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It's Not a Mood Swing: Depression During Pregnancy

It’s Not a Mood Swing: Depression During Pregnancy

By Amalah

Hi Amy,

I have been reading your Pregnancy Week by Week  and it’s been a big help. Your humor really helps me feel less alone.

My question is this: How can you tell what are normal mood swings?

I want to preface this by saying that I would never ever harm myself or my little girl (I am 20 weeks 3 days along). Ever. I am not worried about doing anything crazy, I am just so sick of having these awful thoughts. I’ve never been depressed before, but ever since I got pregnant, whenever I feel down I don’t just feel a little sad- I feel the all out “what’s the point of anything nothing matters, I’m just going to stay in bed and hope I disappear” sort of despair.

I’ve tried talking to my husband, but I’ve just made him so worried for me, and it ends up turning into me reassuring him and pretending I feel better because I don’t want to make things harder for him. He doesn’t try to make me feel worse, but when he tries to cheer me up he tells me how proud of me he is for everything I’m doing, and I just feel this overwhelming guilt on top of the hopelessness that I already feel.

I also haven’t mentioned anything to my doctor, but that’s mostly just because I know I’m not suicidal, and I don’t feel comfortable talking to him about it anyway.

Is there anything I can do to help myself from feeling so awful? I don’t feel like that all the time; I’m usually happy, excited to meet our little girl, and very active. My diet is great, weight gain is healthy, and I work out. I have a lot of good days. But the bad days are horrible, and sometimes they really get in the way.

Any advice would be greatly appreciated.

Thanks,
A

Ack ack call a doctor call a doctor.

I am not a doctor, so while I obviously am not qualified to make any sort of diagnosis via email and the Internet Tubes, I am going to be blunt and brutal here and say that no, these mood swings do not sound “normal” to me. They sound like prenatal/antenatal depression. Which is a thing that absolutely exists, and sadly does not get talked about enough. One in 10 pregnant women will suffer from some form of anxiety or depression during pregnancy. ONE IN TEN.

What you’re describing — good days mixed with overwhelming feelings of sadness, hopelessness and guilt — are all telltale symptoms of a clinical depression, very likely linked to your pregnancy hormones. It’s not something you can control, it’s not something you caused in any way…but it’s not something you can just sort of…mash down and ignore and hope for the best. YOU NEED TO CALL A DOCTOR.

If you don’t feel comfortable talking to your OB about this, get a new OB, or call your primary care physician or a mental health professional. Stop downplaying your feelings because you’re not suicidal or having thoughts of harming yourself. Your mental health is just as important as your physical health. Not to mention that untreated depression can very much escalate and go on to affect you physically.

It can also lead to pregnancy complications and preterm labor. Yes. Fact.

Which is why you need to TELL SOMEONE (other than your husband) exactly what you wrote here: You’re not just feeling a little down from time to time, you’re veering into “nothing matters” pits of despair, overwhelming guilt, pretending to feel better so you aren’t a burden, unpredictable mood swings despite staying active and working out and having — by all other measures — a healthy, happy, wanted pregnancy.

Again: This isn’t your fault. This is a very common pregnancy symptom that has nothing to do with you or your ability to mother and love your baby. It’s like morning sickness or gestational diabetes, but in your brain chemistry. And while it’s “common” it’s NOT something you can ignore and not talk your doctor about because you feel guilty, silly or embarrassed. You can’t just will yourself out of this, or go on pretending that you’re fine, just fine, I swear I’m fine.

You asked what you can do to help yourself from feeling so awful. You can do that by asking for help from someone qualified to help.

Here is  a list of other resources on prenatal/antenatal depression and anxiety. Read them, use them, then please please please talk to someone in real life about how you’re feeling.

Depression in Pregnancy (American Pregnancy Association)

Depression During Pregnancy (postpartum.net)

Depression During Pregnancy (Baby Center)

Pre/Antenatal Depression (PANDAS)

Depression During Pregnancy (Postpartum Progress)

The Truth About Prenatal Depression (SheKnows)

Amalah
About the Author

Amy Corbett Storch

Amalah

Amalah is a pseudonym of Amy Corbett Storch. She is the author of the Advice Smackdown and Bounce Back. You can follow Amy’s daily mothering adventures at Ama...

Amalah is a pseudonym of Amy Corbett Storch. She is the author of the Advice Smackdown and Bounce Back. You can follow Amy’s daily mothering adventures at Amalah. Also, it’s pronounced AIM-ah-lah.

If there is a question you would like answered on the Advice Smackdown, please submit it to amyadvice@gmail.com.

Amy also documented her second pregnancy (with Ezra) in our wildly popular Weekly Pregnancy Calendar, Zero to Forty.

Amy is mother to rising first-grader Noah, preschooler Ezra, and toddler Ike.

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Comments

  • Lilly

    Big hugs to you! 100% agree with Amy, but please, please call now. Don’t wait another minute. First of all, because depression ALWAYS escalates, which means that you might not be suicidal now, but you might be tomorrow. Second, because this is a beautiful time in your life, and you deserve to enjoy it! Tell your OB. I am sure he/she has heard this 100 times before, and if he/she doesn’t take it seriously, change doctors. ASAP.

  • MR

    OP, good for you for reaching out! Now, pick up your phone and call your doctor NOW. Amy and pp are correct, this is not normal emotional swings. This is depression, and you need to talk to your doctor TODAY. ((hugs)) It WILL get better, but you need to get help now.

  • Hi, I’m Natalie.

    What Amy said. Also, for people who don’t get it, this: http://hyperboleandahalf.blogspot.ca/2013/05/depression-part-two.html

  • Amy

    I went through this too, 10 years ago when we knew all about POSTpartum depression, but who had ever heard of depression (or anxiety) DURING pregnancy.  The awareness is so much better now!    

    There is help.  You did the right thing reaching out.  Just print this letter and take it to your doctor, and say, “I wrote this.”  And if your doctor doesnt help you, because some doctors suck, keep trying until you find one that will.  You do NOT have to suffer for the next 19-1/2 weeks.  And giving birth won’t necessarily fix it, anyway, so just fix it now, ok?  You’ll feel so much better after a couple weeks of treatment, you won’t even believe it.  

    Hang in there, it’s going to be ok.  Definitely like Postpartum Progress on Facebook – lots of help and support there.  

  • solmaz

    Just want to add my experiance. Do not expect your gyno to know much about mental health even though it maybe pregnancy related. Call and make an appoinment with a psychiatrist as well.

  • Lionheart

    THIS.

    Thank you to the Momma-with-a-question for bringing up this issue. Thank you Amy for linking to all the resources available.

  • Dorothy

    I had undiagnosed prepartum depression with my first. I didn’t even know it was a possibility until 3mon postpartum. It turned into postpartum depression (I was diagnosed at 5mon pp). When I got pregnant with #2, I went off my meds under the supervision of my psyciatrist. Worst idea ever, the depression was worse. Currently 7 weeks pp and doing much better. So you aren’t alone. And everyone is right, you don’t necessarily just snap out of it when baby is born. So get help. And consider switching Obs. Giving birth can be a time of great vulnerability, you want to trust everyone who is there.

    I also want to echo solmaz, look into seeing a mental health professional (preferably one with experience with pre- and post-partum depression). You’d never consider going to your pysciatrist to set a broken leg, why would you go to a medical professional for mental health?

    Good luck!

  • Allison

    I totally had this all 3 of my pregnancies so far. The first 2 I realized after the fact that I had been depressed, for the 3rd pregnancy I told my dr (not my fav thing to do.) And instantly he got me on antidepressants. Best decision ever! It helped me actually get my butt off the couch and feel myself. Trust me, it is so worth it.

  • Emily

    Please listen and talk to someone. You sound like you are exactly where I was at 20 weeks. And it did not go away until almost 8 months post partum. I love my son but we had a rough beginning and the only thing I regret is not having been able to enjoy what was a very special time I will never get with him again. 

  • Stephanie

    Yes, please, please, please call your doctor now. Don’t wait a second longer. 

    Hoping you get the help you need as soon as possible. 

  • Athena

    Um… slightly tangential, but does anyone know how you’re supposed to tell between normal depression and pre-/post-partum depression? Because… I asked that question every time a doctor or midwife or plunket person or family member asked me about it, and no-one has ever given me a satisfactory answer. Or any answer, really.
    Other than that, how long after the pregnancy can PPD start? Because I didn’t have problems bonding with my son at the start, but now I kind of am, but I don’t know if that means it’s PPD and not just a particularly bad bout of the same old same old… I’m also dubious because I’m pretty sure a year and a half is too long after for PPD to start.

    • MR

      PPD is any time in the year after giving birth. The difference between normal depression and pre/post partum depression is simply what caused it. Treatment isn’t really any different, although obviously they look at different meds if you are pregnant or nursing.

  • M

    I want to reach out to the original poster with a “me too” and “still-sometimes” comment. Partly depression, partly rage, I had a problem with this in my two previous pregnancies, and I sought help not with my ob/gyn but with a therapist who specialized in anger management. This time around has been much worse–unlike the OP, I actually was scared I would snap. This time, I went through my ob/gyn, and despite the fact that I described myself as “in crisis” and “at the edge of my rope,” I was not able to get an appointment with a therapist who specialized in pregnancy related depression/rage for over three months.

    My point is that sometimes the mental healthcare system for pregnant women is too slow/stupid to help. While you can and should seek out postpartum resources (there are support groups in most states that can help not just with postpartum issues but with what you’re experiencing now), you might also consider striking out on your own (via https://therapists.psychologytoday.com/rms/). Sometimes you just need to talk to someone–now–who can listen and offer both perspective and strategies for coping. Good luck, OP, we’ve been there, and it’s really, really hard.

  • Shannon

    Amy, thank you so much for answering this letter! I think there is a lot of pressure on pregnant women to be happy and glowing and excited and that’s not what pregnancy looks like for everyone.

    LW, it might help to think about what you would do if you were having a physical symptom that was interfering with your every day functioning. If you had shooting pains down your leg some days, not every day, but enough that you couldn’t get out of bed or comfortably go through your daily life those days, you would talk to a professional! This falls in the same category to me. Good luck!

    Athena-a professional is best to diagnose the difference, but I was trained that the line has to do with whether you’re able to function in your daily life without significant interference or discomfort. There are some good assessments a professional can walk through to figure out the extent of the problem and suggest good solutions. They can also suggest some things the individual hasn’t thought of: for example, sometimes the culprit can be anxiety instead of/in addition to depression.

  • Diane

    I’d like to also say to call your doctor!! I have been there and put off talking to my doctor because I felt silly, crying all the time about nothing (and I mean serious sobbing over my husband going to the gym without me), and just generally feeling miserable. He ambushed me at an OB appointment and told the doctor because I refused to, and it was such a relief just to know it wasn’t me being crazy, it’s totally common, and totally treatable. You aren’t alone, honey. This can be better. And it’s such a special time that if you don’t do something, you’ll regret missing out on what could be the happiest time of your life. This isn’t your fault, but you can talk to someone and do something about it. Good luck and congratulations on the (upcoming) baby!

    • wendy

      This. I had a miscarriage in november and got pregnant again after that straight away. People keep asking me if I am enjoying my pregnancy yet. Or even telling me I should be. All u want to answer is shut uuuuuuuppp!. Am I depressed?  No. Is this one big happy party on a big fluffy floating cloud? Hell no!! Just stop telling me how wonderful I should be feeling tyvm.

      • wendy

        Oops.. all *I* want to answer, of course. And I intended to reply on Shannon’s post.  Pregnancy brain. ..

  • Ellie

    Tell a doctor, preferably both your ob and a psychiatrist/psychologist who sees a lot of new parents.

    Pregnancy hormones can definitely rearrange your brain. My husband and I noticed my normal depression actually eased for the duration. (we were watching for it to worsen) Clearly, you’re the more common type.

    Good luck!

  • Katy

    OP hugs hugs hugs. Talk to a doctor, seek counseling, and if that doesn’t work, medication can help to get your brain chemicals back to “normal”. Some are safe during pregnancy, and it doesn’t mean you’ll be on them forever. And if your doctor’s office can’t give you a good referral, your insurance company may have a mental health referral hotline and they can hook you up with a therapist.

  • Julie Beth

    Maybe this is veering into sanctimommy territory, but might I suggest that if you’re not comfortable talking to your doctor about this, he may not be the guy you want to be in labor with. That’s pretty personal, and you really need someone you trust and who respects you.

  • L

    Hey!

    So that link in Amy’s reply about prenatal depression…I wrote that. I really struggled during pregnancy and postpartum and it was isolating and terrible and I wish I could give you all the hugs.

    I highly, highly recommend talking to someone about what you’re feeling. My OB ended up referring me to amazing mental health nurse practitioner who was a former L&D and postpartum nurse and then specialized in pregnancy and postpartum mental health.

    Pregnancy can be an emotional struggle for tons of reasons, but it was incredibly validating to hear that none of those reasons were so rare or irrational at all. And that YOUR health (mental and otherwise) is just as important as your baby’s.

  • Autumn

    If you need a referral from your MD to see a specialist, do a bit of homework before you talk to him.  Research someone who is available in your area, takes your insurance, and then bring that name and number to your appointment.  

    If you present it as I’m having some trouble, and I think seeing this professional would help me, you could avoid the awkwardness of the visit you are worried about while still getting yourself the help you need.  I did this when I had a leg injury, and I knew my MD (who is awesome) wouldn’t refer me first to the specialized therapist I needed.  

    And please get help!  I was heading towards post partum depression after 6 months home with my daughter, and it wasn’t a fun destination.  i was lucky I felt much better after my return to work, but don’t count on luck happening.  

  • A

    Hey all,

    I am the mama to be who asked for advice. I just wanted to say that I really appreciate everyone’s concern and support and I just wanted to say that I will be getting counseling to help me through my depression. I talked to my doctor about it the other day and he said it seems mild right now, and that he’s glad that we’re dealing with it now before/in case it got worse. Ugh. If this is mild then I’m glad too; I’m not sure how anyone deals with this alone!

    Thanks again guys! 🙂 

    • Myriam

      So glad to hear that you will be getting help!

    • I had an MD say I had “mild depression” after doing a quick questionnaire with me once. It seems to be that they define it more by how many bad days you have, rather than by the intensity of the badness. Because I was… well, awful, near suicidal maybe, but only one or two days a week — every week, for some time. But his questions were only about how often I’d felt certain ways in the last week.

      Also I think I may have had PPD after a miscarriage, though it was never officially diagnosed. Reading other people’s accounts, mine probably was kind of mild in comparison? Not sure how anyone deals with it alone either, even mild is so hard, and so bad. Hugs. 

  • Marina

    So glad to hear you talked to your doctor! Just wanted to add that my midwife’s reaction when I brought up the possibility of prenatal depression was not encouraging (she got the same deer-in-the-headlights look that my husband/friends had when I brought up depression with them) but she did refer me to a counselor who helped SO much. It was incredible to go talk to someone who listened to the thoughts I had that seemed so overwhelming to me and just responded in such an accepting and matter of fact way. My midwife’s reaction was not at all a reflection on her as a midwife–she was wonderful through every other element of my pregnancy and birth–but simply that there are specialists to deal with depression and she was not a specialist. So, I’m glad to hear you’re going to see a specialist! 🙂

    Another thing that helped me was talking to other moms who are recovering from prenatal and postpartum depression–hearing from other people, yeah, it’s so weird and scary to have these thoughts, it doesn’t mean you love your children any less or that you’re a bad mom, here are some everyday things that helped me dealing with the same things. You might ask your counselor whether there are any local groups along those lines.

  • So glad you’re getting help. I’m… in a similar place right now, trying to figure out whether these are mood swings or depression. I have a therapist, though I haven’t seen him in… a few months? And I suppose either way I just need to arrange the babysitting and go again.

    I do have a couple of the risk factors for antenatal depression, I know — a previous complicated pregnancy, and a previous miscarriage (a different pregnancy than the complicated one). Oh, and the miscarriage was kind of complicated too, complete with a trip to the ER. (I don’t know if that’s a risk factor, but it sure feels significant at the moment.) But unlike after my miscarriage, I haven’t had much in the way of intense bad times like you describe, I’m just… blah. All the time. So blah. I had a happy moment at the ultrasound, and I thought it was the relief of knowing my baby’s okay this time (my miscarriage was a missed one, I found out the heart had stopped at the ultrasound) and I’d be better now… but then I went back to blah.

    Interfere with my daily functioning? I don’t know, I’m on the couch all the time because that seems to help with the ever-present morning sickness. (I’m at 11 weeks.) True, I occasionally feel better physically but stay on the couch, but that’s just habit at this point? I know I don’t deal with change or with pain well, but that doesn’t mean every time I’m handling turmoil badly I’m depressed…

    Blah. Okay, this is sounding worse typed out…

    Not to mention the fact that I felt the need to leave this comment because I just really really want to talk about this with someone right now. Okay.

    • Oh, apparently when they talk about pregnancy complications as a risk factor they mean the *current* pregnancy, not previous ones. Phhhth, whatever, it’s totally relevant. Especially since one of my complications, Cholestasis, has a 70-90% recurrence rate.

      • wendy

        I can relate. My story is similar, but I do go to work still. I’m also still mostly  blah. I function, I’m healthy, I’m not unhappy. But I am blah a lot. I don’t think I am depressed. Just… can never go back to that happy-go-lucky attitude I had in my first, quite uneventful pregnancy. I miscarried last november and got pregnant again straight after that. Maybe that was a bad idea after all, idk. It’s just not easy at all.. hugs to you, though. I think we are allowed to feel a little blah.

        • Hugs. Definitely allowed. I’m a SAHM, after being laid off last year (right before I found out about the pregnancy that later miscarried). My 2yo is pretty easygoing for a 2yo, so I can get away with not doing much all day, and sometimes I wonder how much that contributes to the blah. Like, I know I never feel my best after hours of browsing facebook! 🙂 But maybe it doesn’t matter exactly how much is my actions driving my feelings or my feelings driving my actions or both playing into each other — I mean… I don’t know how to put this. It’s all allowed, and understandable. But I also want to be careful about spiraling down to a really dark place. And to try to talk and get support in place before it becomes harder. (Though maybe after the morning sickness goes away it’ll get *easier*! Wouldn’t that be nice?)

          I do have more depressed moments and bad days occasionally, but there haven’t been a lot of them. Sometimes after I talk about things like the ER visit I start feeling lightheaded… I should probably talk with my therapist about that stuff. I don’t think I have full-on PTSD, but I think I could use some more processing and healing.

          Hugs again. Not easy at all.

          • Wendy

            You know, I think you are right. If you feel you need to talk to you therapist, then that would definitly be the best thing to do. It’s part of taking care of yourself and your family. I can see you are going the right way though. You are introspective and that’s good. You think about things. Sending hugs again. Hope you feel better soon!

          • Thanks again! Yeah. On vacation at the moment and feeling somewhat better for now, but… yeah, there’s a lot to process. Which is fine, no one has to win the pain Olympics or be definitely mentally ill before getting to speak with a therapist. 🙂 Hugs back to you again!

    • Marina

      One of the things that helps me when I’m in a am-I-or-am-I-not-depressed spiral is that, hey, there are people who are specially trained to figure this kind of thing out. 🙂 You don’t have to be sure you’re depressed to see a therapist. Wondering whether or not you are is a very, very good reason to see a therapist. There is no therapist on earth who’s going to say, “How dare you come see me when you only feel sort of shitty, not completely 100% shitty!” If the therapist thinks you’re probably not clinically depressed, they will still talk about possible coping skills and lifestyle changes with you, which might be a big help.

      And also… you deserve to feel better. You deserve to not feel blah all the time. Your children deserve a mother who doesn’t feel blah all the time. If there’s something someone can do to help you not feel so blah, you deserve it.

  • Lauren

    Please please please please call your doctor. Now. You are describing textbook clinical depression and if you don’t seek some help now it most likely will exacerbate as postpartum depression once your baby arrives. That is exactly what happened to me and what I was feeling during pregnancy was not nearly as pronounced as what you are going through…unfortunately I brushed it off and ended up with severe PPD almost immediately after my son’s birth that was so intense that I was suicidal. I beg you to get help now, I do not want any one to face what I had to go through. What you are experiencing is a lot more common than you think so please try not to feel ashamed. Prenatal and postpartum depression are very treatable. Please call a doctor, therapist or social working as soon as you can. Good luck. 

  • Heather

    I had a deep depresison during my pregnancy. My doctor knew about it and supported my efforts to stay healthy in all the ways I needed her to. I feel fortunate because my depression resolved as soon as my son was born (people saw a noticeable difference after about 18 hours) and did not evolved into PPD.

    I found out later that my husband and mom had been conspiring about what would happen if it did become PPD because they felt that I was close to being unsafe for myself. It can be treated, or it can be endured but above all else – keep yourself safe. Good luck, I hope the sun shines on your face for a moment today.

  • A (OP)

    Just wanted to give an update! I had my apt this past Wednesday. I’m really glad I went. She was surprisingly easy to talk to, although I did crack way too many jokes due to nerves… (During the assessment one of the questions was “Do you share needles” and I was like, “I mean, I try not to…” And then I spent the rest of the session wondering if she thought I was a druggie… haha)

    But other than that I did get a lot off my chest and I’m going to see her regularly with the goal of helping myself manage my anxiety with the promise of, “We won’t try anything cheesy, I swear,” so I like this lady.

    Thanks for all the support everyone! xoxo

    • So happy to hear that your first session went well. Thank you so much for the update.

  • Dawn

    I think it can be really hard to sort his out. In retrospect, I think that I was depressed during my pregnancy. At the time, I knew that I was struggling, but I had a lot of nausea for a few months and a stressful job, so I sort of eased into being depressed. I constantly pretended I was doing better than I was. People don’t want to hear that you’re sick and miserable. They want you to be excited. I felt like I was constantly faking it, which in itself was exhausting. Even so, I didn’t realize how bad it was until my baby was born, and I immediately started feeling so, so much better.  when in doubt, consult a professional. If in a future pregnancy I feel the way I did before, I will be ready for it and find professional support. 
    That said, I don’t think that feeling uncomfortable covering this issue with an OB means you should get a new OB. I wanted a lot from my OB, and I got it. I am comfortable having the mental health side of it addressed by another specialist.

  • It is admiring that you have the humility to know where your expertise stops and someone else’s starts. It is also so important to acknowledge the mental health side of pregnancy (and life in general). Too often does that get overlooked or down played, especially by our own minds. To the OP – I hope that you were able to get the support you needed to get through those difficult times and that you have a happy and healthy baby 🙂 Thank you Amy for saying it how it is and addressing the issue head on!