When depression and/or anxiety start during pregnancy it is called antenatal depression or anxiety.
Approximately 1 in 5 women and 1 in 10 men experience depression and anxiety sometime in the perinatal period—that time during pregnancy and up to 12 months after birth. 
It can be a reaction to the pregnancy itself, for example if the baby is unplanned or unwanted, or due to health issues the mother has such as persistent nausea, or due to other major life stresses such as serious relationship problems. Medical assessment is necessary in such circumstances.
If you experience such symptoms it is recommended that you seek early assessment by a health care professional so that steps can be taken to provide you with appropriate support or treatment.
Therapy during pregnancy can reduce your chance of developing postnatal depression dramatically. Putting in place a support network of family, friends, doctor, midwife, counsellor and support groups before the birth will make the period following birth much easier.
Emotions in the pregnancy trimesters
Pregnancy is a time when there are many expectations about how you should feel, “you must be so happy” … “how exciting for you”. The physical changes of pregnancy are accompanied by many emotional changes and for some people emotional distress. You may be experiencing some uncertainty about the timing of the pregnancy, it may mean that career or long-term goals will be delayed or create financial problems.
Feeling uncertain about your new role as a parent, fears about the pregnancy or how you will cope with labor and delivery, may add to feeling guilty about being unhappy, because everyone expects you to be content. These emotions are not unusual, and are part of the common changes in emotion associated with each trimester.
Mood swings tend to be most pronounced in the first 12 weeks of pregnancy, alongside the many physical changes such as fatigue, morning sickness, nausea, vomiting, and breast tenderness. Emotions can be unstable, and feelings of low mood are not uncommon. These mood swings can range from great joy to deep despair. Sometimes you may become tearful without knowing the cause. It is commonly believed that changes in the hormones oestrogen and progesterone contribute to the mood changes early in pregnancy.
The second trimester is generally less turbulent. Morning sickness generally passes and worries about miscarriage tend to lessen. From about the 20th week of pregnancy you might be able to feel the baby move and this realization that the baby is real can bring about excitement about the pregnancy. There is often an increase in energy and wellbeing in the second trimester.
The third trimester often brings anxiety about the birth, especially if there has been a difficult birth previously or if this is your first child and you don’t know what to expect.
During the final weeks of pregnancy these anxieties and fears may increase. You might also be concerned about the reality of becoming a mother and changes in relationships with your partner and family. You may experience sleeplessness, and it may be difficult to find a comfortable position. You may feel particularly vulnerable to rejection, loss or insult at this time. There will also be warm feelings that can be very uplifting.
Symptoms of Antenatal Depression
For about 10% of pregnant women these emotions experienced during pregnancy can become overwhelming and hard to shift. They are different from the usual emotional changes if they last longer than two weeks and interfere with the pregnant woman’s ability to function in everyday life. Antenatal depression is often overlooked because it is hard to identify and it is less well understood than postnatal depression.
You may be experiencing antenatal depression if you experience:
- Inability to concentrate and difficulty remembering.
- Difficulty making decisions or achieving everyday tasks.
- Anxiety and panic attacks.
- Feeling emotionally numb.
- Extreme irritability.
- Avoiding family and friends.
- Sleep problems.
- Extreme or unending fatigue.
- A desire to eat all the time or not wanting to eat at all .
- Weight loss or weight gain not related to pregnancy.
- Loss of interest in sex.
- A sense that nothing feels enjoyable or fun anymore.
- Feeling like a failure, feelings of guilt and hopelessness.
- Persistent sadness.
- Thoughts of death or suicide.
- Thoughts of wanting to harm your baby.
Factors that can contribute to antenatal depression
Pregnancy hormones may contribute to the emotional ups and downs that affect all pregnant women. Other factors can contribute to the development of depression during pregnancy.
- Family or personal history of depression. If depression runs in your family, or if you have had past episodes yourself, you may be more likely to become depressed.
- Discontinuing prescribed medication. There can be a worsening of symptoms if you discontinue taking medication for pre-existing mental illness because of the pregnancy, especially if stopped suddenly.
- Relationship difficulties. Difficulties between you and your partner or you fearing a lack of support when your baby is born, can have a major impact on your emotional wellbeing.
- Stressful life events. Any major life change, such as a move to a bigger home in anticipation of your baby’s arrival, divorce, job loss or death in your family can contribute to depression.
problems with the pregnancy.
- A troubled pregnancy with a lot of medical monitoring or illness such as severe morning sickness or pain can take its emotional toll.
- Infertility or previous pregnancy loss. If you experienced difficulties getting pregnant, or have had a miscarriage or stillbirth in the past, you may find yourself worrying about the safety of this pregnancy.
- Unplanned or unwanted pregnancy. The timing of the pregnancy may cause significant stress if not part of the plan or relationship with the father.
- Past history of abuse. Pregnancy can trigger painful memories in women who have survived emotional, sexual, physical, or verbal abuse.
- Health issues for either you or the baby during pregnancy.
- Lack of social support. Feeling unsupported when you are facing the changes that parenthood will bring and social isolation can contribute to depression.
- Financial difficulties. Financial problems can significantly increase the amount of stress you feel during pregnancy.
Effects of antenatal depression on the baby
There is a growing body of research which indicates that a stressed, anxious or depressed woman is not ideal for her baby during pregnancy. Changes to the baby’s heart rate and its responses to stress are thought to result from severe and untreated antenatal depression, however more research is needed.
Consideration for the wellbeing of the baby needs to be given when making decisions about the treatment of antenatal depression to avoid these impacts.
Treatment of antenatal depression
Early treatment of depression and anxiety is the most effective path to recovery. Don’t put up with your feelings for too long as it can get harder to shift them the closer the day of delivery approaches.
- Take it easy. You don’t need to need to set up the nursery, clean the house, or work as much as you can before you go on maternity leave. Make some time for yourself, read a book, have breakfast in bed, or go for a walk. If you already have children, arrange for family or friends to look after them and have some time to yourself.
- Eat well and exercise. Taking care of yourself is an essential part of taking care of your baby. It can be hard to eat well or exercise when you feel sick and uncomfortable. Try small frequent meals throughout the day and regular walking, swimming or antenatal yoga or Pilates.
- Include your partner if possible. Your partner might be able to detect that you have changed, even before you realise or admit that something is wrong. They are likely to be worried about the pregnancy and how life will be after the birth, alongside their concern for you. Communicate with them, you need their support, and they can only provide support if you’re open with them. Encourage them to find out about antenatal depression and involve them in supporting you.
- Talk about how you are feeling. Give your friends and family the opportunity to be supportive by talking to them about your fears and worries. Once you start talking you will be surprised how many people have had similar experiences. Involve them in planning your supports for after the baby is born.
- Inform your midwife and doctor. Tell the people who are caring for you during your pregnancy about your thoughts and emotions as they can help you to understand what is happening and monitor and support you.
- Seek counselling or see a psychologist. If you’ve tried to work through things on your own but nothing seems to work, seeing a psychologist or counsellor will help. You need to find someone you feel safe with, and whom you can trust.
- Antidepressants. You may benefit from antidepressant medication especially if the wellbeing of you and the baby is at risk. It is understandable that you would be hesitant to take medication during your pregnancy but there are some antidepressants which are safe for pregnant women. Talk to your doctor or midwife about the possibilities.
- Find out about postnatal depression. It is not automatic that you will develop postnatal depression but it can happen, and it is important to know what to look for if your emotions continue after the birth of your baby. Your midwife and doctor need to be aware of how you are feeling so they can help you find the supports you need.
- When you need to seek help quickly. If you are feeling suicidal phone your state’s Mental Health Line which operates 24/7. If it is an emergency phone Triple-0. If you feel disoriented, unable to handle daily life or if you’re having panic attacks, talk to your doctor or midwife immediately. Seeing a counsellor, psychologist or psychiatrist is not a sign of weakness. It’s a sign that you are taking the steps necessary to keep yourself and your baby safe and healthy.
Where to get information and support
1300 22 4636
Post and Antenatal Depression Association Inc (PANDA)
1300 726 306 (Mon – Fri 9am – 7:30pm EST)
– written by forum member MuminMind using info from PANDA and the Blackdog Institute
For more information on anxiety and depression in pregnancy and parenthood
visit our perinatal and postnatal depression and anxiety info hub