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Depression and mood swings during pregnancy

Pregnancy mood swings: how to manage the ups and downs

You’ve probably experienced or heard that pregnant moms have more emotional ups and downs and are prone to cry at the sappiest shows or even commercials. It is truly an emotional time. When you are expecting a baby, you may first experience overwhelming joy, but you may also feel other intense emotions.

Pregnancy is a period of both physical and emotional transition. There are highs and lows and hormonal changes to contend with as you adjust to this significant life change. The support of family and friends can help improve your wellbeing and quality of life during pregnancy. Also, simply being prepared by knowing what to expect and having some helpful tips at the ready can make riding those waves a little easier. Simple things like exercise and taking time to focus on the positive can help (1).

Another practice that can help is taking time to note key pregnancy milestones. Slow down to appreciate the moments along the way such as that first positive test and your first noticeable symptom, the first heartbeat, first ultrasound, first kicks, and moving into the next trimester --even external signs such as your first maternity outfit or when you begin to show and others take notice.


Is it normal to have fear and anxiety during pregnancy?

While there are many positives to celebrate throughout your pregnancy, be prepared to also experience some fear and anxiety. This is natural, and can even be helpful. On a biological level, both the anxiety and fear systems in the brain ramp up during pregnancy. As you near the end of your pregnancy, you may have anxiety about pain during labor or concern about delivery. There is a lot you don’t have control over during pregnancy, and this uncertainty can fuel fearful thoughts. 

Dr. Mary Kimmel, co-director of the perinatal psychiatry program at the University of North Carolina School of Medicine says that fear and anxiety are normal emotions, and people have them for a reason. In pregnancy, these emotions help ensure you keep your baby safe and protected after giving birth. However, it’s important to recognize when you are getting stuck on a particular fear or having trouble coping with it. Those who have had anxiety in the past are more at risk of having it during pregnancy because of the increased stress. Perinatal experts advise pregnant women to be aware of these thoughts and feelings, and to find a place to talk about them and work through the emotions (2).


Is it normal to cry a lot during pregnancy?

Weepiness is certainly normal and something that affects almost every pregnant woman. The experience of pregnancy and new motherhood brings up a complex mix of emotions which leads many women to cry more easily and more often as a way to let those emotions out. Fluctuating hormone levels contribute to weepiness during pregnancy. 

It can be tricky to know when the crying and intense emotions indicate something more serious. If you find you are crying a lot without letting up, it may be a symptom of depression, which can affect about 7% of women during pregnancy, according to the Mayo Clinic. Watch for other symptoms such as losing interest in activities you normally enjoy, or having unusual feelings of guilt or lack of self worth. Depression during and after pregnancy is a serious condition, with health consequences for mother and baby. Healthcare experts encourage women to seek help if they think they may be depressed (3).


Depression in Pregnancy

A pregnant woman is more likely to become depressed than a woman who is not having a baby, according to the Canadian Paediatric Society (4). We used to think that being pregnant was protective against depression as well as other psychiatric illnesses because of high levels of estrogen, but scientists now know this is not the case. A 2019 study published in the journal Obstetrics & Gynecology found that between 2000 and 2015 the rate of depression in women hospitalized during pregnancy increased seven-fold (5).  

Prevalence of depression during pregnancy can be as high as 20%. These are probably conservative estimates, as cases of maternal depression are often underreported or underdiagnosed. Risk factors for depression include genetic predisposition and environmental factors, as well as a number of social, psychological, and biological factors. One factor given increasing consideration is inadequate nutrition (6).


Mood Swings in pregnancy

Changes in metabolism and the hormones estrogen and progesterone contribute to mood swings in pregnancy, as do fatigue and the physical stress of pregnancy on your body. Significant changes in your hormone levels can affect your level of neurotransmitters, which are brain chemicals that regulate mood. Mood swings are most pronounced during the first trimester between 6 to 10 weeks and again in the third trimester (7).

Hormones trigger mood swings during pregnancy, but it’s not only the hormones. Pregnancy discomforts such as nausea, which affects up to 70% of pregnant women, can cause emotional distress as well as physical. Not knowing when and where you might feel sick can add to your unease. Mood swings and their causes and triggers can vary throughout your pregnancy.

Fatigue is a common pregnancy symptom and another source of mood swings. Imagine how moody you can feel any time you aren’t getting enough sleep

Irritability and even anger during pregnancy is another of the emotional mood swings some women experience. This intense emotion is often thanks to hormone changes, just as you might experience irritability right before their period arrives.

Emotional triggers
Uncertainty can lead to anxiety. If you have experienced problems with fertility, pregnancy complications, or a previous miscarriage you are likely to be extra anxious, especially during the first trimester of your pregnancy.

During the second trimester, your body shape begins to change which can be emotional for some women. Prenatal testing during the second trimester also can also cause emotional distress. Even deciding whether or not to have prenatal testing, and anxiety about the results, can be stressful.

There is so much information available to pregnant women today, however it’s best to take it in in moderation and try to maintain perspective. Reading about everything that can possibly go wrong during pregnancy and childbirth, and dwelling on every possible complication, can create unnecessary worry.

Physical discomfort
Increased physical discomfort during the third trimester means it can be difficult to get comfortable, especially at night when you are trying to sleep. Fears and concerns about the upcoming birth can intensify, along with worries about mothering either for the first time or adding a new child to your family.

Another experience you might have during the third trimester is “nesting.” Nesting is when you are suddenly overcome with a desire to prepare for baby’s arrival by cleaning, organizing, and physically preparing your space. Not everyone experiences nesting, and it can be mostly a positive experience. For others it can heighten fears about providing for the new child and lead to anxiety.

What is postpartum depression?

Postpartum depression is clinical depression that occurs following childbirth. It is characterized by symptoms that include sadness, irritability, difficulty bonding with your baby, insomnia, and loss of appetite. Postpartum depression can be very serious, but it is treatable and more common than many people realize. The Centers for Disease Control Prevention reports that approximately 1 in 8 women experience postpartum depression. 

Pregnancy hormones suddenly drop, and many women begin to feel symptoms about 2 days after giving birth just as they are adjusting to caring for a new baby. Drastic mood changes— swinging wildly between periods of elation and joy, followed by despondency and depression—are much easier to manage if you realize that they are based on hormonal shifts and fatigue, but the experience can have a serious effect on your sense of yourself as a mother. If you're feeling overwhelmed by symptoms of postpartum depression, contact your healthcare provider immediately. Only your doctor or counselor can diagnose postpartum depression (8).


Nutrients to help support mood during pregnancy

Good nutrition, exercise, sleep, and taking care of yourself during your pregnancy can go a long way to helping with mood. There are several specific nutrients to pay attention to in your diet and look for in your prenatal multivitamin.

  • Vitamin D - This essential vitamin boosts immunity and mood. A deficiency in vitamin D has been implicated in antenatal (during pregnancy) and postpartum depression. While results of this systematic review vary, they indicate a significant association between vitamin D status and depression (9). Because it is so challenging to get the vitamin D we need, we developed Sunny Skies™ Vitamin D Drops. This supplement helps restore and maintain vitamin D levels without worrying about sun damage.

  • Probiotics - Studies have found positive results with compelling evidence for probiotics alleviating depressive symptoms. Currently, most antidepressants work by altering neurotransmitter activity in the brain to improve these symptoms. However, in the last decade, research has revealed an extensive bidirectional communication network between the gastrointestinal tract and the central nervous system, referred to as the “gut–brain axis.” New advances have linked psychiatric disorders to changes in the microbiome, making it a promising area for novel antidepressant treatments (10). Look for ways to add more probiotics during pregnancy to support a healthy gut-brain connection.
  • Folate and Vitamin B12 - Both low folate and low vitamin B12 status have been found in studies of depressive patients, and research points to an association between depression and low levels (11). Experts recommend oral doses to improve treatment outcomes. There are many reasons to add folate and vitamin B12 during pregnancy. Folate is a key player in methylation, playing a role in making DNA, gene expression, detoxification of cells in the brain, and regulating homocysteine, a critical factor in heart and neurocognitive health. Because folate is so important for healthy neural tube development, it’s an essential vitamin to look for in a prenatal multivitamin. Vitamin B12 is needed to make serotonin, which can help with mood. It is also needed for your body’s energy production, something especially appreciated during pregnancy. Vitamin B12 can help with memory as well. Folate and vitamin B12 deficiencies are associated with metabolic diseases that may impair memory function (12).

  • DHA - Along with the many benefits of DHA, a deficiency has been linked to an increase in depression. Studies show that omega-3 fatty acid deficiency, due to inadequate intake and fast depletion during pregnancy and lactation, is one of the risk factors of postpartum depression. Dietary supplementation during pregnancy or postpartum reduces some symptoms associated with depression. DHA supplementation to healthy pregnant women can also reduce the risk of postpartum depression (13).
  • Calcium, Iron, Selenium, and Zinc - Credible links between nutrient deficiency and mood have also been reported for calcium, iron, selenium, and zinc. In addition, nutrient inadequacies in pregnant women who consume a typical western diet might be much more common than researchers and clinicians realize. A number of studies have reported inadequate intakes of many important nutrients in pregnant women. Depletion of nutrient reserves throughout pregnancy can increase a woman's risk for maternal depression (6). Attention to a healthy diet is essential during pregnancy and supplementation can help you ensure you are getting the nutrition you need. 

Foods that help improve mood

Staying well-nourished is a known way to help stabilize your mood through the ups and downs of pregnancy. A balanced diet of protein, complex carbohydrates (such as fruits, vegetables, and whole grains), and healthy fats is key. In fact, researchers in New Zealand discovered that no food they studied boosts mood or energy as effectively as fruits and vegetables (14). 

  • Whole foods- Consuming a wide variety of fruits, vegetables, legumes (lentils, chickpeas, kidney beans, baked beans, etc) and nuts within the daily diet provides the body with antioxidants and other nutrients which help fight against cell damage in the brain which affects mood and emotions.

  • Omega 3-rich foods- Omega-3 polyunsaturated fatty acids have a profound effect on decreasing rates of inflammation in the body especially in the brain. Inflammation in the brain can cause mood changes and depressive feelings, therefore with a decrease in inflammation a boost in mood will occur. Deep sea fish such as salmon and sardines are great sources of omega- 3s.

  • Daily probiotic and prebiotic-Probiotics are the good bacteria within our gut that aid in digestion of the food we eat but also inhibit harmful bacteria, therefore promoting a healthy digestive tract and overall benefiting the immune system. Examples of probiotic foods include: yogurt and sauerkraut. Prebiotics are the healthy foods that resist digestion so they can make it through to the large intestine where they feed the probiotics (good bacteria). Studies have shown that consuming prebiotics every day can reduce the stress hormone (cortisol) hence improving your mood. Ensure that you’re eating foods like whole grains and legumes every day.
  • Lean protein-Including a variety of lean protein provides the body with protein for active growth of the baby. Once digested, this protein can also help to maintain blood sugar levels to help moderate energy levels as well as stabilising mood through the breakdown of the protein into amino acids, especially tyrosine. Tyrosine has an effect on increasing the levels of hormones to positively enhance mood. This can also be achieved on a vegetarian diet, but it’s helpful to discuss this further with your dietitian.

  • Limit processed and high-saturated fatty foods-Limit foods such as cakes, biscuits, deep fried foods, burgers etc. These foods provide energy but no nutrients for the pregnancy and contribute to excess weight gain and inflammation. Highly processed foods can negatively impact the brain through cell damage, therefore decreasing mood boosting hormones.


    More tips to improve your mood

    In addition to caring for your body with good nutrition and rest, simple activities can help lift your spirits. 

    • Take a break during the day to relax
    • Get regular physical activity
    • Spend time with your partner, friends, and family
    • Go for a walk to change perspective and get moving
    • See a movie or concert with a friend
    • Try pregnancy yoga class or meditation
    • Get a massage

      And overall, try not to be too hard on yourself. Remember that pregnancy is a time of complicated emotions and significant transition in your life. Feeling overwhelmed sometimes is to be expected and won’t last forever.