What you need to know about anxiety and depression during pregnancy

Many develop anxiety and depression at some point during their pregnancy. Throughout the entire perinatal period, approximately one in five people, or up to 20 percent, will develop a mood disorder such as anxiety or depression. Many doctors suspect that because many mental health conditions go unreported due to stigma, that number may be much higher.

Though there are certainly risk factors that can increase a pregnant person's risk for anxiety or depression, such as family history or traumatic life events, all who are pregnant are at risk for developing mental health issues.

All of the physical and emotional changes people undergo throughout pregnancy can feel challenging and overwhelming and trigger underlying anxiety and depression disorders.

Here's what to know about anxiety and depression during pregnancy:

What causes anxiety and depression during pregnancy?

There are a mix of contributing factors that may cause someone to experience signs and symptoms of anxiety or depression during pregnancy.

Ashlyn Torres, LCSW, a licensed clinical social worker with Main Line Health's Women's Emotional Wellness Center, says pregnancy as a whole puts people at risk for anxiety or depression. "There are many contributors to pregnant women developing depression and anxiety. Not only are there the obvious hormonal shifts, but there is an array of other factors, as well. These can include but are certainly not limited to: not feeling well physically (nausea, fatigue, general discomfort); excessive worrying about what is "normal" in pregnancy, the constant flood of information about what one should/should not be doing to ensure a healthy pregnancy; stress and worry about the unknown; questioning what to expect in pregnancy and childbirth; lack of social supports, financial stress, etc." All these thoughts and feelings are completely normal and to be expected at such a pivotal time in one's life. However, symptoms become classified as depression and anxiety when most areas of the pregnant woman's life are affected for most of the day, every day, for a period of two or more weeks.

Some who are pregnant might feel as though their expectations of what pregnancy is supposed to feel like doesn't line up with what it actually feels like. "A lot of times we've created this idealistic version of what a pregnant mom looks like and what it is to be a mom after you deliver, and sometimes your expectations don't necessarily fall in line with reality," says Dr. Preethi Rajendran, an OB/GYN with Main Line Health. Over time, this can cause underlying anxiety and depression.

If one has struggled with mental health issues in the past, there is an even greater risk of them developing similar symptoms in pregnancy. Individuals are also at a higher risk of developing postpartum depression and anxiety, both if they have a history of mental health issues or if they developed these symptoms in pregnancy. Many individuals are fearful of disclosing that they are feeling this way, and this can affect them receiving help and support during this trying time. Society has painted pregnancy as a joyous experience, but this is not always the case with many women. Fortunately, there is help available. Though these factors increase a person's risk, even those with no history of anxiety or depression can develop a mental health condition during pregnancy. "It's common that it arises in pregnancy," Rajendran says.

Signs of depression and anxiety during pregnancy

The symptoms and signs of depression and anxiety during pregnancy are essentially the same as those of anxiety and depression outside of pregnancy.

This includes restlessness and "excessive worrying that's difficult to control or that has an impact on your life, so it's prohibiting you from doing your day-to-day activities or accomplishing things you want to accomplish," Rajendran says.

Some signs and symptoms of depression and anxiety in pregnancy can include excessive worrying about parenthood or childbirth, lack of energy, sleep disturbances, isolation, lack of interest in yourself/pregnancy, feelings of emotional detachment, and chronic anxiety. Some of these symptoms can appear like typical pregnancy symptoms, but when they are excessive, this may be a sign that it is something more significant.

How can anxiety and depression impact the baby's and mom's health?

Anxiety and depression can influence pregnancy outcomes in a few different ways.

A pregnant parent with anxiety or depression faces a higher risk of pre-term delivery. Their babies also have a higher chance of being smaller for their gestational age and tend to have a lower birth weight. Pregnant people with anxiety or depression are also less likely to exercise, eat well, or engage in prenatal care. They're also more likely to use substances like drugs and alcohol.

Anxiety and depression during pregnancy is one of the biggest risk factors for postpartum depression. "When a parent struggles with things like postpartum depression, that can have an impact on ability to bond with the baby and also have an impact on the baby's long-term development," says Torres.

In general, most postpartum parents and their babies do fine, according to Rajendran. "Mental health is just as important as your physical health," she says. The two are intrinsically linked and can significantly affect one another.

How do you cope with feelings of anxiety and depression during pregnancy?

If you've been feeling anxious or depressed during your pregnancy, the most important step is to seek out help as soon as possible. "Women could benefit from being connected to a perinatal mental health professional as soon as they are seen for prenatal treatment as a precaution despite whether they are experiencing symptoms or not. This way they are connected in the chance that they do begin to feel depressed or anxious. It is important for women to feel connected, validated and supported. Having a professional support can do just this. Some of the treatment options available are individual therapy, support groups, group therapy, and psychiatry. Women don't have to suffer alone. By taking care of yourself, you are better able to take care of your baby. Perhaps the rates of postpartum depression would decrease if women sought help during pregnancy or sooner, " says Torres.

Your OB/GYN is a great first resource. Psychotherapy, which can be conducted in either an individual or group setting with a therapist or psychiatrist, can also help you work through your symptoms. "Being with others who are also going through a similar experience with being pregnant and what that means can be really, really effective," says Torres.

Rajendran recommends keeping a journal in which you can write down how you're feeling each day. This can help you determine whether your feelings of anxiety and depression are impacting your quality of life and preventing you from functioning throughout the day. There are also medication options that are safe and effective for those suffering from anxiety or depression in pregnancy.

Prioritizing self-care by maintaining healthy sleep, diet, and exercise routines and building a strong support system can also combat feelings of anxiety and depression. Your support system doesn't necessarily have to be a professional therapist; it can be friends or family members who you feel comfortable relying on and opening up to.

"Every pregnant person, no matter what, should do their best to take care of themselves, because by taking care of themselves they're going to be taking care of their baby, too," says Torres.

Next steps:

Meet Ashlyn Torres, LCSW
Meet Preethi Rajendran, MD
Learn more about the Women's Emotional Wellness Center
Learn more about the Obstetrics/Gynecology at Main Line Health