Depression in pregnancy

It is Tithi’s saadh, and her parents’ flat in Mohammadpur is full. Her khalas slide glass churi onto her wrists, red, green, gold, until her arms chime. There is payesh, there are gifts wrapped in shiny paper, and her cousin announces that the baby kicked during the cricket, so he must be a batsman. “Mashallah, she’s glowing,” says Boro Khala.

Tithi, 29, works at a bank and is good at smiling on cue. Her mother-in-law leans in. “Inshallah a boy this time, na?” Tithi excuses herself, locks the bathroom door, and checks her work email because it is easier than feeling. That night she tells her friend on WhatsApp what she cannot tell anyone in the room. “I’m seven months pregnant and I feel nothing.”

An illustration drawn from common experience. The person is invented; the pattern is not.

Understanding depression in pregnancy

Depression can begin during pregnancy, not only after birth. It brings low mood or numbness, loss of pleasure, poor sleep beyond what pregnancy explains, guilt, worry, tearfulness, and sometimes the frightening sense of not feeling connected to the baby. It is not a lack of love, and it is not ingratitude. Untreated, it can continue after the birth, which is why it matters to recognise it now.

How common is depression in pregnancy?

In a meta-analysis of studies from Bangladesh, the pooled prevalence of depression during pregnancy was 19.5%, although the studies varied widely. A review of 34 studies with 27,379 women in Bangladesh, India and Pakistan found that intimate partner violence, unplanned pregnancy, a family preference for a son, and a poor relationship with in-laws were each linked with depression or anxiety in pregnancy.

Signs and symptoms of depression in pregnancy

• Feeling flat, empty or numb for two weeks or more
• Losing interest in the baby, the pregnancy or things once enjoyed
• Crying easily, or feeling unable to cry at all
• Constant worry, or feeling like a failure
• Sleep and appetite changes beyond what pregnancy brings
• Thoughts that the family would be better off without you

Treatment for depression in pregnancy

UK national guidelines on antenatal mental health list, as an option for moderate or severe depression in pregnancy, a high-intensity psychological therapy such as cognitive behavioural therapy. An antidepressant may be considered when a woman prefers it, declines therapy, or has not improved with it, after she understands the risks of both the medicine and the untreated illness. In rural Pakistan, a CBT-based programme delivered by trained community health workers to women with depression in late pregnancy was followed by far less depression six months after birth: 23% against 53% met the criteria for major depression. A psychiatrist works alongside the obstetrician, checks physical causes of tiredness, and asks gently about safety at home.

What getting better can look like

Tithi’s start might be telling one person the truth, a few sessions where nobody asks about the baby’s sex, and an evening when she puts her hand on her belly and, for a moment, feels the baby move and smiles.

Common questions about depression in pregnancy

Is it normal to feel nothing during pregnancy?

Mixed feelings in pregnancy are common, but weeks of numbness, low mood or loss of interest may be depression. Studies from Bangladesh suggest about one in five pregnant women has depressive symptoms, although the studies varied widely. It is treatable, and asking for help is good for both mother and baby.

Can depression in pregnancy be treated without medicine?

Often, yes. UK guidelines list psychological therapy such as CBT as an option for moderate or severe depression in pregnancy, and medication is considered if needed after discussing the risks and benefits. Never stop or start a medicine in pregnancy without talking to your doctor.

When to see a psychiatrist

If low mood or numbness has lasted two weeks or more during pregnancy, mention it at your antenatal visit or book an appointment. If you have thoughts of harming yourself or feel unsafe at home, call 999.

Care here is personal: built around your history, your health and what you want to change, and reviewed with you as it goes.

Sources

• Hoq et al., Heliyon, 2025 (PMID 39897802)
• Insan et al., PLoS One, 2022 (PMID 35139136)
• Rahman et al., The Lancet, 2008 (PMID 18790313)
• NICE guideline CG192, Antenatal and postnatal mental health (last reviewed 30 May 2025)