Your Pregnancy Matters

SADFACES: Diagnosing depression and anxiety during pregnancy

Your Pregnancy Matters

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Some “normal” pregnancy symptoms might be signs of depression.

For all the joy and milestones that can come with pregnancy, the hormonal and physical changes you’ll experience can make you tired, emotional, and sometimes a little down.

Many “normal” symptoms of pregnancy overlap with symptoms of depression and anxiety – conditions that can complicate any pregnancy and caring for a newborn.

Crossover symptoms can make it tough for patients and doctors to recognize these conditions during pregnancy and in the first weeks after delivery. At the same time, the rate at which women were diagnosed with depression during pregnancy increased sevenfold between 2000 and 2015, according to the Centers for Disease Control and Prevention.

Left untreated, depression and anxiety can get worse during pregnancy. But how is a woman to know whether her symptoms are “normal” or something more serious?

In our Ob/Gyn practice, we screen patients for anxiety and depression twice: at the first prenatal visit and at the six-week checkup. Some programs screen only at the six-week (postpartum) visit, but we feel it’s important to establish mental health care early, if needed. 

Our anxiety/depression screening survey helps patients identify cognitive (emotional/behavioral) and physical symptoms that follow the acronym SADFACES.

“Left untreated, depression and anxiety can get worse during pregnancy. But how is a woman to know whether her symptoms are “normal” or something more serious?”

Shivani Patel, M.D.

What does SADFACES stand for?

SADFACES represents a range of symptoms to help us determine whether a patient might be suffering from anxiety or depression. SADFACES includes:

  • Sleep disturbances, such as sleeping too much or too little
  • Anhedonia, which means lack of interest in activities and hobbies you once enjoyed
  • Depressed mood
  • Fatigue or loss of energy
  • Appetite disturbances, such as overeating or not feeling hungry
  • Concentration difficulties, including indecisiveness, feeling jittery, and racing thoughts
  • Esteem diminished or guilt without a specific reason
  • Suicidal or recurrent thoughts of death

Symptoms of depression can be physical, with classic symptoms including sleep disturbances, fatigue or loss of energy, or appetite disturbances. But cognitive symptoms such as lack of interest in activities, depressed mood, difficulty concentrating, or guilt are also signs of depression.

However, some physical symptoms are considered “normal” during pregnancy and the postpartum period. For example, early pregnancy can cause fatigue and morning sickness, which can affect the appetite. And new moms who are waking up to feed their babies every few hours, trying to keep up with household responsibilities, and perhaps caring for older children are bound to feel tired or lack energy.

Related reading: 10 North Texas moms share advice for new parents 

Cognitive symptoms are more closely associated with anxiety and depression, and perhaps are a good way to differentiate depression from normal pregnancy or postpartum changes. Feeling jittery, guilty, or in a low mood for no apparent reason are classic depression symptoms that can easily be overlooked or dismissed during pregnancy and the postpartum period. However, physical symptoms are still important in helping us determine the severity of a woman’s condition.

It’s important to be honest with your doctor during your screening. We will never judge you for your responses. These discussions help us recognize symptoms of anxiety and depression early so we can formulate an effective care plan, which might include counseling, medication, or a combination of both.

A few closing thoughts

New and expectant mothers have a lot to look forward to, but this phase of life can be exciting and exasperating. Remember: It’s OK to need support, and it’s OK to accept help. Prioritizing your mental and physical health is one of the best things you can do for you and your baby.

To find out whether you or a loved one might benefit from a prenatal or postpartum mental health screening, call 214-645-8300 or request an appointment online