Perinatal Mood Disorders

Perinatal depression encompasses a wide range of mood disorders, including anxiety and OCD, that can affect women during pregnancy and following the birth of her child. Most people think of postpartum depression as related to pregnancy and birth, however, it is important to note that there are a range of moods that can happen during this transitional time, including prenatal depression and anxiety, the “baby blues,” postpartum anxiety, and postpartum psychosis.

Pregnancy, delivery, and the postpartum period are often misrepresented in that many women believe that pregnancy and the birth of a baby automatically produces exhilaration and joy. For many, this time was supposed to be one of the happiest times in life, when in fact, it is one of the most stressful and anxiety producing periods in the life cycle of a family. It is a major health issue for women of diverse cultures and yet these conditions often remain undiagnosed.

As many as 10% of women will experience unexpected depressed or anxious mood during their pregnancies. And more than half of the women who give birth each year experience some negative change in their mental health in the early weeks following the birth. For 15% of those women, the period following childbirth becomes a nightmare as they experience sleeplessness, confusion, memory loss, and anxiety during the already stressful adjustment to motherhood.

New mothers are especially vulnerable to depression anytime within the first year postpartum. Along with the overwhelming demands of caring for an infant comes a loss of time with one's spouse, the loss of adult friendships, and a loss of freedom and familiar routine. This is a challenging time for the entire family, as you attempt to adapt to a new way of life, while knowing that your lives will never again be the same.

What is postpartum depression?

Experts identify several different ways in which postpartum depression can look depending on the kinds of symptoms that present. However, the "baby blues" which affects as many as 75% of new mothers is considered normal postpartum adjustment that does not require any specialized medical care. The blues generally surfaces within a few days of delivery. Women with the maternity blues describe more tearfulness, irritability, and anxiety than usual with an overall sense of overwhelm that can feel like some of the mild mood changes that surface around one’s menstrual cycle. Because these symptoms usually decrease by two weeks, most women do quite well with added rest and extra help caring for their infant, along with reassurance and emotional support that their feelings are normal and temporary.

Postpartum depression can occur anytime within the first year after a woman gives birth and is most likely to present with an extremely anxious mood rather than with depressive symptoms. New mothers often feel overwhelmed to the extent that they feel unable to cope and don’t want to be left alone. Characteristically, symptoms include insomnia and appetite disruption accompanied by rapid weight loss, Women often describe fogginess and mental confusion. For some new mothers, their anxiety comes in the form of repetitive and compulsive behaviors that include counting, checking and an excessive attention to cleanliness and hygiene. Others often report intruding and distressing images and thoughts about harm to their babies accompanied by extensive efforts to avoid what they believe might come true. In some cases, women report extreme panic that can feel like a heart attack and for others, birth trauma may be a trigger for disturbing memories of past experiences in which they felt helpless or powerless.

Other symptoms include:

  • Crying more than usual
  • Feeling sad much of the time
  • Unable to enjoy the things that you used to enjoy
  • So exhausted but still unable to sleep even when your baby sleeps
  • Tired most of the day
  • Feeling like you will always feel this way
  • Feeling inadequate as a mother
  • Wishing you were dead instead of having to feel this way any longer
  • Mood swings

Psychosis is a rare but potentially life-threatening perinatal illness that requires immediate medical treatment to protect both you and your child. If you have psychosis, you may be experiencing some of the following symptoms:

  • Extreme agitation or restlessness
  • Feeling sad much of the time
  • Feeling afraid that you might harm yourself to escape the pain.
  • Having thoughts about harming your baby.
  • Rapid weight loss and refusal to eat
  • Going without sleep for forty-eight hours or more.
  • Feeling as though your thoughts are not your own

Frequently, symptoms go unrecognized because you may think they are part of the stress of caring for a new baby. You might delay in asking for help out of embarrassment, guilt, and a mistaken belief that a "good mother" should be capable of handling the overwhelming adjustment of caring for a new baby with little or no need for help. Also, weaning a baby from the breast and the return of menstruation are significant hormonal events that can alter the biochemical balances in the body and affect the timing of a depression.

Risk factors for perinatal mood disorders

Although there is no exact way to predict a postpartum depression, there are certain elements influence one’s vulnerability to it. Your personal and/or family history of depression and/or anxiety, for example, is an important risk factor. More serious mood disorders like bipolar disorder and/or schizophrenia can increase the risk for postpartum psychosis. The risk of developing postpartum depression is higher if you have had it before. And, your risk increases if you have been depressed during pregnancy and/or have a history of premenstrual mood syndrome.

Stressful situations that include marital tension, health problems with the baby, a complicated pregnancy or delivery, and a lack of social support increase your risk for a postpartum depression. Among the psychological factors that predispose you to postpartum depression are a childhood history of sexual abuse or trauma, chemical dependency in your family, and confusing or negative feelings about the pregnancy and extreme uneasiness about your new role as a mother.

What are the treatments for a perinatal mood disorder?

Decisions about treatment for perinatal mood and anxiety disorders vary according to the severity of symptoms. Professional opinion, however, generally supports the use of antidepressant medications in combination with psychotherapy from a qualified family therapist with specialized training in maternal mental illness. Family and couples therapy is also effective, allowing the family and/or partner to better understand the depression and be a source of support for the mother. Fathers are also at risk for a depression during the postpartum period and therapy provides a safe space where men can explore their unique experience. A marriage and family therapist may work with the couple to explore the history of each person's feelings, and will focus on solutions that the family can implement right away.

Group psychotherapy, involving the participation of other women who are experiencing a perinatal mood disorder has also been found to improve depression by reducing the feelings of isolation that many women feel in the early months after childbirth. It is important to know that if you are breastfeeding, it may not be necessary to stop while taking antidepressants. Be sure to consult with your doctor or a reproductive psychiatrist about medication options that are appropriate for your circumstances.

Can I prevent perinatal depression?

Although a perinatal mood disorder might not always be preventable, it certainly is possible to diminish the severity of symptoms, should they occur. Even before delivery, try to identify and try to minimize significant stressors and if possible delay any major changes like a family move. Put a support system in place during pregnancy so that you will feel less alone and overwhelmed after the baby arrives. In the months following childbirth, make sure you have plenty of help so that you can manage time for self-care, get plenty of rest, and do not deny your feelings or feel guilty for having them. Educating yourself is one of the best ways to ensure early diagnosis and proper treatment.,. Perinatal mood and anxiety disorders are treatable. It’s important for women and their families to know that they are not alone, they are not to blame and with the proper treatment, you will get well. Seeking the help of a qualified therapist is essential to a solid recovery.

Resources

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