Why Doesn't Anyone Look For Pregnancy Depression Until After The Baby's Born?

Photographed by Ashley Armitage.
A few months ago, when actress and author Jenny Mollen was pregnant with her second child, she spoke candidly about her experience with prepartum depression in an Instagram story. She compared the emotional comedown after her first pregnancy to "coming off cocaine," and added that "having a baby is the scariest fucking thing that could happen to a woman."
Mollen's followers reacted with concern, so she posted a follow-up video to let them know that she wanted to share her story to normalize prepartum depression: "This is normal — that's what I'm trying to say," she said. "It's not weird. I would be more freaked out if I weren't freaking out."
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That her followers were so surprised points to the larger problem with prenatal depression: It's largely not talked about. There's a lot of focus and attention on postpartum depression, but prepartum or prenatal depression is just as common and equally important to acknowledge, says Catherine Monk, PhD, professor of medical psychology at Columbia University Medical Center. But many people, including some doctors and clinicians, aren't well versed in how prenatal depression affects pregnant women. Ahead, she answers the basics, from how to tell if someone has prenatal depression to what you can do about it.
What are some common signs of prenatal depression?
The signs are really similar to any kind of typical depression in terms of really feeling low energy, a down mood, feeling hopeless, Dr. Monk says. Someone may also have passive or active suicidal thoughts: "Thinking that the world would be better without you, or thinking about death a lot," she says. People with prenatal depression may be stressed, worry a lot, or feel less optimistic about having a baby, she says.
What's tricky is that some symptoms overlap with pregnancy in general, like changes in sleep. "That can be confusing," she says. During pregnancy, it's common for people to have their sleep disrupted, or experience changes in their appetite, but those can also be symptoms of prenatal depression. If you are pregnant and experiencing these symptoms, it's important to bring it up to your doctor, and they can help discern what's troubling versus par for the course.
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There's an assumption that having a baby must be the happiest thing and happiest time of your life. There's a lot of shame around endorsing sadness in the context of childbearing.

Catherine Monk, PhD
How common is prenatal depression?
An estimated 14 to 23% of pregnant women experience depression, and between 5 and 25% of women will experience depression postpartum, according to the American Congress of Obstetricians and Gynecologists (ACOG). "They're really comparable rates," Dr. Monk says. People with a history of depression or anxiety tend to be at risk for prenatal depression, according to ACOG.
Given how common prenatal depression is, Dr. Monk says there needs to be more attention paid to the mental health of a pregnant person during their Ob/Gyn appointments. And ACOG agrees: it officially recommends screening, treatment, and follow up for depression during pregnancy. "They need to ask, How's your uterus? but also, How are you doing and feeling?" Dr. Monk says, of a pregnant person's Ob/Gyn or midwife. "We want to move in the direction of taking care of the whole woman."
So, why don't we hear about prenatal depression?
According to Dr. Monk, it's common for women to be surprised and wonder, "Why did no one tell me this was a possibility?" Compared to other health topics that pregnant people are educated about and screened for, such as gestational diabetes, depression just isn't talked about — yet it affects up to three times as many people.
"There's an assumption that having a baby must be the happiest thing and happiest time of your life," Dr. Monk says. "There's a lot of shame around endorsing sadness in the context of childbearing, so I think that possibly obstetricians or midwives may not be asking." Not to mention, there are myriad societal pressures surrounding pregnancy and childbirth, so people — pregnant ones and their doctors — just don't mention it, she says.
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Does prenatal depression usually go away after the baby is born?
Every woman is different, and "unfortunately there are lots of different paths," Dr. Monk says. For some, the depression is relieved postpartum, and they feel much better even without treatment, Dr. Monk says. For others, postpartum depression is a possibility, too.
What should you do if you think you have prenatal depression?
Reach out to whomever is handling your prenatal care — whether that's an Ob/Gyn or a midwife — and they should be able to refer you for a mental health consultation, Dr. Monk says. "A mental health professional can help you get a good gauge of what's the best course, how serious this is, and what to look out for going forward to monitor [your] own mood and wellbeing," she says. Dr. Monk also recommends PP Support International, a website that has tons of resources for parents.
The good news is that, just like depression at other times, prenatal depression can often be treated with therapy, lifestyle changes, and medication in severe cases, Dr. Monk says. "There are lots of ways to get help, but it's important to start at the mental health professional."
If you are experiencing depression and need support, please call Mind on 0300 123 3393.
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