If you are reading this from the bathroom floor, a dark bedroom, or a hospital bed with an IV in your arm, I want you to hear this first: you are not being dramatic, you are not weak, and you are not failing at pregnancy.
You may also be feeling something that nobody warned you about. Not just sick, but sad. Flat. Hopeless. Maybe even a little scared of your own thoughts.
If that is you, there is a reason. Hyperemesis gravidarum (HG) and depression are closely connected, and the research says so. Let me walk you through what we know, why it happens, and what actually helps. Hi I’m Alexa, licensed therapist, mom of two and founder of Therapy For California Moms.
First, what hyperemesis gravidarum is (and what it is not)
Hyperemesis gravidarum is severe, persistent nausea and vomiting during pregnancy. It is a different thing from the "morning sickness" people joke about. An estimated 0.3 to 3 percent of pregnancies are affected, depending on the study, and it often involves weight loss, dehydration, trouble keeping down fluids, and sometimes hospital stays for IV fluids or medication.
It is not caused by anxiety, and it is not a sign that you did something wrong or that you do not want your baby. It is a medical condition, and it deserves real medical care from your OB, midwife, or maternal-fetal medicine team.
I am a therapist, not your doctor, so I will leave the medical treatment of HG to your care team. What I want to talk about is the part that often gets skipped: what HG does to your mind.
What the research says about HG and depression
You are not imagining the link. Researchers keep finding it.
A large Finnish study published in The Lancet Psychiatry in 2025 followed more than 4,000 women with HG and over 300,000 women without it. Women with HG were much more likely to have a history of depression before pregnancy (8.8 percent compared with 1 percent). They were also more likely to be diagnosed with new depression after the pregnancy (4.9 percent compared with 1 percent). You can read a summary at Contemporary OB/GYN.
A UK study from Imperial College London, published in BMJ Open in 2020, followed 214 women. Among women with HG, 49 percent had depression during pregnancy, compared with 6 percent of women without significant nausea and vomiting. After birth, 29 percent of the HG group had postnatal depression, compared with 7 percent of the comparison group. The summary is available at MIDIRS.
A Dutch follow-up study of women who had been admitted to the hospital for HG found that depression, anxiety, and trauma symptoms were common years later. It was a small follow-up group, so I hold the numbers loosely, but the authors' conclusion matches what I hear from moms: this does not always disappear when the nausea does. You can find it on PubMed.
A few honest caveats. These studies show an association, not proof that HG causes depression. Some women with HG already had depression before pregnancy, and some of the numbers come from small groups. Researchers have suggested that shared biological sensitivities may play a role, but that is a hypothesis, not a settled fact.
What I can tell you without any hesitation is this: if you have HG and you feel depressed, you are in very common company, and it is treatable.
Why HG and depression show up together
When I sit with moms who have had HG, the same themes come up again and again. Both things can be true: your body is struggling, and your mind is carrying a heavy load because of it.
1. Your body is running on empty
Weeks of vomiting, poor sleep, dehydration, and barely eating wear down your whole system. Exhaustion alone can look a lot like depression. Constant physical misery also makes it nearly impossible to do the things that usually keep your mood steady: moving your body, seeing friends, getting outside, eating a meal you enjoy.
2. You are isolated, often for months
HG can take you out of your life. You cancel plans. You stop going to work, or you drag yourself through it. You cannot be around food smells, so you cannot be around your own kitchen, your family dinner, or your coworkers. A lot of moms tell me they spent most of their first and second trimester alone in one room.
Isolation is one of the most reliable ways to push mood downward, and HG builds it in.
3. You lose pieces of who you are
Many of the moms I work with are capable, driven women who run teams, households, and calendars. HG takes that away overnight. Suddenly you cannot work, cannot drive, cannot care for your older kids the way you want to, and cannot even take a shower without needing a nap.
That loss of identity and independence is a real grief. It rarely gets named, and it feeds depression.
4. You are not believed, or you are told to push through
"Have you tried crackers?" "It will pass." "Everyone gets morning sickness." If you have heard some version of this from friends, family, or even a provider, you know how lonely it feels to be minimized while you are suffering.
Being dismissed teaches you to stop reaching out. Then you are sick, alone, and silent.
5. You feel guilty about not enjoying pregnancy
You wanted this baby. Maybe you worked hard or waited a long time for this pregnancy. And now you are lying on the bathroom floor wondering whether you can survive another week.
That clash between what you thought pregnancy would feel like and what it actually feels like is painful. Many moms tell me they feel ashamed, ungrateful, or like a bad mother for having thoughts like "I cannot do this." You are not. Mixed feelings are not a character flaw. They are a human response to an overwhelming experience.
6. Fear of what comes next
"Will it ever stop?" "What if it happens again?" "How am I going to take care of a newborn after this?" HG leaves a lot of moms in constant anticipatory dread, and for some, it feels like trauma.
Is it depression, or is it just HG exhaustion?
This is one of the most common questions I get, and it is a fair one, because the two overlap. Here are some signs it may be more than the physical toll of HG.
Talk to someone if you notice:
You feel sad, empty, or numb most of the day, even during the moments when your nausea eases up
You have lost interest in things you usually care about, including the baby, and it is not just because you feel sick
You feel hopeless, as in "this will never get better," not just "this is awful right now"
You feel worthless, like a burden to your partner or family
You are crying a lot, or you feel unable to cry at all
You are anxious all the time, with racing thoughts you cannot shut off
You are having intrusive or scary thoughts
You feel detached from your pregnancy or from your baby
You are sleeping far too much or far too little, beyond what nausea explains
You have thoughts of harming yourself or feel like you do not want to be here
That last one deserves its own line. If you are having thoughts of hurting yourself or ending your life, please reach out right now. You can call or text 988 (the Suicide and Crisis Lifeline), or call or text the National Maternal Mental Health Hotline at 1-833-852-6262, available 24/7. If you are in immediate danger, call 911.
You do not need to be at a breaking point to deserve support. If something in this list sounds like you, that is enough reason to ask for help.
HG can leave a mark that has nothing to do with nausea
For some women, HG is not just physically hard. It is traumatic. You may have been hospitalized more than once, felt out of control, or been through experiences where you were not heard. Afterward, you might notice:
Flashbacks or nightmares about the worst weeks
Panic or a racing heart when you smell certain foods or return to the hospital
Strong dread about future pregnancies
Feeling numb, on edge, or easily startled
If this sounds familiar, you are not overreacting. Trauma-informed therapy can help. If your pregnancy or birth did not go the way you expected, you may also find it helpful to read my post on birth trauma therapy in California.
What actually helps
There is no single fix, and I will not pretend there is one. But there are a lot of things that make a real difference.
1. Treat the HG and the mood together
Please tell your OB, midwife, or prescriber how you are feeling emotionally, not just physically. Mental health is part of good HG care, and a good provider wants to know. Depression during pregnancy is treatable, and there are options your prescriber can go over with you, including therapy and, when appropriate, medication.
2. Get therapy that fits your reality
I will say this plainly because it matters: therapy for moms with HG has to be built around how sick you are. That might mean shorter sessions, lying down during a session, taking breaks, or turning off your camera when the nausea hits. It does not need to look like the therapy you pictured.
In therapy, we can work on:
Naming the grief of what HG has taken from you, without judgment
Calming the anxiety and dread that build when your body feels out of control
Challenging the harsh stories in your head (the "I am failing" and "I should be grateful" ones)
Processing trauma if the experience has left you shaken
Rebuilding connection with your partner, your support people, and yourself
Planning ahead for postpartum and for any future pregnancy
3. Choose virtual care, because it is built for this
When you can barely sit up, the idea of driving to an office is a nonstarter. Virtual therapy lets you get support from your bed, your couch, or wherever you feel least terrible. It also means you can see a therapist who understands HG, no matter where you live in California.
4. Shrink your world and protect your energy
You do not need to be productive. A few things moms tell me help:
Lower the bar on everything that is not essential
Ask one specific person for one specific kind of help ("Can you take the kids Saturday morning?")
Set up a low-effort check-in, like a daily text with one trusted person
Accept that "surviving today" counts as a full day's work
5. Find people who understand
Online communities for HG can make you feel less alone, and Postpartum Support International (postpartum.net) offers support for moms during pregnancy as well as postpartum. The HER Foundation also offers education about hyperemesis. Being with people who have been there can shift your whole outlook.
Does it end at delivery?
For many moms, the nausea fades after birth, but the emotional side does not always follow the same schedule. Research suggests that women with HG have a higher chance of depression in the postpartum period, which is exactly why I encourage planning ahead.
A few things to put in place before your baby arrives, if you can:
Tell your provider about your mood history and ask what postpartum check-ins look like
Line up therapy support now, so you are not searching for a therapist with a newborn in your arms
Ask your partner or support people to learn the signs of postpartum depression and anxiety
Make a small plan for sleep, meals, and who takes which shift
If you are already postpartum and the HG months still feel heavy, you are not behind or broken. You can read more about postpartum depression therapy and postpartum anxiety therapy here.
If you are afraid of another pregnancy
Many moms who have been through HG love their kids and still feel real fear about doing it again. Some decide to grow their family anyway. Some decide not to. Some are still figuring it out.
Therapy can be a place to think it through without pressure, to plan with your care team, and to build a support system before you ever get pregnant again. Whatever you decide, the fear makes sense.
How I support moms with HG
I really love working with moms who are going through hyperemesis. I know how isolating it is, and how often the emotional side is overlooked. I am a licensed marriage and family therapist, and my practice is built for pregnancy and postpartum. Every session is online, so you can show up as you are, and I work with moms across California.
If you want to see whether we are a good fit, start with a 10-minute consult call. No pressure and no long forms. Just a conversation about what you are going through. You can book your consult call here, and you can learn more about therapy for pregnancy.
Frequently asked questions
Does hyperemesis gravidarum cause depression?
Research shows a strong association between HG and depression, but it does not prove that one directly causes the other. The relationship is likely a mix of factors: severe physical illness, isolation, loss of daily life, fear, and possibly shared biological sensitivities. What matters most is that if you have HG and feel depressed, it is common and treatable.
How do I know if I am depressed or just sick from HG?
The two overlap, which makes it hard to tell. A helpful clue is whether your low mood lingers even when your nausea eases up. Persistent sadness or numbness, hopelessness, loss of interest, feeling worthless, and thoughts of harming yourself are signs to talk to a provider or a therapist. You do not have to figure it out alone.
Is it safe to get treatment for depression during pregnancy?
Depression during pregnancy can be treated, and options include therapy and, in some cases, medication. The right choice depends on your health, your symptoms, and your history, so it is a conversation to have with your OB, midwife, or prescriber. Untreated depression can affect you, and getting support is a responsible step.
Can therapy help if I am too sick to leave the house?
Yes. Virtual therapy is built for exactly this. Sessions can happen from bed or the couch, and your therapist can adjust the length, pacing, and format around your nausea and energy. You can learn more about how I work with pregnancy on my site.
Will I get postpartum depression if I had HG?
Not necessarily, but studies suggest that the chance of postpartum depression is higher for women who had HG. That is why it helps to plan ahead: tell your provider about your mood, set up support before the baby arrives, and watch for early signs so you can get help quickly.
Can HG feel traumatic?
Yes. Many moms describe HG as traumatic, especially if it involved hospital stays, feeling dismissed, or fear for their health or their baby's. Trauma symptoms like flashbacks, panic, and dread about future pregnancies are real, and trauma-informed therapy can help.
Where can I get help right now if I am struggling?
If you are in crisis or having thoughts of harming yourself, call or text 988, or call or text the National Maternal Mental Health Hotline at 1-833-852-6262 (24/7). In an emergency, call 911. For ongoing support, you can reach out to a therapist who specializes in pregnancy and postpartum.
One last thing
If HG has you feeling low, scared, or like you have lost yourself, please hear me: it makes sense, and you do not have to white-knuckle it. You deserve care for your body and your mind, at the same time.
You are doing something incredibly hard. Let someone help carry it.
This article is for education and does not replace medical advice, diagnosis, or treatment. If you are pregnant and cannot keep fluids down, feel faint, or are worried about your health or your baby's, contact your OB or midwife right away. In an emergency, call 911.
