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Written by Nikolina Miljus our resident psychologist.
We know that many women experience depression during pregnancy, but what are the best treatments?
Medication, alternative therapies, talk therapy, or something else?
Depression in pregnancy is incredibly common. As many as 1 in 10 women [1] will experience symptoms severe enough to be diagnosed as prenatal or antenatal depression.
If you’ve experienced depression in the past you’re more likely to experience depression during pregnancy as well.
For other women, depressive symptoms appear for the first time during pregnancy.
Let’s look at a couple of common scenarios and the types of treatment options that are most effective at relieving depression in pregnancy according to the latest research:
Scenario 1: “I’m Already Taking Antidepressant or Anti-anxiety Medication”
With 1 in 8 women in the US taking an antidepressant or anti-anxiety medication, it’s very common for women to fall pregnant while taking meds.
The temptation may be to suddenly stop taking your medication for fear of its effects on baby, but that is not the best idea.
You could suffer some serious side effects and end up feeling a lot worse. That wouldn’t be good for you or baby.
What we’d recommend is going to see your doctor or psychiatrist as soon as possible to discuss your treatment options.
These are the most common options when it comes to medication:
- You may be advised to continue to take your current medications, especially if they are the SSRI type of antidepressant. (Unless you are taking Paxil in which case you will likely be switched to another, safer medication)
- You could be guided to taper off gradually and encouraged to go drug free throughout your pregnancy. In fact this may be the route you prefer too. If so, see the recommendations for other ways to deal with depression below.
- Your doctor may want to switch you over to a different medication.
Scenario 2: “I’m Not Usually Depressed But I Feel Depressed Now I’m Pregnant”
Prenatal depression is not a condition most moms-to-be are familiar with but it is very common.
Are you experiencing changes in your appetite, sleep patterns or your sex drive, together with fluctuations in your mood and emotions ranging from frequent crying, irritability or lack of emotion and feeling unhappy?
You could well be suffering from prenatal or antenatal depression.
There are other potential symptoms too like emotional numbness, worrying or constant crying or feelings of shame and guilt. Those last two might discourage you from getting help but please be assured that no one is going to judge you for what is a very common condition in pregnancy.
If you are experiencing intense negative emotions or are feeling unhappy for two weeks or more, you should talk to your doctor as soon as possible. The sooner you start treatment the better.
Most Effective Treatments for Depression in Pregnancy
The treatments for depression in pregnancy outlined below are up to 90% effective [2].
There are a range of practical treatments available and choosing the right treatment for you depends on how severe your symptoms are and how risky the treatment might be for your baby.
Some treatments are completely safe for your baby while others can carry a potential risk on both fetal development and baby’s health in the future.
However, untreated depression during pregnancy also carries certain risks, so every mom needs to evaluate the best treatment options for her with the help of her doctor or psychiatrist.
Here is an overview of the best treatments for depression in pregnancy, starting with the ones that are completely risk-free for the baby.
1. Lifestyle Changes
If you are experiencing mild to moderate depressive symptoms during pregnancy, maintaining a healthy lifestyle can be enough to help you cope with them.
Depression during pregnancy can lower your energy levels and make it difficult for you to eat properly and exercise but if you can manage it they will make a lot of difference.
You can also try practicing these lifestyle changes proven to help with depression during pregnancy:
- Taking Supplements
Alongside prenatal vitamins, supplements like omega-3-fatty acids, iron [3], vitamin D3 and zinc [4] decrease the likelihood of depressive symptoms in pregnancy. - Exercise
While you may not feel like it, making sure you get some regular physical activity such as walking, jogging, swimming or moderate cardio will make you feel a whole lot better. That’s because your brain produces the “happiness hormones” called endorphins when you exercise and these help relieve depressed feelings. - Alternative Treatments
Some studies have found that Eastern practices like acupuncture, yoga or meditation can be beneficial for depression in pregnancy while being completely safe for your baby.
IMPORTANT: You should avoid herbal medications often used for depression and anxiety such as St. John’s Wort during pregnancy.
2. Social Support
Something that is often overlooked, but can make a real difference to depression in pregnancy, is the opportunity to share feelings and be acknowledged by our partner, close family or wider social circle.
Even a simple act of talking to another person about how you’re feeling can help you to regulate your emotions more effectively.
Sharing your feelings with your midwife, doula or doctor is often the first step.
They’ll have worked with many women who’ve experienced the same symptoms as you, so they won’t be shocked or surprised to hear you’re feeling depressed.
They’ll be able to point you in the right direction in terms of local support groups available for moms-to-be who are experiencing the same issues you are.
And if you live in a small community and there’s not much support around then there are online organizations that can help.
Realizing you are not alone and that your depression symptoms are pretty common can make a huge difference in how you feel.
3. Psychotherapy or Counseling
The main benefit of psychotherapy (talk therapy or counseling) is that it’s completely risk-free to your baby.
The most effective forms of psychotherapy for depression in pregnancy are cognitive behavioral therapy (CBT) and interpersonal psychotherapy (IPT).
Both of these approaches are evidence-based and focused on providing relatively fast relief (12-16 weeks).
CBT is a very practical approach focused on helping moms-to-be to change the way they think about their emotions and learn the skills to manage depression symptoms more effectively.
IPT focuses on personal relationships and helping you to successfully transition to the new role and directly tackle the challenges brought on by pregnancy.
This approach is especially beneficial for women who’ve experienced past pregnancy-related losses.
4. Medications
When depression symptoms are too severe or psychotherapy treatment is not effective, your doctor or mental health professional might suggest medication treatment with antidepressants.
Antidepressant treatment can be an addition to psychotherapy or a standalone therapy.
Moms-to-be who are feeling depressed often worry that the medications might harm the fetus and newborn baby’s health.
While most babies will be ok, those worries are not unfounded.
The latest research shows an increase in birth defects in women taking certain SSRI medications during the first trimester.
When it comes to choosing the right antidepressant treatment for you your doctor or psychiatrist will carefully evaluate the risks of untreated depression against the potential risks for the baby.
The common risks associated with taking antidepressants during pregnancy are low birth weight and preterm labor.
Complications directly tied to the labor such as post-delivery hemorrhage are also more likely.
Still, the risks of untreated depression during pregnancy can be even higher.
The chances for any complications decrease if the medication treatment starts after the first trimester.
By this point, the essential organ formation is mostly complete.
Most mental health professionals will usually look to start tapering you off antidepressants before the end of the third trimester when possible.
This is so that your newborn baby does not experience any neonatal withdrawal symptoms.
Risks of Leaving Pregnancy Depression Untreated
Depending on the severity of depression during pregnancy, the risks of untreated depression can be very high [5], especially for moms who experience suicidal thoughts or engage in self-harming behavior.
Untreated depression during pregnancy contributes to higher risk for miscarriage, preterm labor, low baby birth weight, and postnatal depression.
Depression can also make it more likely that mom will not be able to provide adequate prenatal care because her symptoms might be stopping her from eating properly and taking adequate supplements.
It could also drive her to smoke, drink alcohol or use drugs.
For mild to moderate depression in pregnancy, choosing healthier lifestyle options or just finding adequate social support can be enough to help you manage your depressive symptoms.
In moderate and severe cases, treatments of choice are psychotherapy and medication treatment alongside antidepressants.
Whatever route you decide to take please be assured that getting the right support will help.
If you have any questions or need further advice, please feel free to leave a comment below or ask us a question by hitting the red button at the top of the page and someone will get back to you.
Additional Sources
1.Perinatal mental illness: Definition, description and aetiology
Michael W. O’Hara, Katherine L. Wisner – Psychiatry and Behavioral Sciences
2. Diagnosing and Treating Depression During Pregnancy
Christina L. Wichman, DOcorresponding author and Theodore A. Stern, MD
3.Iron Deficiency and Risk of Maternal Depression in Pregnancy: An Observational Study.
Dama M1, Van Lieshout RJ2, Mattina G2, Steiner M3.
4.Effects of Zinc Supplementation in Patients with Major Depression: A Randomized Clinical Trial
Elham Ranjbar, MS,1 Masoumeh Sabet Kasaei, PhD,corresponding author2 Minoo Mohammad-Shirazi, MD, PhD,1 Javad Nasrollahzadeh, PhD,1 Bahram Rashidkhani, PhD,1 Jamal Shams, MD,3 Seyed-Ali Mostafavi, MSc,4 and Mohammad Reza Mohammadi, MD4
5.Prenatal Depression Effects and Interventions: A Review
Tiffany Field,1,2 Miguel Diego,1 and Maria Hernandez-Reif3
Antidepressant Use During Pregnancy: Current Controversies and Treatment Strategies
Jennifer L. Payne, M.D.1 and Samantha Meltzer-Brody, MD, MPH2
Omega-3 Fatty Acids and Depression: Scientific Evidence and Biological Mechanisms
Giuseppe Grosso, 1 ,* Fabio Galvano, 1 Stefano Marventano, 2 Michele Malaguarnera, 1 Claudio Bucolo, 1 Filippo Drago, 1 and Filippo Caraci