This week the world watched as the former Meghan Markle opened up about what she was going through as part of the royal family while she was pregnant with baby Archie — and how dark of a place she found herself in.
While the allegations of neglect and racism were eye-opening and shocking, many pregnant women likely found themselves sadly able to relate to another part of the Duchess of Sussex's story: depression during pregnancy.
“It’s actually pretty common,” Dr. Megan Gray, an OB-GYN at Orlando Health Winnie Palmer Hospital for Women and Babies, told TODAY.
The physical side effects of pregnancy are well-known — nausea, fatigue, that telltale swell of the belly. But pregnancy can also have serious effects on a woman’s mental health. And while postpartum depression gets a lot of attention (and rightfully so, as it affects 1 in 9 new moms), depression during pregnancy is equally important to be aware of.
Depression during pregnancy
About 1 in 10 women experience depression during pregnancy, according to the American College of Obstetrics and Gynecologists, but experts believe the number is actually much higher — up to 70% — since the majority of cases may be going undiagnosed. This is partly because some of the symptoms of pregnancy and depression overlap — fatigue, changes in appetite, weight gain, sleep problems — and partly because women may be hesitant to open up about feeling less than positive about their pregnancies.
I don’t like pregnancy at all. It is the worst thing ever. But it is a means to an end. (Yet) society has told women you should love pregnancy and it should be perfect.
Dr. Megan Gray
“We have this societal norm of, ‘Pregnancy is supposed to be beautiful,’” Gray said. “But the reality is, that’s not always the case. I don’t like pregnancy at all. It is the worst thing ever. But it is a means to an end. (Yet) society has told women you should love pregnancy and it should be perfect.”
Sometimes negative feelings about pregnancy are completely normal. But for some women, they can manifest as severe anxiety or depression. And while women who had mental health disorders before pregnancy are especially at risk, no woman is immune.
In an interview with Oprah Winfrey on Sunday, the duchess revealed how she felt terrorized by the press and wasn't receiving the help she needed from the royal institution, which led to suicidal feelings. "I just didn't want to be alive anymore," she said.
Suicidality among pregnant and postpartum women is not uncommon. A report published last fall shows that suicidal ideation and self-harm among women in the year preceding or following childbirth has increased "substantially" over a period of 12 years.
First-trimester depression is definitely a thing
Dr. Navya Mysore, a primary care physician at One Medical in New York City, knows firsthand how feelings of depression can sneak up on a woman in early pregnancy.
“My first trimester was pretty rocky. I had a lot of nausea and vomiting, my fatigue was really outrageous, and I was having a hard time finding the support I needed,” she said. “It sort of blindsided me, and I was like, ‘I’m feeling really down, and really sad.’ It was all these new emotions and also feeling a little isolated.”
She pointed out that these feelings can be especially difficult for women during their first trimester, when they may not have even told family, friends and co-workers that they’re pregnant. Add to that the expectation that pregnancy is a “magical time” when women are “glowing,” and they may feel pressure to put on a happy face.
“They feel like they’re being ungrateful if they say that they’re feeling unwell and having symptoms of depression,” said Dr. Shannon Clark, an associate professor of maternal fetal medicine at the University of Texas Medical Branch in Galveston. “They may also think, ‘This is how all pregnant women feel. I’m not supposed to feel well.’”
Depression can occur at any point during pregnancy. While there's no direct cause-and-effect relationship between pregnancy and depression, there are many reasons that pregnant women might feel less than 100%.
"Your body is going through changes," Gray said. "You're gaining weight. A lot of women have body image disorders — that can play a huge factor. And the fears that come along with pregnancy, as far as, 'My life is changing. What is it going to look like now? How am I going to take care of another person?'"
"There are also significant hormone changes during pregnancy," she continued. "We think the elevation in progesterone may affect mood in someone who has a predisposition for it."
What to do if I’m feeling depressed during pregnancy?
Following ACOG guidelines, all OB-GYNs and midwives should be screening their pregnant patients for perinatal depression. But if you don’t feel like your mental health is being taken care of, speak up — or find a new provider.
For Mysore, finding a new doctor around the end of her first trimester was the answer.
“I found a very lovely OB who is amazing and supportive and she has been very cautious and asks me about my mood and makes sure that doesn’t fall under the rug,” said Mysore, who started to feel better in her second trimester. “(Before), there was a lot of, ‘Oh, you’re a health care provider, so you already know about this.’ And no, I think these experiences are so individual, and it’s not something you can logically think about on your own. Making sure you’re feeling supported and making sure you’re heard is the most important thing.”
If you feel like you can’t talk to your doctor, or don’t have enough time during your prenatal appointments, Clark suggests bringing up how you’re feeling to the nurse who takes your vitals.
“Whatever is told to a nurse during the check-in will make it to the doctor,” said Clark, who added that she gets lots of important information about her patients from her nurses. “And then once the doctor comes in, she might already be expecting to address that.”
Or, women may feel more comfortable bringing up their mental health concerns with a therapist or psychologist, or with their primary care physician.
“It doesn’t necessarily need to be only your OB who’s following you,” Gray said. “But certainly I think it’s important that you have someone to keep an eye on your mood.”
Can you take antidepressants during pregnancy?
Many pregnant women are wary of taking medications during pregnancy.
“There’s the concern, that the doctor will automatically place them on an antidepressant,” Clark said. “But that’s not always the case. Sometimes just following up and counseling will help.”
If a doctor does determine a patient needs to be on medication, or refers a patient to a psychologist who makes that call, there are many options.
While some antidepressants and anti-anxiety medications may be associated with minor risks of birth defects or other developmental issues, many others are safe for pregnant women to take. And in most cases, if a woman needs to be on a medication, the risks of taking that medication are far less than the risks of the mom-to-be going untreated.
“There’s definitely still stigma behind pregnant women who need to take medications for any kind of mental health disorder,” Clark said. “But the fact remains that we need to have a healthy mom to have a healthy baby, and if that means she needs to take medication, that is perfectly fine.”
This story was updated on March 9, 2021.