The Reality of Mental Health Struggles During Pregnancy

Finding out you're pregnant might be the happiest day of your life. But pregnancy is a journey; even if you're nothing but thrilled by the news, other emotions may follow.

"Pregnant people have the societal pressure to feel and act happy, and that pressure forces them to hide their true (unhappy) feelings due to shame," explained Karen Balumbu-Bennett, LCSW, a mental health therapist in Long Beach, California.

There are so many factors of pregnancy that can influence how you feel, from hormones and physical changes to the stress of finances, work, relationships and anxiety about your pregnancy. These factors, along with your psychological and physical reactions to them, can change throughout pregnancy. Sometimes in ways that are unexpected—which can make it hard to be honest about those feelings.

"Pregnant people deserve to share any and all feelings they experience—especially the unhappy ones," Balumbu-Bennett emphasized.

It's perfectly normal for anyone to go through a range of emotions in a given day. When you're pregnant, these shifts can happen more suddenly. Happiness can run right up against sadness, anxiety or anger. Your life is changing in ways you may have always dreamt of—but your life is also changing in ways that might be challenging and scary. And the hormones involved in pregnancy have a tendency to amplify all of it.

That's because estrogen and progesterone can impact neurotransmitters, the brain chemicals that regulate our moods. Your metabolism also plays a role in regulating your state of mind. As your metabolism and hormones change during pregnancy, mood swings can be common—especially in the first and third trimesters.

The best methods for managing mood swings during pregnancy are pretty much the same as how you would normally take care of your mental health—but it's extra important now that you're juggling so many changes. Get plenty of rest, exercise regularly, do things that bring you joy, talk to friends and family about how you're feeling, and most importantly—don't be hard on yourself if none of that feels like it's working.

Temeka Zore, M.D., an OB-GYN at Spring Fertility in San Francisco, California, said recognizing a serious issue can be tricky when so many of the symptoms associated with anxiety and depression are also associated with pregnancy, such as fatigue or changes in appetite.

"But when these are combined with other feelings of sadness or worthlessness then it's likely more than just average pregnancy side effects," Zore explained.

That's why it's so important to communicate symptoms to your doctor.

"I would wake up in the morning, lying in bed very pregnant," recalls Emma Pattee. "And I couldn't remember why I was alive. I knew that... people enjoy living. But I couldn't taste it. I couldn't remember the taste of enjoying life."

Pattee, who works as a freelance writer, was excited about her pregnancy—and she was confused by how terrible she felt. She, like most people, was familiar with postpartum depression—caused by a sudden drop in pregnancy hormones after birth—but why did she feel so sad already?

"Postpartum depression and anxiety are sort of misnomers," explained Jennifer Conti, M.D., an OB-GYN with Stanford Health Care. There is an assumption that women are most likely to suffer with mental health after giving birth. "Really, we should be thinking about mood changes happening all throughout pregnancy," Conti said.

Pattee was hesitant to tell friends and family how she felt, fearing they would think she must not want to be pregnant.

"Everyone missed that I was having a mental health crisis," she said.

But antenatal depression (while you are pregnant) and perinatal depression (any time from becoming pregnant to 12 months after giving birth) are actually quite common. Antenatal depression is estimated to affect 10 percent of women, while perinatal depression affects 10 percent to 20 percent of women in the United States. And perinatal anxiety is thought to affect around 20 percent as well.

If you experience multiple and persistent symptoms of depression—including sadness throughout the day, loss of interest in activities that once brought you joy, sleeping more than usual or insomnia, lack of energy, loss of appetite or trouble concentrating—then you might be facing prenatal depression and you should definitely discuss these symptoms with your doctor.

Perinatal anxiety often occurs alongside depression, but can also be experienced on its own. Doctors and researchers have a harder time identifying perinatal anxiety as a mood disorder because anxiety is so prevalent in big life changes like pregnancy—and it's perfectly normal to experience some of that. But if anxiety is difficult to manage and causes other health problems, then it might require treatment.

By the time Pattee shared the full extent of her depression with her doctor, it was close to the end of her pregnancy. She was offered antidepressants, but at that point, she chose to wait it out. Relief arrived almost immediately after giving birth.

The hesitancy to be transparent about mental health struggles during pregnancy is common. Historically, the risk of depression and anxiety has not been presented to pregnant women, who have often gone undiagnosed. And in the lack of information about these mental health risks, women are more likely to keep the experience to themselves.

Balumbu-Bennett has seen a shift recently toward more focus on prenatal mental health. And many women are finding that talking about it with friends who have experienced similar struggles during pregnancy is helping to lift the stigma. Pattee said the issue really clicked for her when she met someone who shared a similar experience with debilitating depression during pregnancy—but until then, she felt very alone in her mental health struggle.

"Talk to your partner or close friends or family if you find yourself struggling," Zore urged. Being honest and open can help you and others keep tabs on your mental health—and it can also help perpetuate awareness and encourage other women to be more open about their mental health struggles during pregnancy.

One thing is clear: We should all be talking about this more. Doctors, doulas, therapists, pregnant people, and the family and friends of pregnant people can all play a role in destigmatizing the psychological impacts of pregnancy—and hopefully, it will become easier for women to share and find support.

For now, some states do require pregnant women to be screened for perinatal depression—but many professionals and patients say that's not enough. Half of the participants in a recent study at the University of Illinois Urbana-Champaign reported that the results of their screenings were not shared with them and no follow-up took place.

That obviously should not be the case. When these issues arise and doctors do catch them, treatments are available.

"Many of the antidepressants in the SSRI (selective serotonin reuptake inhibitors) family can be taken in pregnancy and safety data does not show an increased risk of birth defects," Zore stated. "There are a few antidepressants that we do avoid in pregnancy and if you are taking one of those, your OB-GYN or mental health provider may switch you to another medication with more safety data."

For anyone who struggles with emotional ups and downs during pregnancy, just talking about it is a great place to start. It's a good idea to build up that support system before you start to experience mood swings, depression or anxiety during pregnancy. Having open conversations about your anxieties, stresses and concerns surrounding pregnancy with your partner, your doctor, or whoever you trust in your life can make it easier to find support if those feelings become overwhelming.