop it suddenly on your own. Stopping abruptly can bring depression back and cause withdrawal symptoms. Talk with your prescriber first, so any change is planned.

Support at home

None of this replaces treatment, but it helps it work. Protect your sleep where you can. Eat regularly. Tell at least one person how you're really doing. And try to keep one hour a day that is yours to recharge: a nap, a shower, a walk, a book. Support groups can help too, and many welcome pregnant moms.

Why recognizing prenatal depression early matters

You don't have to wait until the baby arrives to feel better, and you don't have to be at a breaking point to ask for help. Treating depression now means you go into birth and the newborn weeks steadier, with tools already in place and people already in your corner.

If you ever have thoughts of harming yourself or feel you can't keep yourself or your baby safe, call 911 or go to the nearest emergency room. You can call or text 988 any time, and the National Maternal Mental Health Hotline is open 24/7 at 1-833-852-6262.

Working with me

I'm a licensed clinical psychologist, a certified perinatal mental health specialist, and I work with moms during pregnancy as well as after the baby comes. I use CBT, interpersonal therapy, and psychodynamic work, and I'm happy to coordinate with your OB or psychiatrist. I see moms in Austin or on video, and babies are always welcome in my office.

You don't have to be "bad enough" to benefit from support. Many of the moms I work with aren't clinically depressed at all. They're dealing with the everyday stress of becoming a mom, and therapy helps with that just as much as it helps with depression or anxiety.

The first step is a free 15-minute call. Tell me what has been going on, and I will tell you honestly what I think would help.

Book a free 15-minute call