Treatment Options for Depression During Pregnancy: Your Complete Guide

Risks of Untreated Prenatal Depression:

• For Mother: Poor prenatal care adherence, nutritional deficiencies, substance use, suicidal ideation, 50-75% risk of postpartum depression
• For Baby: Preterm birth, low birth weight, altered fetal stress response, infant behavioral difficulties, long-term developmental impacts
• For Family: Relationship strain, impaired attachment, reduced parenting capacity postpartum

"I was terrified to take medication during pregnancy. But my therapist helped me understand that my untreated depression was already affecting my baby through stress hormones, poor nutrition, and skipped prenatal appointments. Treatment wasn't just for me—it was protecting my baby."

— Rachel, treated for prenatal depression with therapy + medication, healthy baby born at term

How it works: CBT helps you identify and change negative thought patterns and behaviors that contribute to depression.

What you'll do in CBT:

• Identify automatic negative thoughts ("I'm going to be a terrible mother")
• Challenge cognitive distortions (all-or-nothing thinking, catastrophizing)
• Develop coping strategies for pregnancy-specific stressors
• Behavioral activation (re-engaging with activities that bring joy)
• Problem-solving skills for practical challenges

Evidence: CBT shows 50-60% response rates for prenatal depression, with effects lasting into the postpartum period.

How it works: IPT focuses on improving relationships and social functioning, addressing interpersonal conflicts that contribute to depression.

What you'll do in IPT:

• Address role transitions (becoming a parent, identity changes)
• Improve communication with partner and family
• Resolve interpersonal conflicts (relationship strain, family tensions)
• Process grief (loss of pre-pregnancy life, pregnancy complications)
• Build social support networks

Evidence: IPT is equally effective as CBT for prenatal depression and may be particularly helpful when relationship issues are central.

• Seek a perinatal specialist: Our postpartum depression therapy in Austin specializes in both prenatal and postpartum depression, using evidence-based approaches like CBT and IPT. PMH-C certified therapists understand pregnancy-specific challenges
• Telehealth options: Online therapy makes treatment accessible even during pregnancy fatigue
• Insurance coverage: Most plans cover prenatal mental health (check your benefits)
• Frequency: Typically weekly sessions for 12-16 weeks, then maintenance
• Group therapy: Prenatal support groups combine therapy with peer connection

Most commonly prescribed during pregnancy:

• Sertraline (Zoloft) — Most extensively studied, considered first-line
• Escitalopram (Lexapro) — Good safety profile, effective
• Fluoxetine (Prozac) — Longer half-life, extensive data
• Citalopram (Celexa) — Similar to escitalopram, well-tolerated

Safety Data:

• No increased risk of major congenital malformations (birth defects) with first-line SSRIs
• Small increased risk of persistent pulmonary hypertension (PPHN: 3-6 per 1,000 vs. 1-2 per 1,000 baseline)—but absolute risk remains very low
• Possible neonatal adaptation syndrome (temporary irritability, jitteriness in first few days—self-limiting, not dangerous)
• No long-term neurodevelopmental impacts observed in children exposed in utero
• Benefits outweigh risks for moderate-to-severe depression

Medications to Avoid During Pregnancy:

• Paroxetine (Paxil) — Small increased risk of cardiac defects (first trimester)
• Benzodiazepines (Xanax, Ativan) — Risk of cleft palate (first trimester), neonatal withdrawal
• Valproic acid (mood stabilizer) — High risk of neural tube defects
• Lithium — Risk of cardiac malformations (first trimester)

If you're taking any of these medications, do not stop abruptly. Consult your provider about safer alternatives.

Do NOT stop your medication abruptly. Sudden discontinuation can trigger:

• Rebound depression (often worse than before treatment)
• Withdrawal symptoms (dizziness, nausea, anxiety, irritability)
• Increased risk of relapse during pregnancy and postpartum
• Potential harm to pregnancy from severe depression

Instead: Schedule an urgent appointment with your prescribing provider to discuss risks/benefits of continuing vs. switching vs. tapering. For most women on effective medication, continuing is the safest option.

Why Combination Treatment Works:

• Medication stabilizes brain chemistry (improves mood, sleep, appetite)
• Therapy addresses thought patterns and behaviors (provides coping skills)
• Faster symptom relief compared to therapy alone
• Lower relapse rates postpartum
• Can eventually taper medication while maintaining gains from therapy

"I started therapy when I was 14 weeks pregnant, but my depression was so severe I couldn't engage with it. After adding medication at 18 weeks, I finally had enough mental space to benefit from therapy. By my third trimester, I felt like myself again—and my baby was born healthy."

— Kristin, combination treatment for severe prenatal depression

Moderate exercise (approved by your OB) has antidepressant effects comparable to medication for mild depression:

• Prenatal yoga (reduces cortisol, improves mood)
• Walking 20-30 minutes daily (safe for most pregnancies)
• Swimming or water aerobics (low-impact, cooling)
• Strength training with modifications (boosts endorphins)

• Prenatal support groups (in-person or online)
• Regular contact with supportive friends/family
• Partner involvement in treatment planning
• Postpartum Support International (PSI) online meetings
• Peer mentorship programs

⚠️ Approaches to Avoid:

• St. John's Wort — Not safe during pregnancy (interferes with hormones, multiple drug interactions)
• SAMe (S-Adenosyl methionine) — Insufficient safety data in pregnancy
• High-dose folate alone — May help prevent depression but is not a treatment
• Unregulated supplements — Always consult your OB before taking herbal products

Questions to Ask Your Provider:

• "How severe is my depression on a clinical scale?"
• "What are the specific risks of untreated depression for me and my baby?"
• "If I start with therapy alone, what timeline should we expect for improvement?"
• "Which medications have the most safety data during pregnancy?"
• "What monitoring will I need if I take medication?"
• "Can I breastfeed while on this medication?"
• "What's the plan for postpartum continuation or tapering?"
• "Who should I contact if symptoms worsen or I have side effects?"

• Mild depression: Psychotherapy first-line (CBT or IPT), exercise, light therapy, social support
• Moderate depression: Psychotherapy + medication OR therapy alone with close monitoring
• Severe depression: Combination therapy + medication, possibly intensive outpatient program
• Suicidal ideation: Immediate psychiatric evaluation, intensive treatment (partial hospitalization or inpatient)
• Already on effective medication: Usually continue during pregnancy (abrupt discontinuation is riskier)

We offer:

• Evidence-based psychotherapy (CBT, IPT)
• Medication consultation and monitoring
• Coordination with your prenatal care team
• Telehealth and in-person options in North Austin
• Flexible scheduling for pregnancy fatigue and appointments
• Continuity of care into the postpartum period

• Maternal Mental Health Hotline: 1-833-943-5746 (24/7)
• Postpartum Support International: www.postpartum.net
• MotherToBaby (Medication Safety): 1-866-626-6847 | mothertobaby.org
• MGH Center for Women's Mental Health: Evidence-based information on perinatal medication
• Related Article: Recognizing Prenatal Depression Early