Pregnant women who are at a higher risk for developing depression during and after pregnancy generally need to look out for the same warning signs as they might outside of pregnancy and the postpartum period, although depression during pregnancy can be triggered by different or additional worries and stressors.
There are a few factors that can make women more likely to experience depression during pregnancy and the postpartum period. These factors include:
- Anxiety disorder
- Life stressors, including stress at work, financial stress, housing instability, familial or relationship stress, or anything else that’s adding extra emotional strain throughout pregnancy
- A history of depression or other mood disorders
- A lack of social support. This can happen to single parents but can also happen to parents parenting with partners if they’re living far from extended family, have strained relationships with their families, or if they don’t have friends who are able to provide the practical and emotional support needed during pregnancy or after delivery.
- A lack of workplace support. For example, when a woman’s workplace doesn’t offer strong support to parents in the form of paid time off for medical appointments and maternity or family leave. The support of their partner’s workplace is also a factor, as this can determine how present they will be to support her both during the pregnancy and after the baby’s arrival.
- Unintended pregnancy. Parents who don’t feel like they’ve prepared a plan for parenting ahead of time can feel extra stress which puts them at higher risk for depression.
- Intimate partner violence and being involved in an emotionally abusive relationship
- Violent or emotionally abusive relationships with family members
Staying ahead of the curve
Women who are at a higher risk of developing depression during or after pregnancy can do a few things to start to get ahead of mood disorders, so that if they do appear, they’re already ready to deal with them. When it’s possible, one great way to start is by entering talk therapy – while it’s often a treatment for depression and PPD, it’s also a great way for pregnant women who don’t have depression to stay tuned in to changes in their moods, and to identify types and sources of stress as they emerge. And if depression does emerge, women who have already sought talk therapy will already have trust-based relationships with therapists to draw on.
Another way to keep an eye out for mood changes, and the possibility of mood disorders, is for pregnant women to keep track of their sleep patterns, to make note of any changes, and to make sure they’re getting plenty of rest. It’s also a good idea to make a plan for getting enough rest after delivery. This is helpful both because changes in sleep patterns, including sharp increases and decreases in sleep, are signs of depression, but also because lack of sleep has been suggested as a contributing factor in postpartum depression.
Women who have had depression or other mood disorders in the past should keep an eye out for symptoms they’ve experienced before, but there’s no guarantee that depression during or after pregnancy will look exactly the same as depression that the same person has experienced at other points in time.
Many doctors recommend that women who are already being treated for depression before pregnancy continue that treatment throughout pregnancy. For women who have discontinued treatment during pregnancy, if depression returns, it’s a good time to talk through the risks and benefits of returning to the pre-pregnancy treatment plan. Even when there are risks associated with certain medications, in many cases, the risk to mom and baby of untreated depression may be considered riskier.
What depression during pregnancy looks like
Signs of depression during pregnancy include:
- Feeling sad without any break from it (all downs, no ups)
- Having trouble enjoying the things you usually like to do
- Frequent crying
- Severe mood fluctuations
- Excessive sleeping or trouble sleeping
- Avoiding conversations about feelings
- Low self-esteem about motherhood, or feeling especially unprepared for parenthood
- Excessive anxiety about the baby
- Not responding well or feeling comforted when the people in your life try to reassure you
- Having trouble sticking to a healthy prenatal care routine
- Using smoking, drinking, or illicit drugs as a means to cope with emotions
- Low weight gain for your pregnancy’s trajectory due to decreased appetite or diet
- A sense of hopelessness
- Thoughts of suicide or hurting yourself
- Thoughts of hurting someone else, including the baby.
Women who notice one or more of these symptoms, or feel like these symptoms are starting to get in the way of their healthiest possible pregnancy should talk to their healthcare providers about the possibility of depression.
- Pregnancy and pre-existing mental health conditions
- How will you know if you have postpartum depression?
- Lori T. Altshuler, Victoria Hendrick, Lee S. Cohen. “An update on mood and anxiety disorders in the postpartum period.” The Primary Care Companion to the Journal of Clinical Psychiatry. 2(6): 217-222. December 2000. Retrieved July 2 2018. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC181144/.
- Mayo Clinic Staff. “Depression during pregnancy: you’re not alone.” Mayo Clinic. Mayo Clinic, November 24 2016. Retrieved July 2 2018. https://www.mayoclinic.org/healthy-lifestyle/pregnancy-week-by-week/in-depth/depression-during-pregnancy/art-20237875.
- Marie-Louise H. Rasmussen, et al. “Risk, treatment duration, and recurrence risk of postpartum affective disorder in women with no prior psychiatric history: a population-based cohort study.” September 2017. Retrieved July 2 2018. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5614423/
- “Postpartum depression risk, duration, and recurrence.” Eureka Alert! American Association for the Advancement of Science, September 26 2017. Retrieved July 2 2018. https://www.eurekalert.org/pub_releases/2017-09/p-pdr091917.php.