Antepartum Depression: Symptoms, Causes, Treatment

Antepartum depression, also called prenatal depression, is a mood disorder that begins during pregnancy. It is less well known than postpartum depression, which begins in the first year after the baby is born.

Together, antepartum and postpartum depression are referred to as perinatal depression or major depressive disorder with peripartum onset. Those with perinatal depression may experience extreme sadness, anxiety, and fatigue, which can make it challenging to carry out daily tasks, including caring for themselves or others.

According to the American College of Obstetricians and Gynecologists (ACOG), perinatal depression is one of the most common medical complications during pregnancy and the postpartum period, affecting one in seven people who are pregnant.

Untreated, antepartum depression can have adverse consequences for both the person who is pregnant and the baby. However, effective treatment is available, and most people experience an improvement in their symptoms with treatment. 

Symptoms

The symptoms of antepartum depression can range from mild to severe. In rare cases, symptoms can be severe enough to put the health of the person who is pregnant and the unborn baby at risk.

The most common symptoms include:

• Persistent sad, anxious, or “empty” mood
• Irritability
• Feelings of guilt, worthlessness, hopelessness, or helplessness
• Loss of interest or pleasure in hobbies and activities
• Fatigue or an abnormal decrease in energy
• Feeling restless or having trouble sitting still
• Difficulty concentrating, remembering, or making decisions
• Difficulty sleeping or oversleeping
• Abnormal appetite, weight changes, or both
• Aches or pains, headaches, cramps, or digestive problems that do not have a clear physical cause or do not ease with treatment
• Persistent doubts about the ability to care for your baby
• Thoughts about death, suicide, or harming yourself

Symptoms can go unnoticed as changes in sleep, appetite, and libido may be attributed to normal pregnancy occurrences. In addition, studies have found that people are reluctant to report changes in their mood during their pregnancy.

However, it is important to seek help from your doctor if you are experiencing any of the symptoms highlighted above. A medical professional will be able to determine whether what you are experiencing is due to antepartum depression or another cause. 

Remember that not everyone will experience the same number and types of symptoms. Some may experience a few symptoms, while others may experience several.

Causes

It is not known exactly what causes antepartum depression, but it is thought that a combination of genetic and environmental factors contributes to its development. These factors include:

• Changes in hormones that occur during pregnancy
• Emotional demands of childbearing
• Stressful life events

Those with a personal or family history of depression or bipolar disorder or those who have experienced perinatal depression before may have a greater chance of developing this condition.

Treatment

It is important to get treatment for antepartum depression. Untreated, it poses an increased risk for negative birth outcomes, including preterm labor, low birth weight, and intrauterine growth restriction.

Effective treatment is available and, once they have received treatment, most people feel better and their symptoms improve. Treatment most commonly involves therapy, medications, or a combination of the two. 

Psychotherapy

Several types of psychotherapy can help with antepartum depression. Those shown to be effective include:

• Cognitive behavioral therapy (CBT): This type of therapy is used to help people with depression and anxiety. It aims to teach different ways of thinking, behaving, and reacting to situations. 
• Interpersonal therapy (IPT): This type of therapy focuses on improving interpersonal issues with the goal of improving communication skills within relationships and developing social support networks. 

It has been argued that IPT may be more suitable for those going through pregnancy as this period is associated with significant role transitions and changes to interpersonal relationships.

A 2011 meta-analysis on treatments for perinatal depression found that IPT has a greater effect than CBT in treating perinatal depression. However, both of these interventions have been proven effective in significantly reducing symptoms of depression.

Medications

The most common medications used to treat antepartum depression are antidepressants. It is estimated that 2%-3% of pregnant people take antidepressants during pregnancy.

The most prescribed antidepressants for antepartum depression are selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs).

The risk of birth defects and other problems for babies of those taking antidepressants during pregnancy is very low.  However, there are risks, and you should work with your doctor to weigh these with the benefits of treatment.

Research into the effectiveness of these medications for the treatment of antepartum depression and especially how they compare to other interventions, such as therapy, is limited. This means that it can be difficult to draw definitive conclusions as to whether medications or therapy is a better intervention.

Risk Factors

Factors that increase the risk of antepartum depression may differ from those that increase the risk of postpartum depression. This is because certain factors, such as social support, may be different before and after the arrival of a baby.

Factors that have been associated with an increased risk of developing antepartum depression include:

• Anxiety
• Stress
• History of depression or anxiety
• Lack of social support, including partner support
• Domestic violence
• Unintended pregnancy
• Lack of private health insurance
• Low socioeconomic status

ACOG recommends that those at an increased risk of perinatal depression, including those with current depression, anxiety, or suicidal thoughts, should be closely monitored during pregnancy.

Coping

Experiencing depression during pregnancy can be very challenging. It is important to speak to your doctor and to start treatment as soon as possible. It also can help to reach out to loved ones for support. You might also want to consider finding a support group for people going through the same experience. 

Another way you can support yourself is through self-care, which can reinforce your treatment plan and help reduce anxiety, depression, and fatigue. Self-care tips and coping tips include:

• Exercising regularly: Doing regular, gentle exercises can improve other symptoms you may experience during pregnancy, too. Talk to your doctor if you are not sure a particular activity is safe. 
• Getting enough sleep: This is especially important during pregnancy and is a key factor in managing symptoms of depression. Poor sleep quality has been associated with an increased risk of suicidal ideation in pregnant people.
• Eating a healthy diet: Your diet may change during your pregnancy as your body requires more calories and nutrients. A healthy diet can contribute to a successful recovery. 

Dealing with a loved one who is experiencing antepartum depression also can be a challenge. You may even notice the symptoms before they do. Encouraging them to seek treatment and offering emotional support will increase the chances of a successful recovery.

A Word From Verywell

All pregnancies involve a variety of changes and can cause a multitude of different emotions. However, if you are experiencing symptoms of antepartum depression, do not ignore those signs. Speak to your doctor about what you are experiencing. Support is out there, and your doctor will help you find the best and safest treatment for you.