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Why do women get depressed during pregnancy?

In short, the reason pregnant and postpartum women are vulnerable to depression is hormones. There are significant hormone fluctuations during pregnancy, with large increases in estrogen and progesterone, and then a rapid drop-off immediately after giving birth.

Pregnancy is also a time of increased stress due to changing life circumstances. It might be your first time as a parent. It might be navigating a new relationship with your partner when it used to be just two of you. It might be trying to be productive on much less sleep. It might be this is an unplanned pregnancy or there is a lack of a good support system. Maybe you had depression in the past or it runs in your family. Your risk is also increased if the pregnancy was medically difficult or the delivery was complicated.

One strong predictor of relapse of depressive symptoms during pregnancy is discontinuation of medication. Many women have told me that upon learning they are pregnant they quickly stop taking their antidepressant medication -- sometimes on their own, other times on the advice of their psychiatrist or obstetrician. Abruptly stopping medication can lead to a relapse of symptoms in pregnancy in over two-thirds of women, a rate much higher than if a woman continues in treatment.
There are clear biological reasons related to shifts in neurotransmitter levels and hormonal shifts.   Pregnancy also takes a toll on the body and fatigue, changes in sleep and appetite and physical discomfort are all factors.   In addition, many women may be conflicted about a pregnancy, even if they want the pregnancy.  And that is completely normal - the advent of a new baby is serious business and requires shifts in identity, time, finances, family roles.  The problem is that the world is often ridiculous in its assumption that every pregnant woman must be thrilled and happy and excited.  Thus, if a woman is not feeling that way all the time, feelings of guilt, shame, and confusion can play a role in the development of depressive symptoms as well. 

People sometimes assume that pregnant women are always joyous and enthusiastic, but this isn't true. We also experience ambivalence, fear, sadness, and sometimes anxiety or depression that may require special help. According to some estimates, about one in every ten pregnant women experiences some depression, which is about the same rate as for women who are not pregnant. Yet pregnancy can make depression more difficult to diagnose. For example, sleep disturbances and lack of energy could be related solely to pregnancy, but they could also be related to depression. You may be depressed if you experience significant changes, including total loss of pleasure in activities that you used to enjoy; persistent feelings of worthlessness, sadness, or hopelessness; stark changes in appetite; prolonged periods of fatigue; uncharacteristic tearfulness; and suicidal thoughts. About half of all episodes of postpartum depression begin during pregnancy and may also be accompanied by persistent, intense anxiety that does not respond to reassurance or the usual support needed by women during this period.

Women may feel depressed during pregnancy because of hormonal changes; the circumstances of the pregnancy (for example, an unplanned pregnancy or a hostile or unsupportive partner and/or family); severe and extended nausea; earlier experiences with infertility and/or pregnancy loss that may give rise to anxiety about the current pregnancy; obstetric complications; or a long period of bed rest.

Our Bodies, Ourselves: Pregnancy and Birth

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Our Bodies, Ourselves: Pregnancy and Birth

ALL THE INFORMATION YOU NEED TO MAKE WISE DECISIONS ABOUT YOUR PREGNANCY AND THE BIRTH OF YOUR CHILD -- FROM THE EDITORS OF THE CLASSIC "BIBLE OF WOMEN'S HEALTH" Pregnancy and birth are as ordinary...
Dr. Mehmet Oz, MD
Cardiology (Cardiovascular Disease)
Though it's difficult to explain what happens neurologically to cause depression, changes in brain chemistry are thought to play a big role. We know that in depressed people, levels of the feel-good neurotransmitters serotonin and dopamine are down, as are steroid hormones - all of which help you cope with stress. Inadequate levels of these hormones may be partly what triggers depressive states.

Even though estrogen likely combats depression in pregnant women, it doesn't work perfectly. In some women, high estrogen and progesterone levels can actually cause depression. Other women, despite estrogen's protective effect, may be experiencing slight (but important) alterations to what's going on along that HPA axis. In this case, just the slightest stressors or emotional changes triggers chemical changes that lead to sharp mood swings - and a hormonal symphony turns into a cacophony.

Typically, stress induces more steroid hormones and alters the amount of circulating epinephrine (aka adrenaline) in the HPA axis that cross-talks with brain hormones. Even minor changes in the amount of neurohormones can disrupt your rhythm and send you into a psychological mess.
YOU: Having a Baby: The Owner's Manual to a Happy and Healthy Pregnancy

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.