There has been more discussion on postnatal depression in recent years, but not quite as much is known about antenatal depression, its symptoms and how to treat it. We are putting this misunderstood condition under the microscope to find out why it happens, what it looks like, and what to do about it.

At Augmentive, we aim to provide holistic, tailored mental health support to everyone so they can live their life to the fullest, so if you have questions about antenatal depression, we’re here to help.

What is antenatal depression?

Antenatal depression is a type of depression that occurs during pregnancy. It can be very serious if left untreated, can continue after the baby is born, and can impact the wider family and the child too, so it is important to seek help if you feel you are experiencing symptoms.

A meta-analysis of studies on antenatal depression found that the condition affected between 15% and 20.7% of pregnant people with varying severities, and the prevalence was higher in low or lower-middle-income countries. Another study suggests that anywhere from 20% to 40% of pregnant people develop prenatal depression, so although there does not seem to be a definitive figure on the prevalence of the condition, it is clear that antenatal depression affects a significant number of women.

How antenatal depression different from postnatal depression?

Antenatal depression is different from postnatal depression in that the symptoms appear during pregnancy, rather than after the baby is born. Perinatal depression is another term worth mentioning as it refers to depression experienced any time from the moment of conception until after giving birth.

What are the risk factors for antenatal depression?

Sometimes antenatal depression can feel incredibly random, as people with no prior history of depression can start to experience symptoms and not recognise what is going on.

A review of the risk factors associated with antenatal depression found that the following factors can contribute to antenatal depression:

• Age: Younger maternal age (between 15 and 25) evidently increases the risk of depression in pregnancy, thought to be due to potentially unfavourable or unstable economic or social situations, lower educational achievement, lower income or unemployment. Contradictorily, other studies have suggested older maternal age (30 years and up, or 35 years and up according to other studies) increases the risk of antenatal depression, potentially due to issues conceiving, anxiety about pregnancy complications and more. Interestingly hormones don’t seem to play much of a role in the age factor, only social and economic challenges!
• Economic status: Studies have found that those with a low socioeconomic status could be more at risk of antenatal depression.
• Relationship status: According to studies, those who are single, not cohabiting with a partner, not in a stable relationship, or not in a satisfactory relationship could have an increased risk of antenatal depression.
• Social environment: Social isolation, a lack of social support, feeling isolated in your community (for example, being of a different race than the wider community) has been associated with depression in pregnancy.
• Planning: Unplanned pregnancy has been found to be a risk factor for antenatal depression.
• Nulliparity: Those who have experienced pregnancy loss, previous abortions, or stillbirth in the past have an increased risk of antenatal depression.
• Complications: It is suggested that complications in previous pregnancies/deliveries, or history of caesarean section have been associated with an increased risk of antenatal depression.
• Physical health: Symptoms such as fatigue, nausea or vomiting have been found to be associated with an increased risk of antenatal depression. Of course these symptoms are commonly known as side effects of pregnancy anyway, but studies show that higher severity of physical symptoms corresponds to antenatal depression risk.
• Medical history: Having a history of depression or a family history of depression can increase the risk of antenatal depression.
• Stress/Anxiety: Studies suggest around 50% of pregnant women with depression were also diagnosed with anxiety, which has been associated with an increased risk of antenatal depression.

While some of these factors cannot be changed, such as the age of the pregnant person or their psychological history, there are definitely others that can benefit from intervention, such as increased social support from friends and family, a boost to income stability (savings or gifts), and a highly engaged partner.

What causes antenatal depression?

The above risk factors may suggest some of the possible causes of antenatal depression, however, as mentioned, sometimes the condition can seem completely random.

Another factor to note is how far along a person is in their pregnancy. One study found that the prevalence of antenatal depression was:

• 31.4% in the first trimester
• 34.9% in the second trimester
• 40.5% in the third trimester

The same study suggests that stress could be a key contributing factor in antenatal depression, and there is also a growing body of research around biological causes elevating the risk of depression, such as dramatic hormonal changes during pregnancy, and even potentially some genetic predisposition towards depression as a result of hormonal sensitivities (although this hasn’t yet been studied very much).

What are the common signs and symptoms of antenatal depression?

The symptoms of antenatal depression can come on slowly over a long period of time or come on suddenly. This is different for everyone. Symptoms can also differ from one pregnancy to the next, and can include:

• Feelings of anxiety, overwhelm or excessive worry about your unborn baby
• Racing thoughts
• Feelings of hopelessness and that no one understands
• A lack of interest in activities you once enjoyed
• Feeling disconnected from loved ones
• Feelings of guilt or anger
• Changes in appetite, such as overeating or being disinterested in food
• Issues focusing on things
• Issues sleeping
• Reluctance to follow prenatal health guidelines, or taking part in unsafe practices
• Suicidal thoughts (if you are experiencing these thoughts, seek help from a loved one or a professional as soon as possible)

“I went to a routine appointment and my midwife asked how I was feeling. I hadn’t planned to say anything but I just broke down and burst into tears. I said, ‘I’m not happy, I’m never happy’. She referred me to see my GP.” - Theresa’s story, via Tommys

Can antenatal depression turn into postnatal depression later?

Yes, it can. Sometimes antenatal depression can go away on its own or after the baby is born, but antenatal depression that is left untreated has the potential to become postnatal depression further down the line, and studies suggest that many women with antenatal depression do not seek help for their symptoms.

If you are experiencing symptoms of antenatal depression, you should speak to someone you trust about getting treatment as soon as you can, as the condition can become more serious if left untreated.

Can antenatal depression affect the baby?

Just as postnatal depression can have an impact on your baby, antenatal depression can too.

It has been suggested that symptoms of depression during pregnancy can have consequences for a child’s affective and cognitive development, with some studies suggesting thatt antenatal depression is associated with adverse infant outcomes. These include impairments in social-emotional development and an increased risk of behavioural issues, however there does not seem to be enough data to confirm this.

How to help a partner with antenatal depression

If your partner appears to be suffering with antenatal depression, there are a number of things you can do to help support them through what can be an extremely difficult time. These might include:

• Asking what they need and how you can best support them
• Attending any antenatal classes or pregnancy-related appointments with them to show your support and help them feel less alone in the process
• Try to suggest doing some enjoyable activities together, as you might have done before the pregnancy
• Be patient if they are struggling with anything, and offer to give them space if they feel they need it
• Provide a safe space for them to express their feelings without judgement and reassure them that they have your full support
• Provide more practical support in daily life, like household chores or helping to keep on top of medical appointments
• Help them look for the right support they need, such as support groups or therapy

Ultimately, having a partner with antenatal depression is all about helping them feel supported in as many ways as possible. Don’t forget that it can be a difficult period for you too as their partner, so don’t be afraid to talk to someone you trust about your feelings, and take your self-care into account.

How to treat antenatal depression

Treatment options for antenatal depression may depend on the severity of symptoms, the stage of pregnancy, any history of depression, or any risks that may arise from medication.

The most common treatments to be offered for antenatal depression include:

• Cognitive Behavioural Therapy (CBT): This type of therapy teaches helpful ways of thinking and responding to situations to address depression and anxiety issues. It has been found to be very effective for those suffering from postnatal depression, and is thought to be successful when treating antenatal depression also. In fact, one study found a significant decrease in depression scores for pregnant women following CBT interventions, as well as the improvements being maintained long-term.
• Interpersonal therapy: This type of therapy helps people improve communication in their relationships, create strong social support networks, and manage expectations during pregnancy to address depression.
• Medication: Sometimes medication such as antidepressants are recommended, and these affect how the brain uses certain chemicals to regulate mood. Some people prefer to avoid taking medication during pregnancy, however you can work with your health professional to either discuss alternative options, or to find the best medication for safe use during pregnancy. According to the National Institute of Mental Health, the risk of a foetus being negatively affected by the use of antidepressants during pregnancy is very low.

You may find that one of the above methods works for you, or perhaps a combination of several methods. A meta-analysis of studies has recommended psychotherapy as one of the best tools for tackling depression and anxiety during pregnancy.

If you are interested in trying therapy to help with the symptoms of antenatal depression, Augmentive’s personalised consultation can help you find the best therapist for your needs.

Whether you’re feeling off-kilter or want to shake up your routine, our state-of-the-art mental wellbeing platform gives you quick and seamless access to world-class support on your terms, from private psychiatric assessments and reviews to broader mental health care: join us today.

DISCLAIMER: The content published by Augmentive is not designed to treat, diagnose, cure, or prevent any disease or condition. Always consult your GP or a qualified healthcare provider with any questions regarding a medical condition and before starting any therapy, diet, exercise, or any other health-related programme.