Depression during pregnancy
Depression (also called major depression) is a medical condition in which strong feelings of sadness last for a long time and interfere with your daily life. It needs treatment to get better.
About 1 in 5 women have depression sometime in their life. And 1 in 7 women is treated for depression at some time between the year before pregnancy and the year after pregnancy. Depression before or during pregnancy is different than postpartum depression (also called PPD). PPD is a kind of depression that some women get after pregnancy.
Here are the top things you need to know about depression during pregnancy:
- If you’ve had depression before, you’re more likely than other women to have depression during pregnancy.
- If you’re taking an antidepressant and find out you’re pregnant, don’t stop taking the medicine without talking to your provider first.
- There are many kinds of treatments that can help you feel better that are safe for you and your baby during pregnancy.
- If you’re pregnant or planning to get pregnant and you have or think you may have depression, talk to your health care provider.
How do you know if you have major depression?
Major depression is more than just feeling down for a few days. You may have depression if you have any of these signs that last for more than 2 weeks or:
Changes in your feelings
- Feeling sad, hopeless or overwhelmed
- Feeling restless or moody
- Crying a lot
- Feeling worthless or guilty
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 if the signs 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 your baby?
Yes. If you’re pregnant and have depression that’s not treated, you’re more likely to have:
- Premature birth. This is birth that happens too early, before 37 weeks of pregnancy.
- A low-birthweight baby. This means your baby is born weighing less than 5 pounds, 8 ounces.
- A baby who is more irritable, less active, less attentive and has fewer facial expressions than babies born to moms who don’t have depression during pregnancy
Being pregnant can make depression worse or make it come back if you’ve been treated and feeling better. If you have depression that’s not treated, you may have trouble taking care of yourself during pregnancy. For example, you may not eat healthy foods and not gain enough weight. You may skip your prenatal care checkups or not follow instructions from your health care provider. Or you may smoke, drink alcohol, use street drugs or abuse prescription drugs. All of these things can affect your baby before he’s born.
If you have depression during pregnancy that’s not treated, you’re more likely to have PPD after pregnancy. PPD can make it hard for you to care for and bond with your baby. Treatment for depression during pregnancy can help prevent these problems.
What causes major depression?
We’re not exactly sure what causes depression. 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.
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.
Risk factors for major depression include:
- You’ve had major depression or another mental illness in the past, or you have a family history of depression or mental illness. This means that someone in your family has had the condition.
- You’ve had stressful events in your life, like the death of a loved one or an illness that affects you or a loved one.
- You have problems with your partner, including domestic violence (also called intimate partner violence or IPV).
- You have little support from family or friends.
- You have money problems.
- You smoke, drink alcohol, use street drugs or abuse prescription drugs.
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. They may include:
- Your prenatal care provider. This is the person who gives you medical care during pregnancy.
- A health care provider who treats your depression. This may be a psychiatrist or your primary care provider.
- A counselor or therapist (also called a mental health professional)
- The provider you choose to care for your baby after birth
Depression can be treated in several ways. You and your providers may decide to use a combination of treatments instead of just one:
- Counseling (also called therapy or talk therapy). This 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.
- 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. Some research shows that taking an antidepressant during pregnancy may put your baby at risk for some health conditions. But if you’ve been taking an antidepressant, it may be harmful to you to stop taking it. So talk with all of your providers about the benefits and risks of taking an antidepressant while you’re pregnant, and decide together what you want your treatment to be. If you’re taking an antidepressant and find out you’re pregnant, don’t stop taking the medicine without talking to your provider first. Not taking your medicine may be harmful to your baby, and it may make your depression come back.
- 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?
About 13 percent of pregnant women (about 1 in 8) take an antidepressant during pregnancy. If you’re taking an antidepressant and stop taking it during pregnancy, your depression is more likely to come back than if you keep taking the drug. This is why it’s so important for you and your prenatal care and mental health care providers to work together to decide on your treatment during pregnancy.
There are several kinds of antidepressants. Most affect chemicals in the brain called neurotransmitters, but each kind does it in a different way. Examples include:
- Serotonin reuptake inhibitors (also called SSRIs), like citalopram (Celexa®), escitalopram (Lexapro®), fluoxetine (Prozac®), paroxetine (Paxil®) and sertraline (Zoloft®). SSRIs are the most commonly prescribed antidepressant medicines.
- Serotonin and norepinephrine reuptake inhibitors (also called SNRIs), like duloxetine (Cymbalta®)
- Tricyclic and tetracyclic antidepressants, like desipramine (Norpramin®) and nortriptyline (Pamelor®)
- Buproprion, including bupropion hydrochloride (Wellbutrin®)
Some antidepressants are safer to use during pregnancy than others. If you’re pregnant and taking an antidepressant, talk to your provider about switching to a medicine that can treat your depression and that’s safer for your baby. 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 certain 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 research 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.
Again, it’s important for you and your health and mental health care team to look at the possible risks of these drugs on your baby as well as the risk of having your depression come back if you stop taking your medicine. There’s no right or wrong way to do this. Learn as much as you can about the medicines 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 health and mental health care providers before you get pregnant. Together you can decide what do to about taking your medicine when you do get pregnant.
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.
For 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, nmha.org or 800-273-TALK (8255)
mothertobaby.org, Medications and more during pregnancy and breastfeeding from the Organization of Teratology Information Specialists (OTIS)
National Alliance on Mental Illness, nami.org or 800-950-NAMI (6264)
National Institute of Mental Health
Substance and Mental Health Services Administration
Last reviewed September 2014
Frequently Asked Questions
What is mononucleosis?
Mononucleosis (also called mono) is an infection usually caused by the Epstein-Barr virus (EBV). It’s sometimes caused by another virus called cytomegalovirus (CMV). EBV and CMV are part of the herpes virus family. Mono is most common in teenagers and young adults, but anyone can get it. Mono is called the “kissing disease” because it’s usually passed from one person to another through saliva. In addition to kissing, it can also be passed through sneezing, coughing or sharing pillows, drinks, straws, and toothbrushes.
You can have mono without having any symptoms. But even if you don’t get sick, you can still pass it to others. Symptoms can include:
- Achy muscles
- Belly pain
- Fatigue (feeling tired all the time)
- Sore throat
- Swollen glands in your neck
If your symptoms don’t go away or get worse, tell your health care provider. He’ll most likely do a physical exam and test your blood to find out for sure if you have mono.
There’s no vaccine to prevent mono. There’s also no specific treatment. The best care is to take it easy and get as much rest as you can. It may take a few weeks before you fully recover.
Can Rh factor affect my baby?
The Rh factor may be a problem if mom is Rh-negative but dad is Rh-positive. If dad is Rh-negative, there is no risk.
If your baby gets her Rh-positive factor from dad, your body may believe that your baby's red blood cells are foreign elements attacking you. Your body may make antibodies to fight them. This is called sensitization.
If you're Rh-negative, you can get shots of Rh immune globulin (RhIg) to stop your body from attacking your baby. It's best to get these shots at 28 weeks of pregnancy and again within 72 hours of giving birth if a blood test shows that your baby is Rh-positive. You won't need anymore shots after giving birth if your baby is Rh-negative. You should also get a shot after certain pregnancy exams like an amniocentesis, a chorionic villus sampling or an external cephalic version (when your provider tries to turn a breech-position baby head down before labor). You'll also want to get the shot if you have a miscarriage, an ectopic pregnancy or suffer abdominal trauma.
I had a miscarriage. How long should I wait to try again?
Before getting pregnant again, it's important that you are ready both physically and emotionally. If you don't need tests or treatments to discover the cause of the miscarriage, it's usually OK for you to become pregnant after one normal menstrual cycle. However, it may take longer for you to feel emotionally ready to be pregnant again. Everyone responds differently to a miscarriage. Only you will know when you are ready to try to get pregnant again.
Are gallstones common during pregnancy?
Not common, but they do happen. Elevated hormones during pregnancy can cause the gallbladder to function more slowly, less efficiently. The gallbladder stores and releases bile, a substance produced in the liver. Bile helps digest fat. When bile sits in the gallbladder for too long, hard, solid nuggets called gallstones can form. The stones can block the flow of bile, causing indigestion and sometimes serious pain. Staying at a healthy weight during pregnancy can help lower your risk of gallstones. Exercise and eating foods that are low in fat and high in fiber, like veggies, fruits and whole grains, can help, too. Symptoms of gallstones include nausea, vomiting and intense, continuous abdominal pain. Treatment during pregnancy may include surgery to remove the gallbladder. Gallstones in the third trimester can be managed with a strict meal plan and pain medication, followed by surgery several weeks after delivery.