Pregnant and Depressed

For many people, pregnancy can be one of the most emotionally taxing experiences of their life.

An illustration of a woman walking past a maternity store.

The mannequins inside A Pea in the Pod, a maternity store in Los Angeles, showed off their bumps in slinky sundresses and chambray rompers. The clerk asked whether I’d been in before. I hadn’t. It was the end of my first trimester, and I was returning jeans I had ordered online. I had not chosen my pre-pregnancy size but a size up (a mistake, the clerk told me), yet the denim’s bad fit—it bunched at my knees—was the least of my problems. When the jeans arrived, I’d been shocked by the bandage-colored elastic that stretched above the waistband, empty casing for a giant sausage. Reluctantly, I’d tugged them on, but the elastic showed even through a black T-shirt. Jeans would be like brie or sushi, something I’d do without for the next six months.

At A Pea in the Pod, I brought a romper I’d seen on a mannequin into the fitting room, along with a few body-con dresses. As I dressed and undressed, I tried to fast-forward through the next two trimesters, when my stomach would be more beach ball than food hangover. I pictured the pregnant women I’d seen in my ob-gyn’s office, their hands hatched beatifically over their bellies, wearing floral silks and delicate flats, and in the mirror I saw no such photogenic future for myself. Why would you accentuate this? I caught myself thinking. What’s the point of spending money on clothes for a garbage body that’s about to be stretched and ruined? You’re trash; you’re disposable, I told myself. You container; you stupid vessel. I could hear the blood in my brain pulsing as it churned up negative thoughts—obsessive, caustic, frightening.

I exchanged the jeans for the romper and left the store, hot, shaking, tears smearing my sunglasses. When I got to my car, I sobbed. What was the point? In six months I’d have a baby on top of all these feelings. How could I handle that? There was no way life was supposed to feel like this, and I was sure everything would only get worse.

Everything I’d read had prepared me for changes in physical health, but somehow I didn’t expect pregnancy to affect my mind—at least not until after birth. Pregnancy was supposed to be a time of joy, even amid its bodily hardships. The flush of morning sickness, the labor-drenched brow: The mother-to-be is glowing, luminous, even in the throes of physical strain. In reality, for many people, pregnancy can be one of the most emotionally taxing experiences of their lives.

A 2012 study found that 70 percent of the pregnant women surveyed reported symptoms of anxiety or depression; another study estimates that 8 percent of American women take antidepressants during pregnancy. Some figures put the number of women who will deal with a mood and anxiety disorder during pregnancy at one in five. Yet, despite this, prenatal depression—sometimes referred to as antenatal depression—remains difficult for women to discuss and difficult for medical professionals to disambiguate from preexisting conditions. Intense feelings of worry and sadness, paranoia, sleep disruptions: The symptoms of prenatal depression mimic those of depression unrelated to pregnancy. Plus, carrying a child is an overpowering experience that naturally leads to some big emotions, not all of them good.

Alexandra Sacks, a reproductive psychiatrist with Columbia University Medical Center and the co-author of What No One Tells You: A Guide to Emotions From Pregnancy to Motherhood, commonly sees patients who report emotional distress, worry, and even anger during pregnancy. “These are all natural emotions,” Sacks told me.

Those emotions, and their continuous upheaval during pregnancy, are called “matrescence,” a term that Sacks and her co-author, Catherine Birndorf, reintroduce in What No One Tells You. Coined in the 1970s by the medical anthropologist Dana Raphael, matrescence is described as a time of tumult similar to adolescence. “Adolescence is a transition of development from childhood to adulthood that we associate with adjustment,” Sacks said. “It’s physical, hormonal, emotional. It’s telling that we don’t have a popularized term for motherhood like that.”

Consult any What to Expect–type guide to pregnancy; from the first trimester on, “moodiness” is among the symptoms. The bombardment of hormones (estrogen and progesterone) plays a part; so, too, do fatigue and sleep interruptions, as well as the many other countless, constant shifts a woman experiences in her body.

“The experience of feeling overwhelmed by the enormity of the change is not the same thing as depression,” Sacks emphasized. She diagnoses prenatal depression using a scale designed for postpartum depression, which includes criteria such as how frequently a woman has “felt sad or miserable” or “anxious and worried for no good reason.” Environmental stresses (such as financial or marital strife) and preexisting mood disorders are risk factors for all forms of perinatal depression, including those presenting during pregnancy and those following it. “Many people go into pregnancy already depressed, anxious, or having untreated illness,” Birndorf told me. “Pregnancy, for the most part, doesn’t make it better. It often makes it worse or complicates things, and if it doesn’t get treated during pregnancy, then people end up with postpartum issues.”

Fifteen percent of women will suffer from depression following childbirth—and some of those cases could be prevented by catching depression that starts during pregnancy. What’s more, depression, like any other medical condition, comes with risks for the fetus as well as the mother. Children of women suffering from prenatal depression are twice as likely to be born preterm, and prenatal stressors may affect birth weight, head circumference, and neurological development.

Still, prenatal depression carries a special stigma that often silences pregnant women, ironically at a time when everyone from the canvasser collecting petition signatures to the barista has something to say to them. The writer Jessica Grose, who edits The New York Times’ parenting newsletter and who chronicled her own experience with prenatal depression in a series of articles for Slate in 2012, recently reflected on her illness: “I still feel embarrassed by what I went through, as if needing psychiatric help during pregnancy is a black mark on my maternal report card.”

The days after breaking down at A Pea in the Pod were nervous and fragile. I went about my work and social life, one ear attuned to the station in my mind that had so frightened me.

About a week after the incident, I saw my ob-gyn. In the smooth calm of the hospital, supine and covered by a paper skirt, I reported on the negative thoughts—or the breakdown, as I was calling it to myself—with clarity and confidence, aiming for the objectivity with which I’d describe heartburn or hemorrhoids. My doctor listened and frowned. He asked whether I was seeing a therapist; yes, I said, off and on for two decades. For what? For mild depression, generalized anxiety disorder, and an ever-rotating series of eating disorders. He told me that I was a mother now—time to stop identifying as mentally ill. He didn’t like that I knew the phrase “passive suicidal ideation.” He told me that these were “dark thoughts,” and wrote me a prescription for Zoloft.

I didn’t pick it up. Though medication may be the right choice for other women in my position, I chose instead to work with my therapist to shift my perspective on what emotions I “should” be feeling during pregnancy. I chose to give myself permission to go through matrescence, which like my own adolescence 20 years earlier, proved to be a time both thrilling and fraught.

When it comes to pregnancy, society has, as Grose told me, “a moral halo around anything construed as natural.” This might lead people to believe that there is a right way to be pregnant, or that there is a script for a normal pregnancy. But “there’s a wide range of normal that nobody knows about,” Birndorf told me.

“How distressed are you by these thoughts and feelings that you’re having?” she asks women to consider. “How much is it impacting your functioning? How much is it changing how you move through the world? If those answers to those questions are ‘a lot,’ then you’re talking about something else.”

Normal or natural pregnancy for me, I came to realize, involved the same mild depression I’d been living with for years. The more I looked at my feelings—with the support of my therapist and my husband; in a daily journaling practice; sometimes with friends—the more it helped to think of myself as going through “matrescence.” I was never diagnosed with prenatal depression, perhaps because my depression was not, and will not, be confined to pregnancy. My therapist helped me to acknowledge the fear, the ambivalence, and the profound change that becoming a mother entails. Maybe pregnancy was a chance for me to transform my relationship with depression, with control, and with my body, he offered; maybe I would meet this challenge and give birth to two new people in the fall.

I did not expect that being depressed during pregnancy could lead to wellness, but 10 days from this writing, when I meet my son, I’ll do so knowing that I’m as healthy as I’ve ever been in my life, with greater self-awareness, a firmer grip on my own coping skills, and a clearer voice with which to reach out. “If you can figure out how to help yourself or get the help you need during your pregnancy, you may not end up with a postpartum problem, because you’ve dealt with it during pregnancy,” Birndorf said. If pregnancy is a time to prepare for the arrival of a new life, I’ve done all I can.