Antenatal depression, sometimes called prenatal depression or depression in pregnancy, is less spoken about than postnatal (postpartum) depression. Perinatal depression is a blanket term for depression during pregnancy and depression that develops in the year after childbirth. Antenatal depression can be very dangerous for mum – who may feel society’s expectation that pregnancy be a joyful time makes reporting symptoms uncomfortable—as well as for baby. It’s important that we normalise discussing the full spectrum of emotions a woman can experience in pregnancy, both for the women who need treatment and people studying topics as serious as suicidal ideation in pregnancy. Pregnancy is an extremely hormonal and neuroplastic time—researchers can now see the multiple changes a woman’s brain goes through—and the way these changes affect you is highly individualised and unique to this specific period of gestation. In short, if your first pregnancy was a breeze and you have no history of any kind of mental health problems, you are still vulnerable to antenatal depression in your second and any other pregnancy. However, there are some things that put you at a higher risk of developing this condition. Antenatal depression is more likely if you:

Have a personal or family history of mental health problems.
Smoke, drink, or use recreational drugs in pregnancy.
Have sleep problems.
Have a bad diet (even taking the best antenatal supplements will not fully compensate for this).
Lack social or professional support for your pregnancy.
Experience relationship problems.
Are coping with or developing a chronic condition.
Experience or are at risk of domestic violence.
Did not intend to get pregnant.
Have or have had certain socio-economic problems, e.g., poverty, poor education, racial discrimination.
Experience stressful or unexpected life events.
Have gestational diabetes, hypertension, or antenatal anxiety.

Antenatal anxiety, obsessive-compulsive disorder, and other psychological issues that are distinct from depression are still considered significant risks to maternal health and should be promptly reported and treated.

What does antenatal (prenatal or perinatal) depression feel like?

Depression can be a hard thing to articulate no matter when you experience it, and that’s OK. Typically, the sign you need to tell someone is the symptom’s regularity. Something as simple as reporting a consistent pattern of uneasy feelings could be enough for your doctor or midwife to understand that you need mental health support. If you do have a history of depression, it may not manifest in the same way as it once did. Symptoms to look out for include:

Persistent tearfulness
Persistent sadness
Persistent low mood
Persistent fatigue or low energy
Persistent listlessness or unresponsiveness
Self-isolating
Self-harm, or the desire to self-harm
Suicidal thoughts
Persistent memory problems

Some of these things can be hard to distinguish if your pregnancy symptoms—sickness, swelling, etc.—are affecting your mood and activities, so it is important that your partner or someone who sees you regularly keeps an eye on you, if only to flag to you that your behaviour is out of the ordinary. Sometimes it’s hard to view ourselves objectively, especially when the body is going through significant changes.

Can depression in pregnancy affect the baby?

There is evidence that your emotions can impact the health of your baby in pregnancy and after birth. However, worry begets more worry and won’t help either of you. The most important thing is that you focus on getting yourself proper help as soon as potential symptoms of antenatal depression are identified.

Will antidepressants harm my baby?

This depends on the antidepressant. Worries that medication may negatively affect your baby should stop you from taking medication if it has been prescribed to you by a medical professional who knows that you are pregnant, nor should it prevent you from reporting symptoms. The family of antidepressants we know most about where pregnancy is concerned are called selective serotonin reuptake inhibitors (SSRIs), and they’re generally considered safe for your baby, but it’s still important not to take them without your doctor and any other healthcare professionals working with you knowing. Antidepressants can interact poorly with other substances. If the antidepressants you were prescribed before pregnancy are considered inappropriate for you in pregnancy for any reason, your doctor can usually work with a pharmacist to find something that will help you.

How can I prevent antenatal depression?

Antenatal depression is not your fault; sometimes it cannot be prevented, and Unii does not want anyone to use the following suggestions to self-criticise. This is just general advice on keeping yourself mentally well in pregnancy.

Seek help for any sleep problems. Most doctors will recommend against sleep medication in pregnancy, but fear of this shouldn’t keep you from reporting this issue. It could be that your doctor feels that the mental health benefits of a certain sleep prescription outweigh the risks to your health and that of your baby.

Eat as well as you can. This sounds easier than it is for many women. Pregnancy sickness is common, as are hormonally-induced sluggish digestion and heartburn, and you may also be dealing with cravings or be struggling with an eating disorder. Your doctor or midwife can give you advice about food, and you may be referred to a dietitian if necessary.

Stay as active as you can. Again, some women struggle with this more than others. If your pregnancy causes dizziness, pain, or other problems that could make it difficult to be active or more worried about falling, daily exercise is extremely challenging. Try to engage in outdoor activities for an extra mental health boost, and anyone you can recruit to support and encourage your exercise routine is invaluable for a healthy pregnancy.

Seek help with other children. Pregnancy places massive demands on your body, and even women who’ve been through it before can’t predict how hard it will be to cope. Reaching out for support or leaning on people more than you typically would is entirely appropriate. A short interval between pregnancies can be especially difficult for a mum’s mental health, as nature designs her to be acutely aware of the needs of the older baby even while responding to the needs of the newer or growing baby. She needs encouragement and lots of help and should have this recognised.

Identify your triggers. If certain activities or people are more likely to upset or stress you out, pregnancy is a gold-standard excuse to avoid them.

Manage stress. This is an annoying piece of advice, we know, as none of us would ever experience stress in our lives if dealing with it were easy. There is evidence that maternal stress can complicate a pregnancy and have longterm negative effects on her baby, so it’s an important one to examine even if you are not worried about antenatal depression.

Practice self-care. This looks different to every woman. Some women go the yoga, meditation, and mindfulness route, while others just need a manicure and an early night with a good book.

What will my healthcare team do to prevent me from experiencing antenatal depression?

This depends on the resources available to you. Help could range from anything from preventative advice to high-quality, consistent communication, prompt diagnosis, and specialist help when necessary. Healthcare professionals do right by pregnant women when they screen for antenatal depression, particularly in high-risk cases, using tools like the Edinburgh Postnatal Depression Scale, though as we’ve mentioned, depression manifests differently for different people, and it’s not always easy to ask for help. Lack of social acceptance, financial resources, and cultural boundaries can affect an individual mum’s ability to communicate even when she has the mental capacity to do so. Speaking to your doctor or midwife—who will be discrete and can make appropriate recommendations—is vital to your health and that of your pregnancy.

For more advice on taking care of yourself in pregnancy, labour, and birth, check out Unii’s Antenatal Classes, with prenatal video episodes taught by senior NHS midwives, an award-winning obstetrician and gynaecologist, and six other leading healthcare experts. Only at unii.com.

Antenatal Depression: Recognising and Managing Symptoms