Pregnancy is often painted as a glowing, joyful time, but for many, it’s also a whirlwind of mood swings and hormonal shifts that can take a toll on mental health. Case in point: antepartum depression—a type of perinatal mood and anxiety disorder (PMAD) that develops during pregnancy. While most people have heard of postpartum depression (which happens after birth), antepartum depression deserves just as much attention.

In fact, 50 percent of PMADs, which include conditions like perinatal anxiety, obsessive-compulsive disorder (OCD), and post-traumatic stress disorder (PTSD), begin during pregnancy, with the other half surfacing postpartum, says Paige Bellenbaum, LCSW, a maternal mental health advocate, therapist, and founding director of The Motherhood Center in New York City.

Spotting the signs of antepartum depression is the first step to getting help and ensuring a healthier journey to parenthood for you and your baby.

Why does antepartum depression occur?

Antepartum (or prenatal) depression can happen at any point during pregnancy, from conception to birth, Bellenbaum says. It’s surprisingly common, affecting about 1 in 10 pregnant people, according to The American College of Obstetricians and Gynecologists (ACOG).

While its exact cause can vary, certain risk factors increase the likelihood of developing depression during pregnancy. These include, per Bellenbaum:

• A personal or family history of mental health conditions
• Stressful life events like financial struggles, relationship challenges, job loss, physical or sexual abuse, substance use, or unresolved grief
• Social determinants of health, such as the environment where someone lives, works, and ages, which can influence overall well-being
• Complications in pregnancy, childbirth, or breastfeeding
• A prior experience with a perinatal mood or anxiety disorder (PMAD), which carries a 50 to 75 percent chance of recurrence
• Unplanned or unwanted pregnancy
• Carrying multiples (e.g., twins or triplets)
• Undergoing infertility treatments

Studies¹ show that despite its prevalence, depression during pregnancy is often underdiagnosed—both by healthcare providers and the pregnant person themselves. According to the Mayo Clinic, several factors contribute to this oversight:

• Overlap of symptoms: Symptoms of depression, such as changes in sleep, energy, appetite, or sex drive, can closely resemble those of pregnancy. This makes it easy for both the pregnant person and their provider to dismiss mood-related concerns as “typical” pregnancy side effects.
• Focus on physical health: Prenatal care often emphasizes physical well-being, like monitoring fetal development or managing physical symptoms, while mental health can take a backseat.
• Stigma around mental health: In some communities, cultural beliefs or misconceptions about mental health may make you hesitant to bring up feelings of sadness, anxiety, or other mood changes out of fear of judgment or guilt, especially if societal expectations suggest pregnancy should always be a joyful time.

What depression symptoms are most common in pregnancy?

Feeling a little blue or having occasional mood swings during pregnancy is normal—but how do you know when it’s more serious? Depression can sometimes disguise itself as the typical ups and downs of pregnancy, but it’s important to spot the warning signs.

Talk to your OB/GYN if you experience any of these symptoms for at least two weeks, according to the American Pregnancy Association:

• Persistent sadness or a depressed mood most of the day
• Loss of interest in work or activities you usually enjoy
• Feelings of guilt, hopelessness, or worthlessness
• Trouble sleeping or sleeping too much
• Changes in appetite, leading to unintentional weight loss or gain
• Extreme fatigue or lack of energy
• Difficulty concentrating, focusing, or making decisions
• Restlessness or slowed movements noticeable to others
• Thoughts of self-harm or suicide*

Depression isn’t just “feeling down.” If these symptoms resonate with you, don’t hesitate to reach out for help—your mental health is just as important as your physical health.

*Editor’s note: If you or a loved one are experiencing a crisis, please know that immediate help is available. You can call or text the National Suicide Prevention Lifeline at 988 for free and confidential support 24/7. You can also check out the Suicide Prevention Resource Center for additional resources.

Can antepartum depression lead to other health complications?

Yes, antepartum depression can affect both the parent and baby, making it crucial to address it early. When depression during pregnancy goes untreated, it can affect self-care—leading to skipped prenatal checkups, poor nutrition, and lack of rest, according to ACOG. The ACOG and other studies² also note that untreated depression during pregnancy has been linked to:

• Poor fetal growth in the uterus
• Premature labor
• Low birth weight
• Higher risk of postpartum depression

Additionally, antepartum depression can also lead to certain emotional challenges for the baby, such as crying more, having trouble being soothed, and experiencing behavioral concerns when they become older.

Many birthing parents with untreated depression during pregnancy struggle into the postpartum period. Bellenbaum has seen countless birthing parents overwhelmed by feelings of hopelessness, dread, and disconnect, only to find these symptoms worsening after birth. Early intervention is key, she says. The sooner depression is treated, the faster parents can return to their baseline, making it easier to care for themselves and their baby.

Coping strategies for antepartum depression

Dealing with antepartum depression can feel overwhelming, but there are effective ways to find relief and support. Here’s how:

1. Talk to a professional

Getting professional help is one of the best steps you can take. A perinatal therapist trained in treating PMADs can make a huge difference, Bellenbaum says. For acute symptoms, a specialized program like The Motherhood Center's Day Program provides high-quality, focused treatment to help you feel better faster, she says.

Looking for a mental health professional? These resources can help:

• Postpartum Support International (PSI): This organization offers a provider directory to find perinatal mental health professionals near you. They also have coordinators who can guide you to the right resources.
• The Motherhood Center (NYC and virtual): Offers therapy, medication management, and support groups for those experiencing PMADs. Their team includes reproductive psychiatrists who can safely prescribe medication during pregnancy.

2. Join a support group

Connecting with others who are going through similar challenges can help you feel less alone. Both PSI and The Motherhood Center offer virtual support groups tailored to pregnant and postpartum individuals.

3. Consider medication

For some, medication like selective serotonin reuptake inhibitors (SSRIs) can be a safe and effective option, Bellenbaum says. Research suggests that certain SSRIs pose little to no risk to a developing fetus, she says. Untreated depression, on the other hand, can harm both you and your baby.

However, the ACOG warns that it’s important to weigh the risks of medication against the risks of untreated depression. Your healthcare team is a good resource to help you choose the right treatment for you and your baby.

How to support someone with antepartum depression

It truly takes a village—not just to raise a baby, but to support an expecting parent before the baby even arrives. Having a strong support system of partners, family, and friends can make all the difference. In fact, loved ones often notice signs of worsening depression before the person experiencing it does, according to ACOG.

When someone is struggling with antepartum depression, it can feel like drowning—desperately paddling just to keep their head above water, Bellenbaum says. “This is how I felt when it was happening to me,” she says. In that state, self-care can feel impossible, and it’s hard to recognize what’s really happening to you. This is where loved ones play a vital role in spotting the signs and helping access the right support.

Here’s how you can help someone with antepartum depression, per Bellnebaum:

• Learn the signs and symptoms: Educate yourself about perinatal mood and anxiety disorders (PMADs). A great resource is The Motherhood Center's guide.
• Offer reassurance: Let the birthing parent know they’re not alone, how they feel is valid, and that with the right support, they will feel better.
• Help connect to care: Research perinatal mental health services that support expecting parents and assist in making an appointment to ensure your loved one gets the care they need.

Support isn’t just helpful—it’s essential. Together, you can create a safety net that empowers the birthing person to heal and prepare for the joys (and challenges) of parenthood.

The bottom line

Antepartum depression is more common than you might think, but it often flies under the radar. Spotting the risk factors and recognizing how its symptoms can blend in with the usual ups and downs of pregnancy is crucial to getting the help you need.

The good news? You’re not alone, and there’s plenty of support out there. Whether it’s therapy, support groups, or medication, taking action can pave the way for a healthier, happier pregnancy—for both you and your baby.

“The most important thing to do is to get help as soon as possible. Don’t wait for it to pass; don’t white knuckle it,” Bellenbaum says. “The sooner you get the right kind of support, the sooner you can feel like yourself again and enjoy the journey of motherhood as you always wanted to.”