Why do depression and anxiety occur in pregnancy and what are the symptoms? Learn ways to protect your mental health while pregnant and when to seek support.
Pregnancy is often described as one of the happiest times in life. Amid the congratulations from those around you, the preparations for the nursery and sentences like "Now you're living the best days of your life," if you are carrying very different feelings inside, you may feel alone and guilty. Yet depression during pregnancy and anxiety are far more common than people assume and need to be taken seriously. Feeling sad, anxious or exhausted while pregnant does not mean you cannot be a good mother. In this article I will try to explain how depression and anxiety in pregnancy can be recognised, why they can arise, how they differ from normal mood swings, and what you can do to support your mental health during this time.
What Is Depression During Pregnancy?
Depression during pregnancy is a mood problem that appears during pregnancy and involves a low mood lasting almost every day for at least two weeks, together with loss of interest and pleasure and other accompanying symptoms. Specialists look at pregnancy and the postpartum period together and use the term "perinatal period." This is because in some women who experience postnatal depression, the symptoms actually began during pregnancy.
While postnatal depression is talked about more in society, depression in pregnancy is often overlooked. One reason is that some symptoms, such as tiredness, changes in sleep and differences in appetite, are confused with the natural effects of pregnancy. The other reason is that the expectation that "a pregnant woman should be happy" makes it harder for expectant mothers to voice what they feel. If you are curious about the period after birth, you can look at the article on postnatal depression.
What Are the Symptoms of Depression and Anxiety in Pregnancy?
Mood swings in pregnancy are quite common. Hormonal changes, physical complaints and life preparing for a major change can increase the urge to cry and sensitivity. But if the symptoms below have been going on for a long time and clearly affect your life, they need a careful look.
Signs linked to depression
- A feeling of sadness, emptiness or hopelessness lasting most of the day
- Disinterest in things you used to enjoy and in preparations for the baby
- Intense feelings of guilt and worthlessness: "I'll be a bad mother"
- Loss of energy beyond the expected effects of pregnancy
- Marked difficulty concentrating and making decisions
- Withdrawing from people, isolating yourself
- Pessimism about the future
Signs linked to anxiety
- Uncontrollable, constantly repeating worries about the baby's health
- Intense fear of giving birth
- Constantly checking physical symptoms, frequently searching online
- Restlessness, tension, difficulty falling asleep
- Sudden surges of panic, palpitations, shortness of breath
- Unwanted, distressing and recurring thoughts
How it differs from a normal mood swing
Crying, worrying or feeling low from time to time in pregnancy is natural. The difference usually lies in these points: Have the symptoms lasted more than two weeks, do they continue for most of the day, and do they clearly affect your daily life, your relationships or how you look after yourself? If your answers to these questions are yes, talking to a professional can be a good step. These symptoms on their own do not amount to a diagnosis.
What Causes Depression During Pregnancy?
Depression in pregnancy does not have a single cause. Usually biological, psychological and social factors come together.
Biological changes
Pregnancy is a time when rapid and major hormonal changes take place in the body. These changes can affect mood. In addition, physical complaints such as nausea, sleep problems, pain and tiredness can strain emotional resilience. Because some physical conditions, such as thyroid problems, can also affect mood, medical follow-up is important.
Past experiences
Having experienced depression or anxiety before can increase the likelihood of these problems appearing in pregnancy. Previous pregnancy losses, a difficult birth experience, or a long and wearing IVF process can also lay the ground for intense anxiety at this time. I covered the psychological effects of these experiences in more detail in the article on pregnancy loss.
Relational and social factors
Not receiving enough support from a partner and those close to you, ongoing conflict in the relationship, an unplanned pregnancy, living alone, or being in a city far from family are among the risk factors. Economic hardship is also an important burden. In this period of continuing high cost of living, birth costs, a baby's needs and uncertainty about returning to work after maternity leave can be serious sources of worry for many families.
Cognitive factors
High expectations such as "I must be a perfect mother" and "I must be able to control everything" can increase anxiety and guilt when they meet the uncertainties of pregnancy. Pregnancy is a time when many things happen that a person cannot control, and people with a high need for control may struggle more in this situation.
Pregnancy and Mental Health in Turkey: Unseen Burdens
In our culture, pregnancy is a process in which the extended family is also closely involved. This interest can be a great source of support, but it can sometimes become a burden. Comments such as "Don't eat this, don't do that," "It wasn't like this in our day" and "Is it a boy or a girl?", along with constant advice and expectations, can make it hard for the expectant mother to find room for her own feelings.
There is also the expectation to "be grateful." Women who have waited a long time for a child, or who have had IVF treatment, in particular may meet the reaction "You wanted this so much, why are you unhappy now?" when they say they are struggling in pregnancy. This reaction leads to hiding feelings and carrying them alone. Yet wanting something very much does not prevent you from feeling its difficulties.
Imagine a woman pregnant with her first child who, at family gatherings where everyone talks about this time with a smile, cries when she is alone at night and cannot tell anyone. She asks herself, "What kind of mother am I that I can't feel joy?" What this woman is experiencing is not a character flaw but a sign of a need for support.
Saying you are struggling in pregnancy is not ingratitude; it is an act of care towards yourself and your baby.
Expectant fathers can struggle too
During pregnancy it is not only expectant mothers but also expectant fathers who can experience intense anxiety and low mood. The thought that financial responsibility will grow, changes in the relationship and the expectation of "I have to be strong" can make it hard for men to voice their feelings. Tension and withdrawal in an expectant father often show up as irritability, burying himself in work or coming home late. When a couple notice each other's difficulties and can talk about them as a shared matter rather than a source of blame, this period becomes more bearable for both.
Fear of childbirth is also a subject often talked about at this time but frequently not addressed enough. A previous difficult birth, frightening stories heard, or mistrust of the health system can feed this fear. Talking about your questions on childbirth with your doctor and midwife, getting information about the birth process and working through your fears with a professional can help make this anxiety manageable.
What Can You Do to Support Your Mental Health in Pregnancy?
The suggestions below are no substitute for professional support, but they can help you take good care of yourself at this time.
1. Put names to your feelings
In moments during the day when you are struggling, ask yourself: "What am I feeling right now? Fear, sadness, anger, tiredness?" Putting a name to a feeling makes it a little more manageable. Keeping a short feelings journal helps you see which situations are hardest for you. For example, you may notice that your feelings intensify in the days before certain family visits or doctor check-ups, or after sleepless nights. This awareness helps you prepare for those moments in advance.
2. Set a worry time
If worries about the baby's health occupy your mind throughout the day, set a fifteen-minute "worry time" each day. When a worry comes during the day, make a note of it and tell yourself, "I'll think about this at five o'clock." At the time you have set, look at your notes; separate those you can do something about from those outside your control. For worries within your control, prepare concrete steps, such as a list of questions to ask your doctor.
3. Limit internet searching
Searching online at every new physical sensation often increases anxiety. Try writing the questions on your mind in a notebook and asking them at your next doctor's check-up. When you think there is an emergency, go straight to a health facility.
4. Define your support network
Draw three columns on a sheet of paper: Who can I open up to emotionally? Whom can I ask for help with practical things? Whom can I turn to for information? This list makes it easier to know who to reach out to at a difficult moment.
5. Communicate openly with your partner
Pregnancy is a transformation the couple go through together. It is important to share your feelings and needs with your partner and to ask them for concrete support. Concrete requests such as "If you make dinner in the evenings I can rest a little" are met more easily than "Support me more."
6. Be gentle with your body
Light walks to the extent your doctor considers suitable, regular meals, as regular sleep as possible and short rest breaks during the day can support your mood. Slow breathing exercises help calm the body, especially at moments when anxiety rises.
7. Give yourself permission to set boundaries
You can be kind but clear towards comments and advice that do not do you good: "Thank you for your suggestion, I'll talk to my doctor and decide." You do not have to answer every question or accept every visit.
When Should You Seek Professional Support?
Support from a professional is important in the following situations:
- If sadness, hopelessness or loss of interest has lasted more than two weeks
- If anxiety and worries clearly affect your daily life and sleep
- If you find it hard to take care of yourself, to eat or to go to medical check-ups
- If you experience intense fear attacks like panic attacks
- If you have had depression or anxiety before and notice the symptoms returning
- If thoughts of harming yourself or the baby cross your mind
If you have thoughts of harming yourself or do not feel safe, please call 112 (emergency services) without delay. It is also important to tell the doctor who follows your pregnancy about your emotional struggles. Decisions about medication in pregnancy must be made through a joint assessment by a psychiatrist and your obstetrician-gynaecologist; do not decide on your own to start or stop medication.
How Is Depression During Pregnancy Approached in Therapy?
During pregnancy, psychotherapy can be an important support, a place where the expectant mother can express her feelings in a safe setting and strengthen her coping skills. In cognitive behavioural therapy, automatic thoughts such as "I'll be a bad mother" and "Something will happen to my baby" are noticed and examined with a more balanced view. We work on cycles of worry, checking behaviours and avoidance. With behavioural activation, activities that suit the circumstances of pregnancy and do the person good are added to daily life.
A schema therapy perspective can help us understand how deep beliefs about motherhood and the person's relationship with their own mother reflect on this period. Pregnancy is a time that can also bring to life feelings about the person's own childhood. Where appropriate, sessions that include the partner can make it easier for the couple to manage this period together.
When going to face-to-face sessions becomes harder in the later stages of pregnancy, online sessions can also be an option. You can find out about this on the online therapy page, and about individual work related to depression on the depression and mood page.
Frequently Asked Questions
Does depression in pregnancy affect the baby?
A mother's mental health matters because it can affect how she looks after herself, her nutrition and her sleep during pregnancy. For this reason, noticing and supporting depression and anxiety in pregnancy is valuable for both mother and baby. It is important to see this not as a source of guilt but as a reason to seek support.
Is it normal to cry all the time in pregnancy?
Because of hormonal changes, emotional sensitivity may increase in pregnancy and crying from time to time is natural. But if the crying and sadness spread across most of the day, last more than two weeks and affect your life, talking to a professional is helpful.
Is it safe to have therapy during pregnancy?
Psychotherapy is a method that can be used to support mental health during pregnancy. No medication is used in therapy; whether medication support is needed is decided through a joint assessment by a psychiatrist and an obstetrician-gynaecologist.
Will depression in pregnancy go away after the birth?
In some women the symptoms may ease after birth, while in others they can continue or increase in the postnatal period. For this reason, it is important to address symptoms noticed in pregnancy without waiting. It may do you good to know that getting support from a professional is possible during this process.
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Eda Erkan Alapala
Klinik Psikolog. İstanbul Kent Üniversitesi Klinik Psikoloji Tezli Yüksek Lisans mezunu; bilişsel davranışçı terapi, çocuk merkezli oyun terapisi ve çocuk-ergen psikoterapisi alanlarında eğitimlerini tamamlamıştır.
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