Prenatal depression is a thing—a very real, important thing

When I was expecting my first child, I was prepared to encounter morning sickness, fatigue and even swollen feet that necessitated moving up a shoe size. What I didn’t anticipate was the emotional toll pregnancy would take: Beyond the normal fluctuations of hormones, I was among the estimated 1 in 7 expectant mothers who experience prenatal depression, also known as perinatal depression.

Far from the blissful, goddess-like image often projected on pregnant women, this left me feeling unenthusiastic toward otherwise happy moments in life, uninterested in the activities I usually loved and unsure of my role outside of mom-to-be. After struggling with similar feelings at previous points in my life, the crippling sense of apathy that tends to characterize my depression wasn’t foreign to me. Yet, I was caught off-guard—unaware there was even such a thing as prenatal depression.

Britney Spears called attention to the condition in her recent pregnancy announcement. But the condition remains sadly under-diagnosed. It’s time we all started talking about it.

What is prenatal depression?

Prenatal depression is a condition marked by major or minor depressive episodes that occur during pregnancy, or even within the 12 months after delivery. It is one of the most common complications affecting pregnant and postpartum women, according to The American College of Obstetricians and Gynecologists (ACOG). But it’s notoriously difficult to diagnose.

“Perinatal depression often goes unrecognized because changes in sleep, appetite, and libido may be attributed to normal pregnancy and postpartum changes,” state the authors of an ACOG committee opinion paper. “In addition to health care providers not recognizing such symptoms, women may be reluctant to report changes in their mood.”

Risk factors for developing the condition include a prior history of anxiety or depression, but also increased stress, lack of social support or domestic violence.

Related: Prenatal depression is the most under-diagnosed pregnancy complication in the U.S.

Prenatal depression often goes untreated

As long as we only talk with women about the joyous aspects of pregnancy and impending parenthood, we’re doing everyone a disservice, says postpartum therapist Thai-An Truong of Lasting Change Therapy. “These societal expectations lead women to feel shame when they don’t always feel happy and excited about pregnancy,” says Truong. “They often know that it is an issue, but it’s scary to open up to talk about.”

As a result, a 2003 study found 86% of pregnant women who expressed “significant depressive symptoms” in obstetric appointments were not receiving any form of treatment.

There has since been progress: In January 2016, the U.S. Preventative Task Force issued a long-overdue recommendation that healthcare providers screen for depression during pregnancy.

Still, treatment is lacking, says Erin Barbossa, LMSW. In order for that to change, she says healthcare professionals need to be more proactive with treating mothers’ emotional symptoms. “From my perspective, unfortunately, our medical system really lacks putting the mental health lens on unless symptoms are really severe,” Barbossa says. “We tend to focus on the physical symptoms related to the health of the baby, and if all of those check out, all is good enough.”

Related: New guidelines from the U.S. Preventive Services Task Force could help prevent perinatal depression

Watch out for the signs

According to ACOG, prenatal depression warning signs that warrant outreach include:

• Depressed mood most of the day, nearly every day
• Loss of interest in work or other activities
• Feeling guilty, hopeless or worthless
• Sleeping more than normal or having trouble sleeping
• Loss of appetite, losing weight, or eating much more than normal and gaining weight
• Feeling very tired or without energy
• Having trouble paying attention, concentrating or making decisions
• Being restless or slowed down in a way that others notice
• Thinking about death or suicide

On the surface—especially for parents navigating pregnancy for the first time—some of these symptoms may seem normal. But Barbossa argues they can be both ‘normal’ and “distressing in a way that deserves attention and intervention.”

And that attention shouldn’t be limited to in-and-out healthcare appointments: We—as sisters, friends and fellow mothers—need to create safe spaces to talk about our true experiences without fear of judgment or shame. “When expectant mothers feel they aren’t alone in their experience, they are more likely to talk about it during an appointment and more likely to receive assessment,” explains Barbossa.

When I was struggling, my confusion and guilt only complicated matters. I desperately wanted this baby—so what was my early apprehension saying about my abilities as a mother? Nothing, says Barbossa.

Rather, it’s natural to feel intense, potentially conflicting emotions during the huge life transition that is pregnancy.

“Becoming a mother is one of the most vulnerable things we do,” she says. “We grow something inside our body and love something so unconditionally it hurts. Sometimes that hurt literally comes up as physical and emotional pain.”

Related: Shay Mitchell offers advice to moms dealing with prenatal depression: ‘don’t be afraid to talk about it’

Reach out for help

While prenatal depression isn’t an indication of your future parenting skills, it is a medical condition that deserves acknowledgement and treatment. As a postpartum therapist who also treats pregnant mothers, Truong says her aim is to give expectant parents the chance to work through their emotional experiences.

Outside of professional treatment, Truong says we would all benefit by creating safe spaces for each other. If you sense an expectant mom is struggling, Truong suggests using phrases such as, “Feeling scared or even angry doesn’t make you a bad mom, it just makes you human”—or by not saying anything at all and just hearing her out.

Now in my second pregnancy, I was better able to identify the symptoms of prenatal depression and put my intervention plan into action. Honestly, that’s all thanks to knowing there is help that comes without judgment and hope that comes with treatment.

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