Perinatal Anxiety and Depression: Signs, Screening and Where to Get Help

Pregnancy is supposed to feel happy, and when it does not, many people keep quiet. Anxiety and depression during pregnancy and after birth are among the most common complications of this time, they are not a sign of weakness, and they respond to treatment. This page explains how common they are, what to look for, how screening works, and exactly where to get help.

How common is anxiety and depression in pregnancy?

Very common. The US Preventive Services Task Force (USPSTF) says perinatal depression, a depressive disorder during pregnancy or after childbirth, affects as many as 1 in 7 women and is one of the most common complications of pregnancy and the postpartum period.¹

• Depression: a systematic review of studies using structured clinical interviews found combined point prevalence of major and minor depression ranging from 6.5% to 12.9% at different stages of pregnancy and the first postpartum year.³
• Anxiety: a review of 102 studies with nearly 222,000 women found self-reported anxiety symptoms in 18.2% of women in the first trimester, 19.1% in the second and 24.6% in the third. About 15.2% met criteria for a diagnosed anxiety disorder.²
• Generalized anxiety disorder is estimated at 8.5% to 10.5% during pregnancy, according to the USPSTF.⁷

If you reached this pregnancy after a long time trying, fertility treatment or a loss, it makes sense that worry may come with you. That experience deserves care too.

Signs to look for

Depression and anxiety can look different from what people expect. Talk to your clinician if, for two weeks or more, you notice:

• sadness, emptiness or irritability most days
• losing interest in things you usually enjoy
• feelings of guilt, hopelessness or worthlessness
• worry that is hard to switch off, or panic attacks
• changes in sleep, appetite, energy or concentration beyond normal pregnancy changes
• pulling away from people
• thoughts that you or the baby would be better off without you, or of harming yourself

ACOG's toolkit describes perinatal depression as including changes in appetite, sleep, energy, motivation and concentration, and negative thinking such as guilt, hopelessness and worthlessness, which can include suicidal thoughts.⁵

Who is at higher risk?

The USPSTF suggests counseling for people with one or more of these risk factors: a history of depression, current depressive symptoms that do not reach a diagnosis, low income, adolescent or single parenthood, recent intimate partner violence, elevated anxiety symptoms, or a history of significant negative life events.¹ A history of depression before, during or after a past pregnancy also raises the risk of postpartum depression, according to ACOG.¹⁰

Screening: what to expect

Screening is routine and is meant for everyone, not only people who seem to be struggling.

• ACOG recommends that everyone receiving prenatal and postpartum care be screened for depression and anxiety with standardized, validated instruments, at the initial prenatal visit, later in pregnancy and at postpartum visits.⁴⁵ Common questionnaires include the Edinburgh Postnatal Depression Scale (EPDS), the PHQ-9 and the GAD-7.⁵
• USPSTF recommends screening for depression in adults including pregnant and postpartum persons,⁶ and screening for anxiety disorders in adults 64 or younger including pregnant and postpartum persons (both grade B).⁷

A screen is not a diagnosis. A high score leads to a conversation, a fuller assessment and a plan. It is fine to answer honestly; this is exactly what the questions are for. Expect the first screen at your first prenatal appointment.

What helps: treatment options

Talk therapy

The USPSTF found convincing evidence that counseling interventions, such as cognitive behavioral therapy (CBT) and interpersonal therapy, prevent perinatal depression in people at increased risk, and recommends that clinicians provide or refer them (grade B).¹ In the trials it reviewed, counseling was linked to a 39% lower likelihood of perinatal depression.¹ Therapy can be one-on-one, in a group, or with a partner or family.¹⁰

Medication

Antidepressants are another option, and ACOG notes it can take 3 to 4 weeks to start feeling better.¹⁰ The decision weighs the risks of medication against the risks of untreated illness for you and the baby, so make it with your clinician. Do not stop a prescribed antidepressant suddenly. After birth, ACOG notes that zuranolone is the first medication approved by the FDA for postpartum depression in adults.¹⁰

Online and phone therapy

If local therapists have long waits, telehealth can be faster. When you choose a service, check clinician credentials, whether it has specialists in fertility or perinatal mental health, insurance and price. For perinatal mood and anxiety disorders specifically, the Postpartum Support International HelpLine shares information and local resources.⁸

Free helplines

How partners and family can help

Partners often notice changes first. Gently naming what you see, offering to come to an appointment, taking on night-time or household tasks, and helping make the first call can make a real difference. Partners can call the hotlines too: the National Maternal Mental Health Hotline is open to loved ones.⁸

Next steps

1. If you are in crisis, call or text 988 or call 911 now.
2. Otherwise, tell your ob-gyn or midwife how you have been feeling, or ask for a screening questionnaire. Do not wait for your next routine visit.¹⁰
3. Save the hotline numbers above in your phone.
4. Ask for a referral to a therapist, or explore online therapy options.

If your worry is about a specific symptom, early pregnancy symptoms and miscarriage signs explain what is normal and when to call. After a loss, pregnancy loss support lists organizations that can help. More first-trimester guides are on the Pregnant hub.