Depression and anxiety during pregnancy
Published
Pregnancy is supposed to be a happy time, so feeling low or on edge can seem like something to hide. It is not. Depression and anxiety are common in pregnancy. They say nothing about what kind of parent you will be, and they can be treated before the baby arrives. Waiting until after birth to mention it is not the safer choice.
How common is it?
A review of 21 studies found depression in about 7% of women in the first trimester and about 12 to 13% in the second and third trimesters (Bennett et al., Obstet Gynecol 2004, PMID 15051562). Anxiety is at least as common. A review that pooled 102 studies found that about 18% of pregnant women reported anxiety symptoms in the first trimester, rising to about 25% in the third, and about 15% met criteria for an anxiety disorder (Dennis et al., Br J Psychiatry 2017, PMID 28302701). So if what you feel is mostly worry rather than sadness, it is still worth raising.
A lot of "postpartum" depression starts in pregnancy
The word postpartum makes it sound as if depression only begins after birth. Often it does not. In a study that screened 10,000 new mothers four to six weeks after birth, about a third of the depressive episodes found in women who screened positive and were evaluated had started during pregnancy, and about a quarter had started before pregnancy (Wisner et al., JAMA Psychiatry 2013, PMID 23487258). If you feel this way now, you are not too early to ask for help.
Normal pregnancy, or something more?
Pregnancy itself can cause tiredness, poor sleep, appetite changes, and trouble concentrating, which is why depression is easy to miss. The signs that point past ordinary pregnancy: losing interest in things you used to enjoy, feeling hopeless or worthless, crying most days, feeling numb or cut off from the pregnancy, worry you cannot switch off, or panic attacks. If these last most days for two weeks or more, raise them. Thoughts that you would be better off dead, or that others would be better off without you, do not wait two weeks: call 911 if you are in immediate danger or have an urge or plan to act; otherwise call or text 988 now. The full list is on our warning signs page.
Screening, and what a high score means
ACOG recommends screening for depression and anxiety during pregnancy and after birth (Clinical Practice Guideline No. 4, PMID 37486660). The questionnaire is short and asks about the past week or two. Answer it honestly. A high score is not a verdict on you as a parent. It is a reason for a closer look: your clinician will ask more questions and talk about next steps, which may include a referral for treatment, or same-day help if you have thoughts of harming yourself or your baby. If you are worried about what happens with your answers, ask your clinician before you fill it out. If no one has given you the questionnaire, ask for it.
Questions about medication
If you already take medication for depression or anxiety, do not stop it on your own when you find out you are pregnant. Talk to your prescriber first. The same conversation applies if you are thinking about starting one. ACOG has a guideline on treating mental health conditions during pregnancy and breastfeeding that prescribers can use (Clinical Practice Guideline No. 5, PMID 37486661). Questions worth bringing: What are the risks of this medication in pregnancy, and what are the risks of leaving my symptoms untreated? Is therapy an option alongside or instead of medication? Should anything change as my due date gets closer? Is this medication compatible with breastfeeding if I plan to? Who do I call if my symptoms get worse?
Why it matters to treat it now
Treatment is for you first. It can matter for the baby too. A review of 29 studies found that depression during pregnancy was linked with a higher risk of preterm birth and low birth weight, although the size of the link varied from study to study and by country (Grote et al., Arch Gen Psychiatry 2010, PMID 20921117). A broader review found that mental health conditions in pregnancy and after birth are associated with more emotional and developmental difficulties in children, but that these outcomes are not inevitable, and that treating the parent's condition and helping with caregiving difficulties both matter (Stein et al., Lancet 2014, PMID 25455250).
When to act on it
If low mood or worry is there most days for two weeks or more, or it keeps you from sleeping, eating, or getting through the day, talk to your OB, midwife, or primary care clinician at your next visit or sooner. If you or your baby are in immediate danger, or you have an urge or plan to harm yourself or the baby, call 911 or go to the nearest emergency room. If you are having thoughts of harming yourself, call or text 988 now. Hallucinations, sudden confusion, beliefs that do not match reality, or being unable to sleep at all can be signs of psychosis, during pregnancy or after birth: call 911 or go to the nearest emergency room.
For lines that can help today, including the National Maternal Mental Health Hotline at 1-833-852-6262 (free, 24/7, English and Spanish), see Get Help Now. If worry is your main symptom, read our article on postpartum anxiety. For what to expect after birth, see baby blues vs. postpartum depression.