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Why We Need to Talk About Depression During Pregnancy

When Sepideh Saremi, 32, started crying frequently and feeling moody and tired during her second trimester of pregnancy, she just chalked it up to shifting hormones.

depression during pregnancy

And, as a first-time mother, her unfamiliarity with pregnancy. But as the weeks went on, Saremi, a psychotherapist in Los Angeles, noticed a spike in her anxiety, plummeting moods, and an overall feeling that nothing mattered. Still, despite her clinical training, she brushed it off as everyday stress and part of the pregnancy.

By the third trimester, Saremi became hypersensitive to everything around her and could no longer ignore the red flags. If her doctor asked routine questions, she felt like he was picking on her. She started to struggle with all social interactions that weren’t work-related. She cried all the time — “and not in that clichéd, hormonal-pregnant-lady way,” Saremi says.

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Near the end of my pregnancy, I had a terrible feeling of dread and regret, and really low self-esteem. [Like] I’d made a terrible mistake deciding to have a baby because there was no way I would ever be a good mother.

Depression during pregnancy isn’t something you can just ‘shake off’

According to The American College of Obstetricians and Gynecologists (ACOG) and The American Psychiatric Association (APA), between 14 and 23 percent of women will experience some symptoms of depression during pregnancy. But misconceptions about perinatal depression — depression during pregnancy and after childbirth — can make it tough for women to get the answers they need, says Dr. Gabby Farkas, a New York-based therapist who specializes in reproductive mental health issues.

“Patients tell us all the time that their family members tell them to ‘shake it off’ and get themselves together,” Farkas says. “Society at large thinks that pregnancy and having the baby is the happiest period of a woman’s life and that’s the only way to experience this. When in fact, women experience a whole spectrum of emotions during this time.”

Shame prevented me from getting help

For Saremi, the road to getting proper care was long. During one of her third trimester visits, she says she discussed her feelings with her OB-GYN and was told she had one of the worst scores on the Edinburgh Postnatal Depression Scale (EPDS) that he’d ever seen.

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I felt super-ashamed of myself, like I'd failed at my most important job, which was being a healthy pregnant person. It actually prevented me from getting help at the time.

But there is help for depression during pregnancy, says Catherine Monk, PhD and associate professor of Medical Psychology (Psychiatry and Obstetrics and Gynecology) at Columbia University. In addition to therapy, she says, it’s safe to take certain antidepressants, such as selective serotonin reuptake inhibitors (SSRIs).

Saremi says she did discuss the results of the test with her therapist, whom she’d been seeing before she became pregnant. But, she adds, her doctors both kind of wrote it off.

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“I rationalized that most people lie on screeners, so my score was probably so high because I'd been the only honest person — which is ridiculous when I think about it now. And she thought I didn't seem that depressed [because] I didn't seem it from the outside.”

“It felt like a light turned off in my brain”

It’s unlikely that a woman who has experienced depression during her pregnancy will magically feel different once her baby is born. In fact, the feelings can continue to compound. When her son was born, Saremi says it quickly became clear to her that she was in an unsustainable situation when it came to her mental health.

“Almost immediately after his birth — while I was still in the delivery room — it felt like all the lights turned off in my brain. I felt like I was fully enveloped in a dark cloud and I could see outside it, but nothing I saw made sense. I didn't feel connected to myself, much less my baby.”

Saremi had to cancel newborn pictures because she says she couldn’t stop crying, and when she got home, she was overwhelmed by “scary, intrusive thoughts.”

I had a beautiful, healthy baby, but I felt afraid all the time. I'd be holding my infant and suddenly an image of me throwing him to the ground would pop into my mind. It was terrifying.

Afraid to be alone with her son or leave the house with him by herself, Saremi confesses she felt hopeless and despondent. According to Farkas, these feelings are common among women with perinatal depression and it’s important to normalize them by encouraging women to seek help. “Many of them feel guilty for not feeling 100 percent happy during this time,” Farkas says.

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“Many struggle with the tremendous change having a baby means (e.g. my life is not about me anymore) and the responsibility of what it means to care for another human being who is fully dependent on them,” she adds.

It was time to get help

By the time Saremi hit one month postpartum, she was so worn out and tired that she says, “I didn’t want to live.”

She actually began researching ways to end her life. The suicidal thoughts were intermittent and not long-lasting. But even after they’d passed, the depression remained. At about five months postpartum, Saremi had her first-ever panic attack during a Costco shopping trip with her baby. “I decided I was ready to get some help,” she says.

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Saremi talked to her primary care doctor about her depression, and was happy to discover he was both professional and nonjudgmental. He referred her to a therapist and suggested a prescription for an antidepressant. She opted to try therapy first and still goes once a week.

Bottom line

Today, Saremi says she feels so much better. In addition to visits with her therapist, she’s sure to get adequate sleep, eat well, and make time to exercise and see her friends.

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She even started the California-based Run Walk Talk, a practice that combines mental health treatment with mindful running, walking, and talk therapy. And for other expectant mothers, she adds:

Every woman should know that perinatal depression exists, and that it's not her fault if it happens to her. It's perfectly OK to ask for help –– and keep asking for help if you don't receive it the first time, until you find it. I'm so glad I kept trying because now things are so much better, and I have a great bond with my son.

Think you might be dealing with perinatal depression? Learn how to identify symptoms and get the help you need.


Caroline Karasik

Caroline Shannon-Karasik's writing has been featured in several publications, including: Good Housekeeping, Redbook, Prevention, VegNews, and Kiwi magazines, as well as SheKnows.com and EatClean.com. She’s currently writing a collection of essays. More can be found at carolineshannon.com. You can also tweet her @CSKarasik and follow her on Instagram @CarolineShannonKarasik.

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