Starting Treatment for Prenatal Depression: Your Options and First Steps

Getting treatment for depression during pregnancy is the right call. Not just okay — right. Untreated depression during pregnancy carries real risks for you, for your pregnancy, and for the postpartum period that follows. Starting treatment now, while you're still pregnant, is one of the most protective things you can do.

You may have specific concerns: Is therapy safe? What about medication — is it safe for the baby? Where do you even start? These are answerable questions, and the answers are less frightening than you may have expected.

Why Treatment Now Matters

Prenatal depression affects an estimated 10 to 15 percent of pregnant people and is significantly underdiagnosed. Many people assume the emotional difficulty they're experiencing is normal pregnancy stress, or that they should wait until after birth to address it.

Both assumptions have costs. Untreated prenatal depression is associated with:

• Higher rates of preterm birth
• Lower birth weight
• Increased risk of postpartum depression (one of the strongest predictors)
• Elevated cortisol and stress hormones that affect fetal development
• Reduced prenatal care engagement

Treatment, on the other hand, reduces these risks. It also gives you a therapeutic relationship and coping skills in place before birth — which is exactly what you want going into the postpartum period.

You are not doing your baby a favor by enduring depression untreated. You are doing both of you a favor by getting help now.

Your Treatment Options

Therapy: First-Line Treatment

For mild to moderate prenatal depression, therapy is typically the first-line recommendation. Two approaches have strong evidence specifically for depression during pregnancy:

CBT (Cognitive Behavioral Therapy): Addresses the thought patterns and behaviors that maintain depression. It's structured, time-limited (usually 12 to 20 sessions), and focuses on concrete skills. You'll work on identifying and shifting the thinking patterns driving the depression — worthlessness narratives, hopelessness predictions, the all-or-nothing thinking that tends to accompany it — and on building behavioral activation (doing things that provide meaning and connection even when depression makes everything feel flat).

IPT (Interpersonal Therapy): Focuses specifically on the relationship and life transition aspects of depression. Prenatal depression often involves grief over life changes, relationship disruption, role transition, or unresolved interpersonal conflict. IPT addresses these directly. It's particularly well-suited when the depression is significantly connected to relational or role changes.

Both approaches are effective. A therapist trained in either (or both) is an appropriate starting point.

Medication: When It's Appropriate

The most important thing to say about medication during pregnancy is that not treating depression also carries risks. This needs to be part of the conversation, not an afterthought.

SSRIs (selective serotonin reuptake inhibitors) are the most studied class of antidepressants in pregnancy. The [American College of Obstetricians and Gynecologists (ACOG)](https://www.acog.org) is clear: for moderate to severe depression during pregnancy, the benefits of treatment with SSRIs outweigh the risks of untreated depression.

"Safe for most pregnancies" is the consensus language. There are specific considerations — neonatal adaptation syndrome, rare cardiac defects discussed in older research that have not been consistently replicated — that your OB or perinatal psychiatrist can walk you through in the context of your specific situation and history.

SSRIs are considered safe for most people during breastfeeding as well, which is a relevant consideration for people planning to breastfeed.

What this means practically: if therapy alone isn't sufficient, or if your depression is moderate to severe, medication is a reasonable option — not a last resort, and not something to fear. The decision is made with your OB or a psychiatrist who can weigh your specific situation.

Lifestyle Support

Regular exercise (with OB clearance), maintaining social connection, sleep hygiene, and reducing isolation are all supported by research as helpful for depression. They're genuine contributors to wellbeing.

They are not substitutes for clinical treatment when depression is significant. If your depression is affecting your daily functioning, your ability to care for yourself, or your sense of whether life is worth living, lifestyle adjustments are supportive additions to treatment — not the treatment itself.

The Medication Fear: A Direct Response

The fear of taking medication during pregnancy is understandable. You are responsible for a baby's development, and anything that crosses the placenta feels alarming.

Here is what the research supports: SSRIs have been studied extensively in pregnancy — more extensively than most medications — precisely because the population who needs them is large and the question is important. The current evidence is that for moderate to severe depression, the risks of untreated depression are comparable to or greater than the small risks associated with SSRIs.

Not treating depression is not a neutral, safe choice. Untreated depression in pregnancy has measurable effects on the fetus — through elevated cortisol, through reduced prenatal care engagement, through the physiological effects of chronic stress. Deciding not to take medication does not mean choosing "no risk." It means choosing a different set of risks.

The conversation to have — with your OB or a perinatal psychiatrist — is not "should I take medication during pregnancy?" It is "given my specific situation, history, and severity of symptoms, what is the best treatment decision?" That's a clinical question with a clinical answer, not a question to answer alone by avoiding the conversation.

Where to Start

Option 1: Start with your OB or midwife. Describe your mood symptoms. Ask for a screening (the Edinburgh Postnatal Depression Scale, or EPDS, takes two minutes). Your OB can make a referral to a therapist and can discuss medication options. This is a natural starting point if you have an existing relationship with your provider.

Option 2: Go directly to a perinatal therapist. You don't need a referral to book a therapy appointment. Contact a practice that specializes in perinatal mental health, describe your situation, and make an intake appointment. You can continue to loop in your OB for medication conversations separately.

Either path works. The goal is to start.

What to Say

If you're calling your OB: "I think I'm depressed during my pregnancy. I've been feeling [describe: hopeless, unable to find pleasure in anything, persistently low, tearful, unlike myself]. I'd like to discuss treatment options."

If you're calling a therapist: "I'm pregnant and dealing with depression that's affecting my daily life. I'm looking for a therapist with perinatal experience who can work with me now and ideally through the postpartum period as well."

Both of those scripts are enough to get you started.

For more information on the types of therapy available for prenatal depression, see our article on [types of therapy for prenatal depression](/resourcecenter/types-of-therapy-prenatal-depression/). For the medication conversation specifically, our guide on [safe medications for prenatal depression](/resourcecenter/safe-medications-prenatal-depression/) covers what you need to know. For how to talk to your doctor about mental health during pregnancy, see our article on [talking to your doctor about mental health in pregnancy](/resourcecenter/talk-to-doctor-mental-health-pregnancy/).

The therapists at Phoenix Health specialize in perinatal mental health, including depression during pregnancy. Most hold PMH-C certification from Postpartum Support International. You don't have to explain what pregnancy is like or justify why you're struggling — they already understand the context. Learn more about [therapy for prenatal depression](/therapy/prenatal-depression/).