Depression During Pregnancy: The Mental Health Problem Nobody Talks About

We talk about postpartum depression — but depression during pregnancy affects up to 20% of Indian women and is almost completely underrecognised. Mrs. Richa Kohli explains why antenatal depression is so easy to miss, what it actually looks like, and why treating it during pregnancy is safe and critically important.

When we talk about perinatal mental health in India — which we do not do nearly enough — the conversation almost always focuses on the postnatal period. Postpartum depression has received increasing recognition in recent years, and that is a genuine advance. But there is a form of depression that is more common than many clinicians realise, affects outcomes for both the mother and the developing baby, and receives almost no public attention: depression that occurs during pregnancy itself.

Depression during pregnancy is called antenatal depression, and it is not the same as being occasionally sad or anxious about a big life change. It is a clinical condition, and it deserves to be taken as seriously as any other complication of pregnancy.

How Common Is It?

The global prevalence of antenatal depression is estimated at 10–20%, depending on the population and the screening tools used. In India, studies have found rates at the higher end of this range — a 2020 systematic review in the Archives of Women's Mental Health estimating 18–20% of pregnant Indian women experience clinically significant depressive symptoms.

These numbers make antenatal depression more common than gestational diabetes in the Indian context — a condition that is screened for at every antenatal visit. Yet routine screening for depression during pregnancy is not standard in most Indian obstetric care settings.

Why It Goes Unrecognised

Several factors conspire to make antenatal depression invisible:

Symptom overlap with pregnancy itself: Fatigue, sleep disturbance, appetite changes, difficulty concentrating, and low energy are all symptoms of clinical depression. They are also common features of normal pregnancy. This makes it easy to attribute the psychological symptoms to the physical experience of being pregnant, and to miss the clinical picture.

Cultural expectations: Pregnancy is framed, culturally and socially, as a time of happiness, anticipation, and gratitude. A woman who is not feeling those things may feel that her experience is wrong or shameful — that she is failing at something she is supposed to find naturally meaningful. This shame makes disclosure harder.

Avoidance of medication: Many women, and some clinicians, are reluctant to consider antidepressant treatment during pregnancy. This is a legitimate concern that deserves a careful, evidence-informed discussion — not blanket avoidance. The risks of untreated antenatal depression are also real, and they affect the baby directly.

What Antenatal Depression Actually Looks Like

Antenatal depression shares many features with depression at other points in life, but its specific context shapes how it presents:

• Persistent low mood, emptiness, or hopelessness that lasts most of the day on most days — not ordinary low days
• Inability to feel pleasure or interest in things that usually matter, including the pregnancy itself
• Intrusive negative thoughts about the pregnancy, the baby, or your capacity as a mother
• Significant anxiety that goes beyond ordinary concern — worry that is excessive, difficult to control, and producing physical symptoms
• Withdrawal from family and social contact — becoming increasingly isolated even when surrounded by people
• Thoughts that you or the baby would be better off if the pregnancy had not happened, or thoughts driven by despair rather than considered decision
• In severe cases, thoughts of self-harm

If you are having thoughts of harming yourself, please reach out to your doctor, a mental health professional, or a hospital immediately.

Why Treating It During Pregnancy Matters — For the Baby, Not Just for You

Untreated antenatal depression is not a private experience that stays inside the mother. The developing baby is directly affected by the maternal hormonal environment, and chronic psychological stress and depression are associated with:

• Elevated cortisol levels, which cross the placental barrier and affect fetal stress system development
• Increased risk of preterm birth
• Lower birth weight
• Altered neurodevelopmental trajectories in infancy and early childhood, including effects on attention, behaviour regulation, and stress reactivity

This is not said to add guilt to an already painful experience — it is said to make clear why seeking treatment during pregnancy is not optional or something to defer. Getting support is one of the most important things you can do for your baby right now.

Is Treatment Safe in Pregnancy?

Psychological therapy: CBT and interpersonal therapy (IPT) are both safe and effective during pregnancy and are the preferred first-line treatment for mild to moderate antenatal depression. A course of structured therapy can produce significant improvement without any medication exposure.

Medication: For moderate to severe depression during pregnancy, the evidence and clinical consensus is clear: the risks of untreated depression to both the mother and the developing baby typically outweigh the risks of a carefully chosen antidepressant at an appropriate dose. SSRIs — particularly sertraline and escitalopram — have the most safety data in pregnancy. The decision to use medication in pregnancy should be made carefully, with full information, between you and your doctor. It should not be made out of fear of the medication alone.

For Those Around a Pregnant Woman Who Is Struggling

The cultural script around pregnancy can make it very hard for a woman experiencing antenatal depression to be honest about it — because the expectation is that she should be happy. If the pregnant person in your life seems withdrawn, tearful, hopeless, or disconnected from the pregnancy — do not minimise it as hormones or as normal adjustment. Ask directly and gently, more than once. Offer to accompany her to an appointment.

You Are Not Failing the Pregnancy

Antenatal depression is not a sign that you are not ready, not capable, or not the right person for this. It is a clinical condition with a biological basis that is occurring at a biologically complex and socially demanding time. It responds to treatment. And the act of seeking that treatment is not a failure — it is the most responsible thing you can do for yourself and for the baby you are carrying.

I am available through a Smart Consultation if you would like to speak with me confidentially about what you are experiencing and understand what kind of support might help.