Mental Health Problems During Pregnancy Are More Common Than You Think

Pregnancy is often framed as a happy, glowing time, but for plenty of people, it can also be emotionally rough. A long-standing U.K. study found that more than one in four pregnant women experienced some form of mental health problem, including anxiety, depression, eating disorders and obsessive compulsive disorder. Newer Canadian guidance and research point in the same direction: mental health concerns during pregnancy are common, they are varied, and they should not be brushed off.

According to Canada’s guidance on mental health during and after pregnancy, about 80,000 people in Canada are affected each year by perinatal mental illness across pregnancy and the postpartum period. Recent findings from a North American study called the SUMMIT Trial also found that about one in five pregnant and postpartum people experience depression and anxiety, while less than 10 percent receive proper treatment.

“It’s a myth that pregnancy would somehow be protective against mental health issues,” says psychiatrist and researcher Simone Vigod. Anxiety, depression, OCD and PTSD can all show up during pregnancy, she says, and eating disorders, bipolar disorder and other more severe conditions can be part of the picture, too.

Sometimes an existing condition flares up. Sometimes symptoms appear for the first time. There is not always one clear reason why. Pregnancy can bring physical discomfort, isolation, changing relationships, financial pressure and plenty of uncertainty. If you already tend to worry, you may find there are suddenly many more things to worry about.

For some people, body changes can intensify concerns around food, control or weight. For others, a history of trauma or panic can make routine pregnancy experiences, including medical exams and unfamiliar physical sensations, much harder to navigate. That does not mean every bad day or crying spell points to a disorder. But it does mean that if something feels persistently off, it is worth paying attention to.

When it's time to speak up

Some mental health changes are easy to dismiss during pregnancy because so much is already changing at once. But psychiatrist Ryan Van Lieshout says there are a few especially important signs to watch for.

One is a lasting emotional shift from your usual baseline. “If a pregnant person experiences low mood, excessive anxiety, emotional flatness or disconnection for more than two weeks, it is important to reach out for help,” he says.

Another is when your emotional state starts affecting daily life. Maybe you are having trouble working, parenting or functioning normally. Maybe you cannot sleep because your mind will not shut off, not because you are physically uncomfortable. Van Lieshout also says scary or confusing thoughts, including thoughts of self-harm or fears that do not make sense, warrant quicker attention.

What to say at a prenatal visit

One reason people stay quiet is that they feel they need to arrive with the perfect explanation. But Van Lieshout says that is not necessary. “A person does not need to self-diagnose or have the right words to get help,” he says.

A good place to start is by describing what has changed, how long it has been going on and how it is affecting your daily life. That might mean saying that you do not feel like yourself, that small stressors feel much bigger than they used to, or that you are not sleeping because your mind is racing. If it helps, bring notes or a screening questionnaire such as the Edinburgh Postnatal Depression Scale to your appointment.

What help can look like

Support during pregnancy is not limited to one path. Vigod says that for people with milder symptoms, options such as peer support, exercise that is appropriate in pregnancy and help addressing major stressors can make a difference. For more persistent anxiety or depression, therapy, including cognitive behavioural therapy or interpersonal therapy, is often a first-line option. Medication can also be part of the conversation when symptoms are more severe or when therapy is not accessible quickly enough.

Access remains a real problem, which is one reason these issues are so easy to downplay. The SUMMIT findings suggest that there may be practical ways to broaden care: therapy delivered by trained nurses, midwives and doulas, and therapy delivered virtually, can be as effective as specialist and in-person care.

If you feel dismissed

Feeling brushed off can make it even harder to keep going, but it does not mean the concern is not real. Van Lieshout recommends being concrete about how long symptoms have lasted, how different they feel from your baseline and what parts of life are getting harder. Bringing a partner, friend or doula can also help if you worry you will freeze up during an appointment.

Vigod notes that there are other doors into care besides an OB or family doctor. Depending on where you live, that may include a midwife, public health nurse, therapist, hospital-based program or peer support group. She specifically points to Postpartum Support International as a helpful resource for free peer support and next steps.

When symptoms are urgent

Some symptoms need immediate help. Vigod says urgent red flags include feeling like your life is not worth living, making plans to hurt yourself, or showing signs of psychosis, such as confusion, hearing or seeing things that are not there, or believing things that do not make sense.

She also stresses that intrusive thoughts can be terrifying but are not the same as intent to harm a baby. That distinction matters because many people are afraid to disclose frightening thoughts if they think they will automatically be judged as dangerous. If you are having thoughts that scare you, tell a healthcare provider anyway. Clarity is safer than silence.

The bottom line

If you feel emotionally off during pregnancy, it is worth bringing up. You don't need to wait until after birth, nor do you need to be certain before asking for help.