PART 1WHAT YOU MIGHT BE NOTICING

Not the glow you were promised.

Anxiety and depression in pregnancy don’t always look the way people expect. Here are some of the things women tell me.

If you’re struggling right now, please read this first

Call 000 or go to your nearest emergency department if you’re having thoughts of ending your life or harming yourself, urges to harm your baby, if you’re seeing or hearing things others don’t, or haven’t slept at all for a couple of nights.

For urgent mental health advice any time, call 1300 MH CALL on 1300 642 255 (Queensland, 24/7) or Lifeline on 13 11 14. See where to go, and how fast ▾

Worry that won’t switch offAbout the baby, the birth, money, whether you’ll be a good mother. It’s there when you wake and when you try to sleep.
Panic or dreadA racing heart, tight chest, or a sudden wave of fear that something terrible is about to happen.
Low, flat or tearyLosing interest in things you used to enjoy, or feeling numb about the pregnancy and guilty that you don’t feel happier.
Irritable and short-fusedSnapping at the people you love, then feeling awful about it.
Frightening thoughtsUnwanted images or thoughts about something happening to your baby, that you’d never say out loud.
Not coping the way you usually doStruggling to work, think clearly or get through the day, when you’re normally the capable one.

Perinatal anxiety and depression affect about one in five mothers in Australia, and they often start during pregnancy, not just after the baby arrives. If this is you, you’re far from alone.

PART 2WHAT’S HAPPENING

It’s rarely just one thing.

When you’re anxious or low in pregnancy, people often put it down to ‘hormones’. Hormones can play a part. But usually it’s a mix of several things stacking up: something in your body, something from your history, and something in your life right now, all landing on a nervous system that’s already working overtime to grow a baby.

That’s actually good news. Because when you know what’s contributing, you can deal with each piece. Some, like low iron or an underactive thyroid, can be treated quickly. Others need support over time. And some you can cross off your list straight away.

That’s what the checklist below is for.

PART 3THE RULE-OUT CHECKLIST

37 things that can contribute, one by one.

Read through each one and tick anything that might apply to you, even a little. Skip what doesn’t. When you’re done, print your list and take it to your GP or midwife, so you don’t have to remember it all on the day. Your ticks stay on this device only.

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BHormones and sensitivity

Pregnancy brings the biggest hormone changes of your life. Some women’s brains are more sensitive to those changes than others.

Your mood has always moved with your hormonesIf you’ve noticed strong mood changes before your period (PMS or PMDD), on the pill, or after a previous birth, you may be more sensitive to the hormone shifts of pregnancy. Tell your GP, as it changes what to watch for.Ask: your GP or midwife
Fertility treatment or a long road to pregnancyIVF hormones, years of hoping, and the fear of losing what you’ve worked so hard for can leave your nervous system on high alert.Ask: your GP or fertility clinic counsellor

CMedicines and substances

Changes to what you take, or stop taking, are one of the most common and most overlooked reasons for a sudden dip.

You stopped antidepressants or anxiety medication when you found outMany women do this out of worry for the baby. In one US study of women with a history of depression, 68% of those who stopped their antidepressant relapsed during pregnancy, compared with 26% who kept taking it. Australian guidelines say antidepressants usually don’t need to be stopped in pregnancy. Please don’t stop or restart anything without talking to your prescriber.Ask: your GP or psychiatrist · soon
Other medication changesStopping or changing ADHD medication, sleeping tablets, pain relief or other regular medicines, or side effects from new ones, can all affect your mood, focus and sleep.Ask: your GP or pharmacist
Caffeine, alcohol, nicotine or other drugsCutting back suddenly can cause headaches, irritability and low mood. Using to cope with how you feel can make anxiety and depression worse. There’s no judgement here, and help is confidential: Adis on 1800 177 833 (Queensland, 24/7).Ask: your GP, midwife or Adis

DYour mental health history

Your history matters, because it tells your care team what to watch for and when to bring in extra support.

You’ve had anxiety or depression beforeThis is the strongest single predictor of anxiety and depression in pregnancy. It doesn’t mean it’s inevitable, but it does mean it’s worth having support in place early.Ask: your GP or midwife
Bipolar disorder, a past episode of psychosis, or a close family member who’s had bipolar or postpartum psychosisThis needs a psychiatrist involved during pregnancy, not just after. The risk of becoming very unwell after the birth is much higher, and a plan made now can make a big difference. Please tell your GP and midwife as early as possible.Ask: your GP for a perinatal psychiatrist referral · now
Intrusive thoughts or OCDUnwanted, horrifying thoughts about something happening to your baby, or even about harming them, are surprisingly common in pregnancy and after birth. They’re distressing precisely because they go against everything you want. Read the intrusive thoughts guide, and tell your GP if they’re taking over.Ask: your GP or a perinatal psychologist
An eating disorder, now or in the pastA changing body, weight checks and food aversions can stir up old patterns. Your midwife can often skip routine weighing or do it without showing you the number.Ask: your GP or midwife
ADHD or autismSensory overload, loss of routine, appointments, and stopping ADHD medication can all push your nervous system past its limit.Ask: your GP or midwife
Depression, anxiety or postnatal depression in your familyA family history can mean you’re more vulnerable. Worth mentioning so your care team can keep an eye out.Ask: your GP or midwife

EThe pregnancy itself

Pregnancy is a huge transition, and it can bring up fears and feelings nobody warned you about.

A previous miscarriage, stillbirth or lossMany women can’t relax until they pass the point where they lost a baby before, and grief can resurface with a new pregnancy. The Gidget Foundation supports parents after pregnancy loss.Ask: your GP, midwife or Gidget Foundation
A previous difficult or traumatic birthFlashbacks, nightmares or dread as the due date gets closer can be signs of birth trauma. Telling your midwife or obstetrician can change how they plan this birth with you.Ask: your midwife or obstetrician
An intense fear of birthSome fear is normal. An intense, overwhelming fear (sometimes called tokophobia) is common, recognised and very treatable. You can ask for a birth plan meeting to talk it through.Ask: your midwife or obstetrician
Worry about the baby’s healthWaiting for scans and test results, or living with a complication, keeps your system on alert. Ask for clear information and a contact person for questions.Ask: your obstetrician or midwife
Mixed feelings about being pregnantNot feeling the glow, an unplanned pregnancy, or grieving the life you had before are all more common than people admit. Ambivalence doesn’t make you a bad mother.Talk to: someone you trust, or a perinatal counsellor
Losing your sense of selfChanges to your body, career, independence and how others see you can shake your identity, especially if you’re used to being capable and in control.Talk to: a perinatal counsellor or therapist

FWhat you’ve lived through

Becoming a parent has a way of bringing the past to the surface, even things you thought were long behind you.

A difficult childhood, or a hard relationship with your own motherPregnancy often brings up questions about how you were parented, and old feelings can return with surprising force.Talk to: a trauma-informed therapist
Past sexual assault or abuseInternal examinations, being touched, and the loss of control in pregnancy and birth can trigger old memories. You’re allowed to ask for a female practitioner, to have someone with you, and to stop an examination at any time.Talk to: your midwife, and a trauma-informed therapist
Other traumaPast accidents, medical trauma, losses or frightening experiences can resurface when your body and your life feel out of your control.Talk to: a trauma-informed therapist

GRelationships and safety

Who’s around you, and whether you feel safe with them, has a huge effect on how you feel.

Feeling unsafe or controlled at homeDomestic violence can start or get worse in pregnancy. In an Australian survey, a quarter of women abused during pregnancy by a former partner said the violence began during the pregnancy. Partner violence in pregnancy is linked with around three times the odds of high depression symptoms after birth. Your midwife will usually ask about safety when you’re on your own. Read the coercive control guide, or call DVConnect Womensline on 1800 811 811 (24/7).Talk to: your midwife, DVConnect or 1800RESPECT
Strain with your partner, or not enough support from themArguments, feeling alone in it, or doing this without a partner can leave you carrying everything yourself.Talk to: someone you trust, or a counsellor
Not enough support around youFamily far away, a recent move or migration, friends who aren’t at the same stage, or nobody to talk to honestly can make everything feel heavier.Ask: your midwife about local groups and support

HLife right now

Practical pressures matter. They’re not ‘just stress’, and they’re not a sign you can’t cope.

Money, housing or work worriesJob security, parental leave, the cost of a baby or unstable housing keep your nervous system braced for what’s next.Talk to: a social worker at your hospital
Big stresses or losses at the same timeA death in the family, illness, a house move or other major changes on top of pregnancy can be too much for any nervous system.Talk to: your GP or a counsellor
High expectations of yourselfIf you’re used to planning, achieving and being in control, the uncertainty of pregnancy and pressure to ‘do it right’ can be especially hard, as can the feeling that you ‘should’ be happy.Talk to: a therapist
Already caring for other childrenExhaustion, guilt about how much you can give them, and very little time to rest or look after yourself.Ask: your midwife about practical support

Ticked something in pink? Please don’t wait. Those need a conversation with your doctor soon.

PART 4WHERE TO GO, AND HOW FAST

Match the help to how you’re feeling.

If you’re not sure which of these fits, go with the more urgent one. Nobody will think you’re overreacting.

Right now · don’t wait
Call 000 or go to your nearest emergency department
- You’re having thoughts of ending your life or harming yourself
- You have urges or plans to harm your baby or someone else (different from unwanted intrusive thoughts that horrify you)
- You’re seeing or hearing things others don’t, or have beliefs others find strange or frightening
- You feel very confused, ‘high’ or racing, or haven’t slept at all for a couple of nights
- You can’t keep any fluids down, or you have chest pain, fainting or severe breathlessness
Call 000. For urgent mental health advice any time, call 1300 MH CALL on 1300 642 255 (Queensland public mental health, 24/7), or Lifeline on 13 11 14.
Within a day or two
Call your GP, midwife or hospital antenatal clinic and ask to be seen urgently
- You’ve felt anxious, low or numb most days for two weeks or more
- You can’t sleep even when you have the chance, or you’ve stopped eating properly
- You’re having panic attacks, or you’re struggling to get through work or the day
- You’ve stopped medication, or you have a history of bipolar or psychosis
- You ticked something in pink on the checklist
Say: “I’m pregnant and my mental health is getting worse. I need an appointment soon.” While you wait, you can talk it through with PANDA on 1300 726 306.
This week
Book a long appointment with your GP
- You’re coping, but the worry or low mood keeps coming back
- You’ve noticed you’re not yourself, or people close to you have
- You’ve ticked a few things on the checklist and want them looked at
Take your printed checklist. You can also do PANDA’s free online mental health checklist first, so you have something to show your GP.

PART 5THE PATHWAY

Getting help, step by step.

This is the route most women take in Australia. You can start at any step.

Tell your midwife, obstetrician or GP
Australian guidelines recommend every pregnant woman is asked about her mental health early in pregnancy and at least once later on, usually with a short questionnaire called the Edinburgh scale (EPDS). Answer it honestly. It isn’t a test you can fail, and it’s how they know to help.
Rule out the physical causes
Ask for blood tests for your thyroid, iron and blood count, and B12 and folate, and ask whether vitamin D is worth checking. Talk about your sleep, nausea, pain and anything else from section A.
Review your medicines
Talk to your GP, obstetrician or psychiatrist about anything you’ve stopped, started or are worried about. Many medications can be safely continued in pregnancy, and the risks of untreated anxiety and depression need weighing too. Never stop suddenly.
Get the right support
Your GP can write a Mental Health Treatment Plan, which gives you Medicare rebates for sessions with a psychologist (ask for one with perinatal experience). The Gidget Foundation offers up to 10 free sessions with a perinatal psychologist, in person or by video, from pregnancy until your baby turns one. If you’re not sure where to start, ForWhen will help you find local services.
Bring in specialist care if needed
If symptoms are severe, or you have a history of bipolar or psychosis, ask for a referral to a perinatal psychiatrist, either privately or through your hospital’s perinatal mental health service. For women who become very unwell, Queensland has inpatient mother and baby units, such as Catherine’s House at the Mater in South Brisbane, with more being built across the state for women during pregnancy and up to two years after birth.
Make a plan for after the birth
The weeks after birth are a vulnerable time too, especially if you’ve struggled in pregnancy. Agree who’ll help with sleep and night feeds, who you’ll call if things slide, and make sure your midwife and GP know your history. Guidelines recommend checking in again 6 to 12 weeks after the birth.

Asking for help in pregnancy isn’t a sign you can’t cope. It’s looking after both of you.

WHY THE USUAL ADVICE HASN’T HELPED

“It’s just hormones” isn’t an answer.

“It’s just hormones” and “every pregnant woman worries” can leave you feeling dismissed, and can mean treatable causes get missed.

“Just think positive” or “you should be grateful” adds guilt and shame to something that was never a choice.

Waiting for it to pass after the birth is risky. Anxiety and depression that start in pregnancy often carry on after the baby arrives, and early support makes a real difference.

WHERE I COME IN

Body first. Then the rest.

I’m not a doctor or a midwife, so the medical checks come first. If something physical or hormonal is driving how you feel, treating that is the priority. And if you have bipolar or a history of psychosis, a perinatal psychiatrist should be leading your care.

Alongside your medical team, I help with what’s going on in your nervous system: the constant worry, fear of birth, a past traumatic birth or loss, and the old wounds that pregnancy can bring back to the surface.

If we’re already working together, bring your printed checklist to our next session, and tell me what your GP or midwife has said. If you’re feeling worse, or ticked anything in pink, please tell me straight away.

WHERE TO GET SUPPORT

You don’t have to work this out on your own.

Emergency000Police · ambulance · 24/7If you or your baby are in danger, or you have any of the ‘right now’ signs above.
1300 MH CALL1300 642 255Queensland · free · 24/7Queensland’s public mental health line. Mental health clinicians can give advice in a crisis and connect you with your local public mental health service.
PANDA Helpline1300 726 306Australia-wide · free · 7 daysFor expecting and new parents, partners and families. 9am to 7:30pm weekdays, 9am to 4pm weekends and public holidays. Not a crisis line.
Gidget Foundation1300 443 438Australia-wide · free sessionsUp to 10 free sessions with a perinatal psychologist, in person or by video, from pregnancy until your baby turns one. Also supports parents after pregnancy loss. Weekdays 9am to 5pm.
ForWhen1300 24 23 22Australia-wide · free · weekdaysHelps you find the right perinatal mental health services near you. 9am to 4:30pm weekdays.
Lifeline13 11 14Australia-wide · 24/7If you’re in crisis or having thoughts of harming yourself.
DVConnect Womensline1800 811 811Queensland · free · 24/7If you don’t feel safe at home. Crisis counselling, safety planning and emergency accommodation.
Your GP, midwife or obstetricianYour starting pointTake your printed checklist and ask for a long appointment. You can say as much or as little as you’re ready to.

WHERE THIS INFORMATION COMES FROM

Sources.

Information on this page comes from Australian clinical guidelines, Australian government and health organisations, and peer-reviewed medical journals.

Perinatal mental health guideline: summary for GPsCentre of Perinatal Excellence (COPE), 2023Australia’s national guideline: screening in pregnancy, EPDS, psychosocial assessment and antidepressants.
PANDA National HelplinePerinatal Anxiety & Depression AustraliaHelpline hours, who it’s for, and the free online mental health checklist.
Relapse of major depression during pregnancy (Cohen et al., JAMA 2006)American Family Physician summary68% of women who stopped antidepressants relapsed, compared with 26% who continued.
Psychological morbidity associated with hyperemesis gravidarumMitchell-Jones et al., BJOG, 2016Women with severe pregnancy sickness had much higher depression and anxiety scores.
Domestic violence and perinatal mental disordersHoward et al., PLoS Medicine, 2013Partner violence in pregnancy linked with around three times the odds of high postnatal depression symptoms.
Domestic and family violence, pregnancy and early parenthoodAustralian Institute of Family StudiesAustralian figures on violence that starts during pregnancy.
Extra beds to keep mums and bubs togetherQueensland HealthQueensland’s public mother and baby units, for pregnancy up to 24 months after birth.
Suicide prevention in expectant and new mothersLife in Mind (Dr Nicole Highet, COPE)Perinatal anxiety and depression affect one in five mothers in Australia.

ABOUT THE AUTHOR

Sarah Buckle

Women’s Specialist Psychotherapist · Brisbane-based, online worldwide

I work with intelligent, capable women experiencing anxiety, panic, trauma and low confidence. I don’t teach coping techniques. I work with my clients to resolve the patterns driving their symptoms. Sessions are online, so I work with women wherever they are in the world.

MEET SARAH ▸

WOMEN’S SPECIALIST PSYCHOTHERAPIST Private Online Therapy · Worldwide · Brisbane-Based Client resources. Anxious or low while pregnant? Let’s find out why.

Not the glow you were promised.

It’s rarely just one thing.

37 things that can contribute, one by one.