Mental Health During Pregnancy: Signs, Safe Treatments, and How to Get Support

Most people report that pregnancy is one of the most exciting and most difficult times of their life. It’s common for people to struggle with their mental health during pregnancy. In fact, mental health and substance use disorders affect almost a quarter of people during pregnancy and during the time after their babies are born.¹

Unfortunately, stigma and shame about mental health and substance use during pregnancy can prevent people from seeking treatment. But if you’re dealing with anxiety and depression during your pregnancy, you’re not alone. Getting the proper care can help you through your pregnancy and in raising a healthy child.

Depression during pregnancy

Depression during pregnancy is referred to as prenatal depression. Prenatal depression can also continue in the weeks following childbirth. Severe depression after childbirth that lasts longer than that is categorized as postpartum depression.² Research suggests that 8-17% of people self-report depression during pregnancy.³

Research shows that people who experience the following characteristics may be more likely to develop depression during pregnancy: ⁴

• Lack of social, family, and/or partner support
• Having a low income
• History of mental illness
• Previously experienced trauma
• Intimate partner violence
• Belonging to a marginalized community
• Loss of custody
• Hormonal changes
• Additional stress

Depression symptoms include: ⁵

• Depressed mood most of the day, every day
• Loss of interest or pleasure in most or all activities
• Sleep issues
• Loss of energy
• Continuing thoughts of death or suicide

To be diagnosed with depression, someone must experience symptoms consistently for at least two weeks.⁶ If someone is experiencing multiple symptoms, one of these must include a depressed mood or a loss of interest or pleasure in activities.⁷ The Beck Depression Inventory is a screening tool that people can use on their own to help assess their symptoms. Another option is the Edinburgh Postnatal Depression Scale, which is a self-screening tool specifically tailored to pregnant and postpartum people.

Untreated depression can not only make it difficult to function on a day-to-day basis but may increase suicide risk among pregnant people.

Additionally, depression during pregnancy can lead to potentially negative pregnancy outcomes such as premature birth, low birth weight, and complications during delivery.⁸ It can also increase the child’s risk of developing a mental health or developmental disorder after they are born.⁹ Pregnant people with depression are also more likely to develop postpartum depression after they give birth.

As a result, it’s very important to catch symptoms early so they can be properly addressed and treated.

Anxiety during pregnancy

While it’s very normal to feel some worry and stress during pregnancy, some pregnant people experience very serious anxiety that should be treated. Research suggests that as many as 20% of pregnant people may have an anxiety disorder.¹⁰

Characteristics associated with developing an anxiety disorder during pregnancy are very similar to those associated with depression, including: ¹¹

• Lack of social, family, and/or partner support
• History of mental illness
• Having a low income
• Previously experienced trauma
• Intimate partner violence
• Having a high-risk pregnancy
• Previous pregnancy loss
• Unplanned pregnancy
• Hormonal changes

Anxiety symptoms include: ¹²

• • Difficulty concentrating
  • Being unable to fall asleep
  • Feeling irritable
  • Nausea
  • Constant worry
  • Always on edge and unable to relax
  • Dizziness
  • Difficulty breathing
  • Heart palpitations (heart beating too fast, skipping a beat, etc.)
  • Uncontrollable sweating and/or shaking

Like depression, untreated anxiety disorders during pregnancy can cause complications during birth – even miscarriage. Untreated anxiety during pregnancy can also impact a child’s mental health and development after they are born, increasing their risk of developing conditions like ADHD.¹³

Substance use and mental health

People often experience mental health and substance use disorders at the same time. This is referred to as “co-occurring disorders.” More than a third of pregnant people who use opioids (such as heroin or oxycodone) also have mental health disorders like depression or anxiety.¹⁴ One study found that over 30% of pregnant people in substance use treatment also had moderate to severe depression.¹⁵

People with both mental health and addiction disorders often use substances to cope with underlying mental health issues. A lack of access to proper treatment for mental health and substance use disorders can increase substance use and contribute to poor mental health.

Unfortunately, most pregnant people in need of treatment during pregnancy do not receive it, often due to stigma and fear.¹⁶ Pregnant people of color are even less likely to access treatment.¹⁷ Increased stigma and discrimination can make people of color feel unsafe in treatment settings.¹⁸ People of color with substance use disorders are more likely to be reported to Child Protective Services, making them less inclined to seek treatment.¹⁹

Use of medications for mental health during pregnancy

Unfortunately, many people do not receive mental health treatment while they’re pregnant. Only about 1 in 10 receive support for depression during pregnancy.²⁰ Antidepressants and antianxiety medications can be immensely helpful for people struggling with their mental health. But are they safe to use during pregnancy?

The short answer is yes. There are some potential concerns associated with exposing an unborn baby to these medications. However, antidepressants have not actually been linked to issues like birth defects.²¹ Additionally, depression and anxiety during pregnancy can have negative effects on an unborn baby—which may outweigh any risks associated with antidepressants. For the sake of your health and your baby’s health, it’s important to take care of your mental health during pregnancy, and this may include the use of medications.

Certain medications are thought to be safer during pregnancy than others. These include: ²²

• • SSRIs like sertraline (Zoloft), escitalopram (Lexapro), and fluoxetine (Prozac)
    • Risks: high blood pressure, potential under-dosing
  • SNRIs like duloxetine (Cymbals) and venlafaxine (Effexor XR)
    • Risks: high blood pressure
  • Bupropion (Wellbutrin)
    • Risks: Some research suggests an increased risk of developing neonatal heart defects, but these studies are minimal and limited.²³

For many years, research indicated that paroxetine (Paxil) could cause cardiovascular issues in infants. Updated studies, however, have discovered no clear association.²⁴

Every situation is different, and you and your doctor will need to come up with the plan that fits your needs best. Before prescribing, your doctor will likely consider the severity of your depression and/or anxiety; previous treatments; and any additional health issues. If you already took medication prior to becoming pregnant, you will likely be able to stay on your course of treatment, but, again, check with your doctor.

Are there other ways to treat mental health during pregnancy?

While antidepressants and antianxiety medications are often very effective mental health treatments, some may benefit more from lifestyle changes. And even if you are on medication, it is always a good idea to take care of your mental health in other ways. Some ideas include:

• Therapy. Speaking with a therapist regularly can be extremely helpful for pregnant individuals. Many therapists specialize in pregnancy and postpartum care. A search on Psychology Today can help you find specialists in your area.
• Support groups. Connecting with others who are in your shoes can help you feel less alone. Pregnancy mood support groups are offered through many medical establishments and other treatment service hubs and can be attended in person or online. Postpartum Support International is a great resource for finding these.
• Exercise. Regular exercise can help soothe feelings of depression and anxiety (and improve health in general). Speak with your doctor about what exercises you can safely do while pregnant.²⁵ For example, many yoga studios offer pregnancy-specific classes.
• Meditation. Studies have shown that meditation and other techniques to increase mindfulness can help reduce depression and anxiety during pregnancy.²⁶ This list provides some meditation techniques specifically tailored towards pregnancy.

A note on treatment for co-occurring disorders

While it can be difficult to access, it’s important to receive proper treatment for mental health and substance use disorders being experienced at the same time (AKA “co-occurring disorders”). It can not only help your baby’s health but reduce the risks that are connected with substance use, including overdose.

If seeking a therapist, treatment program, or support group, be sure to look for those that specifically treat co-occurring disorders as well as those who specialize in pregnancy care. It’s important to note that there are not a lot of these programs, they’re not always easy to find, and many people do not have access to them. In these cases, telehealth and virtual treatment options can be helpful.

Medications for opioid use disorder (MOUD) and medications for alcohol use disorder (AUD) are the gold standard for treating substance use. They are also the recommended treatment for pregnant people with substance use disorders and are safe to use during pregnancy (per the American College of Obstetricians and Gynecologists, American Academy of Pediatrics, and other reputable health organizations).²⁷

Conclusion

It can be scary and isolating to struggle with your mental health during pregnancy. But you are not alone. Often, parents ignore their own wellbeing during pregnancy, thinking they need to prioritize the health of their baby. However, taking care of yourself is just as important for your baby’s health as it is for yours. Your baby is going to need you, and you want to be as healthy as you can possibly be, both physically and mentally, to care for them.