Depression in pregnancy

What is antenatal depression?

Antenatal depression is when you feel sad all the time for weeks or months during your pregnancy. The condition can vary from mild to severe and can affect women in different ways.

Some women have depression after having a baby. This is called postnatal depression. 

Pregnancy can be very emotional. It can be hard to know whether your feelings are normal or a sign of something more serious. Pregnancy hormones can affect your emotional state, you may have trouble sleeping and you may be feeling sick. This can all make you feel low.

Trust yourself. You are the best judge of whether your feelings are normal for you. Talk to your midwife or GP if you or a loved one think you have any symptoms of depression and they last for more than two weeks.

Depression is a mental health condition. It's not a sign of weakness, something that will go away on its own, or something you should just 'snap out of'. Depression can be treated with the right care and support.

What are the symptoms of antenatal depression?

You may have depression in pregnancy if you feel sad for a long time, or have negative feelings that won’t go away or are too much to cope with.

"Pregnancy is meant to be such a happy time but because we don’t talk about mental health in pregnancy women don’t know that it can be a very different story."

Abby, mum of one. Read more...

These can be signs of depression, if you:

• feel generally down most of the time
• can’t be bothered with things
• can’t concentrate or make decisions
• don’t enjoy life
• feel tearful
• feel irritable and don’t want to be with other people
• feel restless
• lose your self-confidence
• feel worthless
• feel guilty
• think about suicide.

You may not have all these symptoms and they may come on slowly or you may start to feel very low all of a sudden.

If you feel like you want to harm yourself or like you want to die, please tell someone. This could be a family member, friend, your GP or midwife. Help is out there right now if you need it. You can also call the Samaritans on 116 123.

"I wasn’t sleeping well and I’d wake up with that horrible feeling of doom starting every day. I’d cry at the drop of a hat about things that wouldn’t normally make me cry." 

Stephanie, mum of two. Read more...

It can be really tough to accept that you’re feeling low at a time when people expect you to feel happy. But being down or depressed during your pregnancy is nothing to be ashamed of. Depression in pregnancy is very common, and you are not alone. 

How common is depression in pregnancy?

Depression in pregnancy is very common. Around 1 in every 10 pregnant women has antenatal depression.

“I started feeling snappy, not my usual self at all – I shrugged it off at first and thought it was just my hormones playing up. However, it started to get worse. I knew I really wanted the baby, but I didn’t feel like I wanted it." 

Clare, mum of one

What causes depression?

You may be more likely to get antenatal depression if you:

• have had depression before
• have anxiety
• are going through a very hard life event, such as the death of a loved one or a divorce
• don’t have support from family or friends
• are having an unplanned pregnancy
• have experienced domestic abuse

But anyone can get depression in pregnancy, even those with no experience of anything in this list. It can happen out of the blue and affects women from all walks of life.

What should I do if I think I have depression in pregnancy?

Tell your midwife or doctor how you feel.  Some women feel very distressed or guilty at feeling low at a time when they feel they should be happy. Healthcare professionals really won’t judge you. They get that depression is a mental health condition. It is not your fault, or something that you just need to ‘get over’ or move on from. They will focus on helping you find the right treatment and support so you can take care of yourself and your baby.  

If you find it hard to talk about your thoughts and feelings, you could write down what you want to say first, or you may want to have someone with you. The main thing is to let someone know so that you can get the right support as quickly as you can. 

Tell the midwife or doctor if you have had depression in the past because you may be more likely to get depression during this pregnancy or after you give birth. They can give you the best support to reduce the chances of you getting depression again.  

"I felt very tired, every time I sat down I’d just doze off to sleep. I never seemed to feel that glow that everybody talks about."

Emily, mum of three. Read more...

What is the treatment for depression?

Treatment for depression tends to involve self-help, talking therapies (such as counselling or cognitive behavioural therapy) and medicines.

Everyone differs, so treatments that work for some people may not work for others. Your doctor will help you decide what’s best for you. If there is one near you, you may be referred to a perinatal mental health specialist. You will be monitored closely during and after your pregnancy.

The treatment you have will be your choice. Your healthcare professional can help you by talking to you about what you’d like to do and telling you about the risks and benefits of all options.

They will also talk to you about:

• what’s best for your stage of pregnancy
• any risks certain medications may pose to your baby
• the risk that you might become unwell again without medication
• how bad your symptoms are
• whether you have had the condition before
• how well the medication has worked for you so far, if you are already taking it

If the recommended treatment is antidepressants, your doctor will discuss the risks to your baby. This will be to do with:

• what is known about their safety during pregnancy
• whether the baby may have some mild symptoms when born and whether breastfeeding may reduce the chance of these occurring.

If you would like to stop medication when you are pregnant, but it’s the best treatment for your depression, your doctor should talk to you about your reasons for wanting to stop medication. They will be able to outline the risks, if any, to you and your baby.

Is it safe to take antidepressants in pregnancy?

If you are offered medication for a mental health condition, make sure you are clear on the pros and cons before you decide on your treatment.

For some women and birthing people, any risks of taking medication will outweigh the risks of not treating their condition.

If you are on mental health medication, do not stop taking it before talking to your doctor. This can lead to withdrawal symptoms. It could also make your depression symptoms come back or get worse.

If your healthcare professional thinks you may need to start or keep taking antidepressants they should explain the pros and cons clearly. They should talk to you about:

• what’s best for your stage of pregnancy
• what mental health condition you have
• how your condition affects you 
• how quickly you’ve become unwell if you’ve stopped taking medication
• what treatments have helped you in the past
• if any medications have caused side effects
• what other treatments you are having, such as talking therapy

If you decide to take medication when you are pregnant you should be offered the one that carries the least risk for you and your baby. You should be prescribed the lowest amount that will work and will rarely be put on more than one type.

If you would like to stop medication when you are pregnant, but it’s thought to be the best treatment for you, your doctor should talk to you about your reasons for wanting to stop medication and about the risks, if any, to you and your baby.

If you accept the risks to you and your baby and still decide to stop the medication, your doctor should talk to you about having cognitive behavioural therapy (CBT), if they think this could help you.

Don’t take St John’s Wort. (Although it can help with depression when you aren’t pregnant, we do not know if it is safe in pregnancy.)

Breastfeeding

You and your healthcare professional may decide that the combined benefits of your treatment (to you) and of breastfeeding (to your baby) outweigh any risks.

You may decide you prefer not to take medication while you’re breastfeeding. There may also be other reasons why breastfeeding is not for you. For example, you may not be having any sleep because you’re up feeding the baby. This can impact your mental health, so you may choose to bottle feed so you can take turns with your partner, if you have one. There’s no need to feel guilty if you decide not to breastfeed. Your baby needs you to be well. 

Talk to your healthcare professional about what is best for you. They will be able to support you if you decide to bottle feed your baby.

I have antenatal depression. Will I get postnatal depression?

If you have had depression before, you are more likely than others to have postnatal depression, especially if you do not get treatment. But it doesn’t mean you will be depressed after giving birth.

If you think you might have antenatal depression  the best thing to do is talk to your midwife or doctor about how you feel. They can help you get the right treatment for you. It may be helpful to take a look at the Wellbeing Plan with your midwife or health visitor and talk through what extra support might be helpful to you during and after pregnancy. The treatment for depression depends on how severe your symptoms are and what services there are that are local to you.

“I had postnatal depression after my first pregnancy and was depressed during my second. Luckily, I was referred for some talking therapy and it helped so much. I managed to work through everything before my second baby was born and it was a much happier experience.”

Maria

You may also find it helpful for you, your partner (if you have one) and your family to read about the symptoms of postnatal depression. This will help you all to notice the symptoms if you do become depressed again after you’ve given birth, so you can get help quickly.

The good news is that postnatal depression can be treated. Spotting the symptoms early and getting the right support for you is key.

How can I help myself?

If you have a partner, talk to them. Share this page with them and tell them that this is how you feel. Once they know that you have a health condition and don’t just ‘need cheering up’ then they will be able to support you better.

Depression can make you want to hide away from the world and you may feel like you don’t want to do much. But try your best to take care of yourself. Start with little tasks, take things at your own pace and ask for help if you need it. Here are a few ways you can look after yourself:

• Talk to someone you trust about your feelings, such as your partner, family member or friend.
• Know that there’s no need to feel guilty or ashamed. These feelings are not your fault.
• Exercise  as much as you can. Keeping active will release feel-good endorphins.
• Eat well even if you don’t ever feel that hungry.
• Avoid alcohol  and smoking. Both of these can harm your baby and make you feel worse.
• Don’t take St John’s Wort. (Although it can help with depression when you aren’t pregnant, we do not know if it is safe for use in pregnancy).
• Read about planning for emotional changes after birth.