For years, everyone from medical providers to celebrities have rallied to raise awareness about postpartum depression. Now it has become common knowledge that the physical, emotional and hormonal changes a person endures after they gives birth can be more than just the “baby blues,” but a serious medical condition that merits screening, assessment and treatment.
However, it’s just as important to acknowledge that these changes can occur well before a person gives birth. Though stereotypes suggest that pregnancy should be a buoyant, exuberant time of dewy skin, perfect hair and floating on a lily pad (what’s a little morning sickness here and there?), prenatal depression is also a very real condition.
What does prenatal depression look like?
An estimated 15 to 20 percent of pregnant people experience depression and anxiety according to Alisa Kamis-Brinda, a licensed clinical social worker and owner of Serenity Solutions, which provides specialized psychotherapy for perinatal mood and anxiety disorders, anger management, anxiety management and addiction.
Many of the symptoms of prenatal depression are like the symptoms of depression and anxiety disorders that aren’t associated with pregnancy or the postpartum period, Kamis-Brinda tells SheKnows.
“These symptoms include feelings of sadness and depression; crying spells; loss of interest or pleasures; sleep or appetite changes unrelated to the pregnancy; poor concentration and focus; hopelessness; helplessness; feelings of guilt, shame or worthlessness; and suicidal thoughts [among others],” she explains.
Who is most impacted by prenatal depression?
Though prenatal depression, like any mental health issue, can impact anyone, there are certain core factors that may leave some more vulnerable to it than others. Natalie Telyatnikov, founder of Better Postpartum, is a maternal health advocate and educator, and throughout her practice, she’s noticed that prenatal depression can be influenced by a variety of factors. These include (but are not limited to): "a history of depression; history of fertility problems; financial stress; marital stress; prior infant loss via miscarriage or stillbirth; history of domestic abuse; strained familial relationships; complications in pregnancy; traumatic life events happening during pregnancy, such as a death in the family; ill health in pregnancy, such as hyperemesis gravidarum syndrome; unbalanced hormones; or having exacerbated pregnancy symptoms, such as chronic insomnia, lethargy or moodiness.”
Telyatnikov observes that prenatal depression is more “expressly common” in pregnant people at “opposite ends of the socioeconomic spectrum,” such as “young (teen) mothers and older mothers [or] well-to-do mothers and impoverished mothers.”
There are so many social and cultural expectations of pregnant people and mothers in general that some may feel too guilty or ashamed to acknowledge that these physical and emotional symptoms might be depression. The old chestnut that it “takes a village” to raise a child applies to protecting the health and well-being of parents-to-be as well.
“You cannot tell just by looking at a new mother if she is depressed for not,” Jamie Kreiter, a licensed clinical social worker, tells SheKnows. Kreiter says that a pregnant person's partner, family members and friends should listen carefully to how that person describes themselves and their feelings.
How is prenatal depression treated?
Kreiter says that she’d also like to see a broader systemic change across the medical field to better identify and address maternal mental health issues.
“As a society, treatment starts with everyone," she explains. "Providers in the field, such as OBs, should screen every woman and provide reputable resources and referrals. Every pregnant or postpartum mother should receive a list of referrals and providers.”
For Kreiter, diagnosing prenatal depression early is so important because “perinatal depression and other perinatal mood and anxiety disorders are very treatable.” She says that her clients do well with cognitive-behavioral therapy and interpersonal therapy, which are both evidence-based treatment methods.
Talk therapy is a popular option for prenatal depression given that some psychotropic medications (though certainly not all) might not work for pregnant people. Kayce Hodos is a specialist in maternal mental health, and she tells SheKnows that she recommends that pregnant people specifically seek out “a mental health clinician who understands perinatal mood and anxiety disorders,” develop a good self-care routine, shore up their social support and take any physician-prescribed medications.
Finding the right treatment team is essential for feeling better. “A good OB-GYN will be informed about screening for prenatal depression and happy to collaborate with a counselor and other community resources,” Hodos says.
Most of all, people struggling with prenatal depression should show themselves some compassion. Hodos adds, “Pregnancy can feel like an overwhelming task, so it’s natural to be emotional. But it’s important to talk to a trusted provider if you’re having trouble managing.”