When Hitha Palepu was pregnant with her second child, she experienced two significant—and scary—panic attacks. “The second panic attack happened when I was at the end of my first trimester,” she recalls. “I think it was work stress, the stress of taking care of a precocious three-year-old, marriage, travel, and growing a human on top of it all. I took on too much, and it all came crashing down around me.” That’s when Palepu, an investor and author, had a breakdown. “I was in hysterics,” she says. “I knew I wasn’t okay; I didn’t feel right.”

Palepu called her father-in-law, a psychiatrist, who suggested she may be experiencing prenatal depression. The condition is one Palepu had never heard of, but it’s certainly not uncommon: According to the American Congress of Obstetricians and Gynecologists (ACOG), between 14 and 23 percent of women will struggle with some symptoms of depression during pregnancy. Additional research has found prenatal depression (also referred to as antepartum depression) to be most prevalent during the third trimester, followed by the first trimester. “To have this person put a name to it validated what I was feeling,” says Palepu, who sought support from her obstetrician and a therapist following her discussion with her father-in-law.

So, if nearly a quarter of pregnant women may experience feelings of depression during pregnancy, why aren’t we talking about it more openly?

What exactly is prenatal depression?

Like clinical depression, prenatal depression is a mood disorder that involves changes in your brain chemistry. It falls under the umbrella of perinatal mood and anxiety disorders (PMAD), which also includes postpartum depression, postpartum anxiety, and postpartum obsessive compulsive disorder (OCD). During pregnancy, your body is already experiencing a host of intense hormonal changes, and they all show up and manifest differently: Some women experience acne and hair growth. Some have morning sickness that is really, in many cases, all-day and all-night sickness. For others, it’s the chemicals in the brain that feel most affected by the physiological change, and they show up in the forms of depression or anxiety.

Certain common factors can contribute to prenatal depression throughout the entire pregnancy, says Juli Fraga, PsyD, a psychologist who specializes in maternal mental health “During the first trimester, hormones are surging, and morning sickness may well be underway, which can impact a woman’s mood,” she says. “During the third trimester, women often feel physically uncomfortable and have trouble sleeping. They may also be worried about the upcoming birth and their roles as new mothers.”

“I had all the help and support in the world. Virtually all women can develop mental disorders during pregnancy and in the first year after delivery.” —Hitha Palepu, prenatal depression patient

Additional factors may increase a woman’s risk of prenatal depression, including a history of mental-health concerns, pregnancy-related complications, past struggles with infertility or pregnancy loss, and childhood trauma, research notes. And like all mood disorders, prenatal depression doesn’t discriminate: “I had all the help and support in the world—a doula, a husband, my parents,” says Palepu, who still experienced prenatal depression. “Virtually all women can develop mental disorders during pregnancy and in the first year after delivery.”

What prenatal depression feels like and how to treat it

Prenatal depression feels like clinical depression—with a growing belly, says Dr. Fraga: The most common feelings and symptoms are fatigue, tearfulness, hopelessness, and irritability. The tricky  thing is, though, since these symptoms are common during pregnancy—even for women who aren’t experiencing prenatal depression—detecting and diagnosing the condition is extra-challenging. Some women may also have thoughts about self-harm.

The best first course of action if you believe you or a loved one is experiencing symptoms of prenatal depression is to seek professional care as soon as possible. From there, you and your health-care provider will decide next steps, which may include therapy, group support, education, and medication in some cases when the associated risks are understood and accepted.

Just as is the case with clinical depression and anxiety, feelings of prenatal depression are unlikely to go away on their own—even after the baby is born. “Pregnancy is stressful on the mind and the body, and once the baby arrives, stress continues,” says Dr. Fraga. “With sleep deprivation, plummeting hormones, and adjusting to one’s new motherhood identity, it’s not uncommon for parents to feel out of control. This can leave many women ungrounded, because life as they once knew it has shifted dramatically.” In fact, research has correlated prenatal depression and postpartum depression in that the presence of one shows an increased likelihood in the other existing as well.

Why aren’t we talking about this more?

In 2020, mental health is less of a taboo topic  than it was a decade ago. Celebrities talk about it. There are movies and TV shows about it. And you might be pretty open about it in your group texts. But because pregnancy is often billed as “the happiest time in a woman’s life,” a common mood many women subscribe to, even if subconsciously, is feeling shameful about experiencing prenatal depression. Palepu’s advice? “Stop thinking ‘I should’ or ‘shouldn’t feel this way.’ Your feelings are your feelings, and it’s okay to feel them. It’s okay to not be overjoyed every minute of your pregnancy. It’s okay to feel frustrated, to feel tired,” she says. “You’re growing a human, you’re depleted. We’re never given a chance to slow down and focus on growing this human and deal with this new identity—to just be for a while.”

“We’re never given a chance to slow down and focus on growing this human and deal with this new identity—to just be for a while.” —Palepu

The need for additional research to better understand prenatal depression is high, as one study even outlines that “despite the considerably high incidence of antenatal depression, little attention has been directed toward mood and anxiety symptoms during pregnancy.”

In the meantime, if you experience symptoms of prenatal depression, remember that there’s help available. “You are not alone,” says. Dr. Fraga. “It is not your fault. Seek support. The sooner you receive treatment, the better your outcome.”

If anyone you know is suffering from postpartum depression, here’s how to be effectively supportive. And here’s what five women with depression wish they could have told themselves.