And for the first seven weeks of my pregnancy, that outlook didnt change. I was able to keep working out, and I was keeping up my usual pace at work.

I couldnt really function in any area of my lifecareer, marriage, activity, etc.

Then the eighth week rolled around, and I was smacked in the face with terrible nausea and vomiting, which I soon recognized as a condition called hyperemesis gravidarum. I felt awful but didnt want to reveal the big news to anyone yet. So I acted as if nothing was wrong as I tried to get through long days at the office. Id hit a wall. I was vomiting in between each patient, and it was difficult to even do the bare minimum.

When I got home each night, I had no energy and crashed without spending quality time with my husband. At that point, I couldnt even make it outside for a walk. But it wasnt just the stomach issues that were bothering me; I was also facing mood swings and unexplained sadness. I couldnt really function in any area of my lifecareer, marriage, activity, etc.

I started to become incredibly isolated, going from the office to home and nowhere else. I was losing my active, ambitious life. I resented having to make decisions based on how I was feeling that day, which often meant canceling plans with friends. I felt I couldnt talk to anyone but my husband about what was going on, and I worried I was burdening him. The strangest part was that throughout those super-low weeks, my ob-gyn never asked how I was doing emotionally or how I was coping. I couldnt believe our checkups were about only my physical condition when I was actually going through the wringer mentally.

I ended up doing my own research on some of the possible causes for my debilitating mood shift and was reminded that even though we hear a lot about postpartum depression, depression can actually occur anytime during the full peripartum period, which encompasses pregnancy and the first year after birth.

The medical community is starting to recognize this: The most recent Diagnostic and Statistical Manual of Mental Disorders expanded its time line for depression and anxiety disorders associated with pregnancy, describing them as peripartum instead of only postpartum. Still, most screenings (its usually a questionnaire) are only offered by ob-gyns after a mom gives birth, despite updated recommendations from the American College of Obstetricians and Gynecologists (ACOG), which advises physicians to screen women earlier and more often throughout the pregnancy phase.

In talking to some of my own primary care patients about their pregnancy experiences, I gathered that mental health convos during the baby journey just arent happening, and its incredibly challenging to get a diagnosis. (Even as a doctor, it was difficult to find resources and help for perinatal depression or any mood issues, and I was never given a formal diagnosis.)

On top of the vulnerability and anxiety, I was struggling to come to terms with the fact that I wasnt having the pregnancy Id imagined. I thought it would be a rosy, beautiful mama moment. In reality, I was questioning if this meant I was going to be a bad mom or didnt really want the pregnancy. Its hard to admit those thoughts, and I carried so much guilt.

Fourteen percent of women who may experience depression specifically while theyre pregnant

Luckily, I found a therapist who was able to help me process my thoughts and feelings. I hired a doula, too, and the two of them became my support system through the first trimester and onward. Acupuncture provided relief as well. I switched to a more empathetic and caring ob-gyn. She took her time with me and cared about my feelings, and I needed that.

As my pregnancy progressed, my mood lifted. The nausea and fatigue faded, and I was able to muster enough energy to exercise again. I could function at work and around friends. I reconnected with the outside world. I was still nervous about becoming a mom, and I didnt feel perfect every day, but I felt more like myself, which was a monumental change.

I want other moms-to-be to know its okay to not enjoy every moment of pregnancyin fact, its normaland that there are options for treatment if you think your mood shifts are indeed signs of depression. Realizing I wasnt alone and seeking out help were turning points for me, and I hope more women can recognize whats going on and find support.

Much more than moody

How the heck are you supposed to discern between garden-variety nervousness ahead of, you know, raising a child, versus depression? During pregnancy, many women might feel they have a really intense version of PMS, says Allison Baker, MD, a psychiatrist at Ammon-Pinizzotto Center for Womens Mental Health at Massachusetts General Hospital. These mood symptoms can be uncomfortable and become clinically significant when they start to impact your ability to function or experience pleasure.

If you start to feel a debilitating sense of sadness, exhaustion, or hopelessness, ask your ob-gyn for a depression screening. Women with previous mental health disorders are also more at risk for mood and anxiety disorders related to pregnancy, likely due to hormonal shifts. Get a referral for a therapist or psychiatrist, who can provide counseling and/or prescribe medication or adjust a current dosage if necessary.

P.S. Its a myth that its not safe to be on psychiatric drugs during pregnancy; the key is figuring out the best treatment plan and weighing the pros and cons of different routes, says Dr. Baker. If your doc isnt listening, consider switching to one who hears you.

This article originally appeared in the October 2019 issue of Women's Health.