Mental health in pregnancy: anxiety, depression and getting help

How common, and what it looks like

Antenatal depression and anxiety affect a substantial proportion of pregnancies — studies in India have found rates comparable to or higher than postnatal depression, and considerably higher in women facing poverty, domestic violence, or pressure over the baby's sex.

Ordinary pregnancy worry comes and goes, responds to reassurance, and does not stop you functioning. What needs attention is different: low mood most of the day, most days, for two weeks or more; loss of interest in everything; hopelessness; constant anxiety that will not settle; panic attacks; intrusive frightening thoughts; or feeling detached from the pregnancy.

Physical signs overlap confusingly with pregnancy itself — exhaustion, poor sleep, appetite changes — which is one reason it gets missed.

Risk is higher with: a previous episode of depression or anxiety, a previous pregnancy loss, an unplanned pregnancy, a difficult relationship, financial strain, isolation from family, or a history of infertility treatment.

And specific to India: pressure about the sex of the baby, living with in-laws in a difficult household, and the expectation to be visibly joyful throughout all contribute, and all go unmentioned at appointments.

Treatment, and what is safe

Talking therapy is first-line for mild to moderate depression and anxiety in pregnancy, and it works. Cognitive behavioural therapy and interpersonal therapy have the best evidence.

Medication is used in pregnancy where it is needed, and the decision is a balance rather than a prohibition. Untreated moderate or severe depression carries its own risks in pregnancy — poor attendance at antenatal care, poor nutrition, substance use, preterm birth, and a much higher risk of postnatal depression.

If you are already on an antidepressant and discover you are pregnant, do not stop it suddenly. Stopping abruptly is a common cause of relapse. Speak to your doctor first.

Some medications are preferred over others in pregnancy, and a psychiatrist can advise on the specific drug rather than the general question. Ask for a referral rather than deciding alone.

Practical things that genuinely help alongside treatment: sleep, daylight, movement, and one person who knows. None of these replace treatment for moderate or severe illness.

Beware of being told to simply be positive for the baby's sake. It is the most common advice given and it adds guilt to illness.

When to see a doctor

Raise it at your next antenatal appointment. If you are not asked — and in most Indian settings you will not be — say it yourself: 'I want to talk about how I'm feeling.'

Seek help within days for: low mood most of the day for two weeks or more, inability to function, panic attacks, not sleeping even when you have the chance, or feeling nothing at all about the pregnancy.

Same day, urgently: any thought of harming yourself or of not wanting to be alive, any thought of harming the baby, hearing or seeing things others do not, or beliefs that feel unshakeable and frightening. Tele-MANAS on 14416 is free, confidential and round the clock; 112 is the emergency number.

Also seek help if you are experiencing violence or coercion at home. This is a major and under-recognised contributor, and it is a medical issue as well as a safety one. The national women's helpline is 181.

This article is general information, not medical advice, and has not been reviewed by an obstetrician or a psychiatrist.

This article is general information, not medical advice, and is no substitute for personal medical advice. For any decision about your or your child's health, please consult your doctor.

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