Depression during pregnancy

KEY POINTS

  • Depression is a medical condition that needs treatment to get better.

  • 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 it without talking to your health care provider first. 

  • Talk to your provider about treatment for depression that's 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 provider.

What is depression?

Depression (also called major depression or 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.

Depression in women is common. In the United States, about 1 in 10 women (10 percent) has signs or symptoms of depression. It affects 1 in 7 women (about 15 perent) at some time during 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.

How do you know if you have 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
  • Having thoughts about death or suicide

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 or abuse street drugs or 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?

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. 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  

Last reviewed: May, 2018