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 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
Depression symptoms include: 5
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.
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
Anxiety symptoms include: 12
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
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
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
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.
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:
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
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.