What It's Really Like to Feel Depressed During Pregnancy

When I found myself pregnant for the second time—with a baby my husband and I very much wanted—I couldn't feel excited. It all happened so quickly that it caught me off-guard.

I'd expected months of trying to the point that I'd be desperate, so sure and clear of what I wanted, the way it had been the first time around. Instead, I found myself experiencing prenatal depression (also called perinatal depression). Read on to learn what having depression during pregnancy was like, how to identify the signs of prenatal depression, and how to cope if you experience it.

A Recipe for Depression

Life stressors plus the physical and emotional toll of parenting likely collided to create a perfect recipe for perinatal depression—a depression that is experienced both pre- and post-partum. Perinatal depression affects 10% to 20% of pregnant people in the US.

According to the National Institute of Mental Health, perinatal depression is caused by a slew of things, including genetics, stress, and physical and hormonal changes.

Stress and uncertainty

During this pregnancy, I felt lonely and scared. My life felt uncertain.

Having left full-time employment after the birth of my daughter, I had been working on a freelance career as a novelist and journalist. But now that new career already felt like it was over.

And then there was my other job—motherhood. How would I cope with that when this new baby came?

I was getting the hang of this motherhood business with one, but would two push me over the edge? Undo me? I'd thought of this before, hypothetically, but now that it was real, it was suddenly a lot more daunting.

All this, of course, was mixed with the fact that I could no longer enjoy a glass of wine and couldn't tell anyone how bad I was feeling without first telling them the happy secret that was making me so very unhappy. I didn't want to share my news too far and wide for fear of a miscarriage and having to go back to everyone and tell them the bad news.

Physical changes

My body was heavy, tired from insomnia that kept me awake from 3 until 7 in the morning. I was exhausted from the constant vomiting and bloated from all the eating, which fended off unrelenting nausea. I also felt invaded, bruised, and bombarded by all the appointments with hematologists, gynecologists, midwives, doctors, and nurses.

I felt sick all day and woke up to be sick or eat during the night. I vomited in public on street corners, at roundabouts, beside parked cars, in the bin, in basins, in the toilet, and in the sink. Some studies have found an association between morning sickness and higher rates of anxiety and depression. No wonder, then, that emotionally, I was even worse: delicate, jumpy, tearful.

I wanted so much to feel happy and joyous and lucky because I knew I was all those things, yet I couldn't quite get a hold of the emotions.

The uncertainty of my life, body, and future was a burden. So, too, was the worry for this precious life I was carrying, so fragile and delicate in its early weeks, and for which I needed to inject myself with a blood-thinning medication in the stomach every day to avoid a clot, in myself and the baby. It's confusing when the very thing you feel most protective of is also a thing you fear.

I Knew I Was Depressed

During my first scan, they took my blood pressure three times because it was so high. For three months, I had been preparing myself for the worst and the best. When I found out my baby was alive and saw its small head, arms, and legs, the tiny, pulsing dot of a beating heart, I finally felt joy. But the joy was brief because so many other emotions crowded it out.

I hid my emotions from my husband, from myself even. It was only the next day, at a painful glucose test when the needle caught the vein, that the tears began to flow, unstoppable. In the bathroom, they dripped onto my beige shoes, making brown splashes.

I was raw with relief and spent emotionally and physically. I imagined telling my children about what I might have been as if I would now not get the chance because, in my mind, I would never work again. I wouldn't be who I wanted to be because I had taken the path of motherhood. It seemed final, a done deal.

Susan Ayers, PhD, a health psychologist and cognitive behavior therapist leading the Center for Maternal and Child Health Research at the City University of London, co-wrote a paper with Amy Delicate, PhD, on recognizing perinatal mental health. In it, they describe mental health and illness as "a continuum from positive mental health to severe illness."

I don't know where I was on that continuum, but I know I was on it.

Signs of Prenatal Depression

Depression during pregnancy can be hard to pin down because symptoms often cross over with hormonal and mood changes that also take place. The National Insitute of Mental Health lists the following symptoms for perinatal depression:

• Persistent sadness
• Restlessness
• Irritability
• Fatigue or energy loss
• Loss of interest in activities that usually bring you joy
• Trouble concentrating
• Sleeping too much or too little
• Body aches
• Fear about the inability to bond or care for a new baby
• Feelings of guilt or worthlessness
• Change in eating habits
• Recurring thoughts of hopelessness, suicide, or death

Thankfully, I didn't experience my symptoms for too long. I edged forward. I decided to tell people I was pregnant before the cautionary 12-week mark, and I told them what I was going through.

Coping With Prenatal Depression

Sharing made me feel better, lighter. I educated myself on perinatal depression and knew I wasn't alone. I wrote about it and was gentle with myself, the way I would be with a friend: kind. I allowed space for this huge mixture of emotions. I also let my husband take care of me. I let him wrap me in love and care, and I took all the cuddles my daughter offered because she, too, could see I wasn't well. I exercised and signed up for Pilates. I went to therapy.

Treatment for perinatal depression is the same as for non-pregnancy-related depression: psychotherapy and medication. While you may be afraid of taking antidepressant medication while pregnant, rest assured plenty of pregnant people do.

Research shows that selective serotonin reuptake inhibitors (SSRIs) do not increase the risk of birth defects. However, research is still ongoing on other types of antidepressants. Since untreated depression can be harmful to you and your fetus, the key is to evaluate the risks and benefits when deciding on treatment. So, talk to a health care provider about your pregnancy and depression to find the best treatment for your situation.

What I Learned

I have learned to appreciate what I have right now, not to worry so much about the what ifs, about tomorrow, about next year. I've adopted the phrase, "We'll cross that bridge when we come to it." No point lying awake working out what I'll do in two years when it's still two years away.

I have delicate days when I have fewer spoons—to borrow from Christine Miserandino's spoon metaphor on depression. This analogy describes the reduced amount of mental and physical energy available for productive tasks when you have a disability or chronic illness (though I don't pretend to have either).

On harder days, I take extra special care of myself. And I know tomorrow will be another day.