How to Cope with Anxiety and Depression During Pregnancy

Research has shown that approximately 16% of people experience clinical anxiety or depression at some point during pregnancy. Yet some studies indicate that screening is neglected, and people often go untreated while pregnant.

For those that do receive treatment, it is often inadequate, says Healy Smith, MD, a reproductive psychiatrist at the Women’s Mental Health Clinic at New York-Presbyterian Hospital in New York City.

Dr. Smith explains that the myth that pregnant people must be happy is still really prevalent. Because of that, health care providers may be less likely to inquire into someone’s mental health when they’re pregnant, and a person might feel ashamed to bring it up. This means many people may be dealing with anxiety or depression during pregnancy without getting the support and help they need.

The American Academy of Pediatrics (AAP) released a policy statement in 2019 stating that doctors should screen for depression during pregnancy to protect the baby’s health.

Policy co-author Marian Earls, MD, MTS, FAAP, says that when you help a parent deal with their mental health, you essentially reach the whole family. The statement also says that pregnant people should be screened for depression after the baby’s birth—specifically when they reach 1, 2, 4, and 6 months postpartum.

If your screening shows you have anxiety or depression during pregnancy, don’t worry—there are safe ways to treat these common conditions. Read on to learn about the symptoms, risk factors, complications, and treatments for anxiety and depression during pregnancy.

Symptoms of Depression During Pregnancy

Diagnosing mood disorders during pregnancy can be tricky because “some of the symptoms can overlap with symptoms of pregnancy, such as changes in appetite, energy levels, concentration, or sleep,” Dr. Smith says. “It’s also normal to have some degree of worry over the health of the pregnancy.”

But if you experience persistent symptoms of depression during pregnancy, especially if you’re unable to function normally, get help. According to the American College of Obstetricians and Gynecologists (ACOG), symptoms of depression during pregnancy include:

• A sense of worthlessness
• Being in a depressed mood most of the time for at least two weeks
• Feeling sad, hopeless, “empty,” and generally discontented
• Changes in appetite
• Decreased interest in the world around you
• Feeling guilty
• Getting too much or not enough sleep
• Low energy
• No longer enjoying the things you used to enjoy
• Poor concentration
• Thoughts of suicide

Symptoms of Anxiety During Pregnancy

The symptoms of anxiety during pregnancy vary by type of disorder. Anxiety disorders include generalized anxiety disorder, obsessive-compulsive disorder (OCD), and panic disorder.

Generalized Anxiety Disorder Symptoms

According to the National Institute of Mental Health (NIMH), generalized anxiety disorder is more than just occasional worrying—it usually involves persistent anxiety and dread that interferes with everyday life. Symptoms include:

• Disrupted sleep patterns
• Excessive worry that’s difficult to control
• Fatigue
• Feeling restless inside
• Irritability
• Poor concentration
• Headaches, muscle aches, stomach aches
• Easily startled
• Difficulty swallowing
• Tremors
• Feeling lightheaded or breathless

Obsessive-Compulsive Disorder Symptoms

According to the National Institute of Mental Health, people with OCD have symptoms of obsessions (repeated thoughts, urges, or images that cause anxiety), compulsions (repetitive behaviors in response to an obsessive thought), or both. Symptoms of OCD include:

• Fear of germs
• Unwanted thoughts about sex, religion, or harm
• Aggressive thoughts
• Needing things in perfect order
• Inability to control thoughts or behaviors
• Spends more than an hour a day on thoughts and behaviors
• Rituals are not pleasurable but provide brief relief from anxiety
• Thoughts and behaviors significantly interfere with daily life

Panic Disorder Symptoms

According to NIMH, people with panic disorder have frequent panic attacks, which feel like a sudden wave of fear or loss of control. Panic attacks often have no warning or trigger. Symptoms of panic disorder include:

• Persistent fear of having a panic attack
• Recurrent panic attacks
• Feelings of intense fear, doom, and loss of control
• Avoidance of places or situations where panic attacks occurred in the past
• Pounding or racing heart
• Sweats and chills
• Trembling
• Trouble breathing
• Weakness or dizziness
• Chest pain
• Nausea

Risk Factors for Anxiety and Depression During Pregnancy

Doctors once thought that all of those hormones rushing around a pregnant body would shield you from depression. We now know that for some people, the opposite is true. But while experts agree that hormones play a role in depression, the exact mechanisms are unknown. Other factors, according to the NIMH, include genetics and environmental factors, like life stress, also contribute.

“It may be triggered by any number of physiologic or life stressors,” says Sheila Marcus, MD, director of the women’s depression program at the University of Michigan Depression Center in the department of psychiatry. Dr. Marcus says that in those with a genetic predisposition to depression, the hormone changes may be one of these stressors.

Anyone can experience anxiety and depression during pregnancy. But research has found that people with the following risk factors are especially susceptible:

• A personal or family history of a mood disorder, such as depression or anxiety
• History of domestic violence
• Having a low income
• Having lower education
• Smoking or drinking during pregnancy
• Having given birth to two or more children

Possible Complications of Untreated Anxiety and Depression

Dr. Smith says there are well-documented but often overlooked consequences of untreated anxiety and depression during pregnancy.

According to ACOG, risks to developing babies of untreated prenatal mental health issues include:

• Low birth weight
• Poor adaptation outside the womb, including respiratory distress and jitteriness
• Premature birth (before 37 weeks)
• A newborn that cries a lot and is hard to comfort
• Emotional or behavioral problems when a child is older

Risks to the gestational parent include:

• Not taking good care of their physical health
• Postpartum anxiety or depression
• Depression if you stopped taking antidepressants during pregnancy

It’s essential to get treatment for anxiety and depression during pregnancy to prevent complications.

Treatment of Anxiety and Depression During Pregnancy

Anxiety and depression during pregnancy require medical attention. But deciding how to treat them in pregnancy is a real challenge, particularly in more severe cases. Together, with help from a health care provider, you will come up with the best approach for your care.

Non-medicinal approaches

ACOG suggests the following treatments for mild to moderate anxiety and depression during pregnancy:

• Psychotherapy, such as cognitive behavioral therapy (CBT), in which a skilled therapist teaches new approaches to managing thoughts and emotions
• Getting enough sleep
• Healthful eating
• Light exercise

What’s more, a February 2019 study reported that the prenatal folate supplement EnBrace HR may effectively prevent depression during pregnancy. The results, published in Annals of Clinical Psychiatry, found that those taking EnBrace HR experienced lower rates of depressive relapse. While the study shows potential, larger controlled trials are needed.

A 2021 review study examined the possible benefits of taking various nutritional supplements or consuming certain foods (often called nutraceuticals) for depression treatment and prevention. It found that omega-3 fatty acids, vitamin D, SAMe, and methyl folate have the most proven effects. However, the study authors acknowledge that nutraceuticals are best used as supportive therapies for major depressive disorder alongside standard treatments.

Antidepressants and anti-anxiety medication

Medication is usually the most effective method for treating anxiety and depression. However, many health care providers and pregnant people are afraid of the medications. The main concern is that most drugs have never been tested on pregnant people, so doctors are unsure of their effects on unborn babies.

The most commonly prescribed options include Wellbutrin and selective serotonin reuptake inhibitors (SSRIs) such as Zoloft, Prozac, Lexapro, and Celexa. According to NIMH, the risks of birth defects and other problems from antidepressants during pregnancy are low. However, working with a health care provider is important to determine which is safest.

Some studies show the following risks:

• Preterm birth and low birth weight (similar to rates of pregnant people with untreated depression)
• Neurodevelopmental disability (and possibly with autism spectrum disorder)
• Short-term effects like fussiness and poor feeding

On the other hand, other studies have not found evidence that antidepressant use in pregnancy is a risk factor for neurodevelopmental disorders, including autism, ADHD, learning disorders, or developmental disorders.

You and a health care provider need to weigh the benefits of antidepressants against the risks.

If you’re currently taking medication for depression or anxiety, consult your psychiatrist before you stop. A 2022 study found that people who stopped taking antidepressants during pregnancy had an increased risk of a psychiatric emergency.

Finding Support and Specialists

If you’re pregnant and have depression or anxiety symptoms, talk to an OB-GYN or midwife. They should be able to treat you directly or connect you with the appropriate mental health care provider. These organizations can also offer confidential help:

Postpartum Support International will connect you directly to a local coordinator who can help you find local resources, offer support, and give tips on managing mood and anxiety disorders during and after pregnancy.

The MGH Center for Women’s Mental Health offers credible information on the risks of untreated depression during pregnancy and evaluation and treatment options.