When you think about pregnancy and new parenthood, you probably envision the joyful moments — selecting a paint color for your baby’s room, shopping for adorable outfits, or snuggling up with your little one during those first few blissful days as a new parent. Yet for many women, visions of yellow ducklings and cute onesies can be overshadowed by pervasive feelings of sadness and anxiety.
There are a variety of mood disorders that can develop during pregnancy and in the postpartum period. Some conditions, like the baby blues, are quite common, affecting up to 80% of mothers, while others are less so.[1]
And while most moms-to-be have likely heard of postpartum depression, they may not be aware of other mood disorders that can occur during this time, such as postpartum obsessive-compulsive disorder (OCD), postpartum post-traumatic stress disorder (PTSD), or postpartum anxiety — and as a result, may not feel comfortable sharing their symptoms.
While these conditions may sound scary, know that treatment is available. Read on to learn more about the mental health conditions that can develop in the perinatal period (which are known as perinatal mood and anxiety disorders, or PMADs), including how symptoms are diagnosed and treated.
What causes PMADs to develop during pregnancy and postpartum?
While there usually doesn't appear to be a single direct cause linked to perinatal mood and anxiety disorders (and every women is different), several factors are thought to play a role, including:[2]
- Hormones, particularly a big post-delivery drop in estrogen and progesterone
- A family history or personal history of depression, bipolar disorder or anxiety
- Fatigue and stress
- A difficult birth or post-delivery experience, which could include a long, hard labor; emergency C-section; a baby in the NICU; or issues related to breastfeeding (pain, engorgement)
- Life changes, such as isolation, illness, job loss, money trouble, moving to a new city, or a lack of support from a partner, family or friends
- Outside pressure or having a type A personality can cause some women to worry excessively or bend to societal expectations to be the “perfect mother” or partner
- Prior trauma, such as sexual assault or a serious accident
- Having an extreme fear of childbirth
- Having a pregnancy via fertility treatments
- Genetics, which are believed to play a role in some mood disorders
Types of perinatal mood and anxiety disorders
Perinatal mood and anxiety disorders can be experienced as mild, moderate or severe. Without treatment, symptoms can go on for many months or years. But whether it’s a mild case of the baby blues or severe postpartum depression, all mood and anxiety disorders are treatable.
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Here’s a look at the most common types of PMADs new parents should be aware of:
1. Pregnancy or postpartum depression
Whether it appears during pregnancy or in the postpartum period, depression is a serious medical condition that can leave women feeling deeply sad, anxious, overwhelmed and unable to cope with the tasks of motherhood.
Postpartum depression can start at any point after birth (symptoms can sometimes appear up to a year after a baby is born), though it usually emerges during the first few weeks.[3]
Symptoms of pregnancy or postpartum depression may include crying, disrupted sleep (which in turn contributes to daytime fatigue), feelings of hopelessness, despair, irritability, difficulty sleeping, and anxiety.
Some new mothers also feel withdrawn and isolated. They may lose interest in taking care of their newborns or fear being left alone with them.
Fortunately, treatment for depression is available. Talk therapy, either one-on-one or in a group setting, can help ease symptoms, as can medications that balance brain chemicals responsible for mood swings.[4]
2. Pregnancy or postpartum anxiety
Unfounded fears or extreme worry may characterize a case of pregnancy or postpartum anxiety. As many as 1 in 5 new mothers may experience perinatal anxiety and panic attacks, research suggests.[5]
Symptoms can include all-day worrying, a sense of danger surrounding the baby’s health and safety, edginess, agitation, jittery feelings, and insomnia. Some women may also have an elevated heart rate, rapid breathing or chest pain, especially if they’re also having panic attacks due to anxiety.
Treatment for perinatal anxiety may take the form of talk therapy or relaxation techniques, like breathing or meditation. For more severe cases, antidepressant or anti-anxiety medications, or SSRIs, might be prescribed.
3. Postpartum obsessive-compulsive disorder (OCD)
Obsessive-compulsive disorder is related to anxiety and can cause women to experience intrusive thoughts (obsessions) that are often about their babies, as well as the need to perform repeated behaviors (compulsions). Postpartum OCD is estimated to affect around 3 to 5% of new moms, but is frequently underdiagnosed.[6]
Although every woman is different, postpartum OCD can manifest as intense worry that their babies will fall, choke or drown. Other symptoms can include constantly checking on a napping baby, repeatedly reviewing the baby’s schedule, or obsessively praying to protect their baby.[7]
OCD during or after birth can be treated with a combination of tools, such as medications like SSRIs, exposure and response prevention therapy (practicing confronting the thoughts, images, object, and situations that make you anxious or provoke obsessive thinking), and cognitive-behavioral therapy sessions.
Treatment for pregnancy-related OCD is often highly effective and useful in relieving the symptoms.[8]
4. Postpartum bipolar mood disorders
Bipolar disorder is a mental health condition that combines two intense mood swings: mania (highs) and depression (lows). Symptoms may consist of extreme sadness and despair, an intensely wired attitude, restlessness, irritability, distractibility, loss of interest in most activities, insomnia (or sleeping too much), and suicidal thoughts.
It’s possible to be diagnosed with bipolar disorder for the first time after giving birth. New moms who were previously diagnosed with the condition may be more likely to relapse during the postpartum period.[9]
To treat postpartum bipolar disorder, regular counseling or therapy with a psychiatrist is usually recommended and your practitioner may prescribe mood-balancing medications. In some severe cases, admission to the hospital or other medical facility may be recommended to control mood swings.
5. Postpartum psychosis
This severe condition is rare, occurring in only about 1 or 2 out of 1,000 women. But postpartum psychosis is serious and requires immediate diagnosis and treatment.
Symptoms of psychosis tend to be extreme, such as erratic behavior, agitation, insomnia, paranoia, confusion, and mania or deep depression. This kind of psychosis can also cause a mother to have obsessive thoughts about her baby and bring on hallucinations. Risks to the mother or the baby are also possible, which is why it's so important to seek treatment right away.
Treating a woman with psychosis often requires immediate hospitalization so that no harm comes to the mother or her baby. Antipsychotic medications or mood-balancing drugs may be prescribed. In very severe cases, electroconvulsive therapy (ECT) may be recommended.[10]
6. Postpartum post-traumatic stress disorder (P-PTSD)
Symptoms of P-PTSD can be similar to those that can develop in a veteran of military service or war. New mothers who have gone through a traumatic birth experience — about 9% of new mothers meet American Psychiatric Association criteria for PTSD — may suffer flashbacks and disturbing memories.[11] Nightmares about labor and delivery, difficulty sleeping, anxiety, and panic attacks are other common symptoms.
P-PTSD treatment may involve therapy where women can express their feelings and re-visit their birth trauma. Eye movement desensitization and reprocessing therapy, or EMDR, is a treatment used to train the brain to reinterpret bad memories in a better, more positive light.
Complementary and alternative medicine (CAM) like hypnosis or acupuncture and medications that treat anxiety and depression are other options.[12]
How are perinatal mood and anxiety disorders treated?
Depression, anxiety and other mood disorders that develop during pregnancy or in the postpartum period are treatable. With treatment, most new moms feel better and see an improvement in their symptoms.
When treating perinatal depression and other mood disorders, a multi-pronged approach is often best. Targeted therapies with a mental health professional (one-or-one or in a group); various medications; CAM treatments; or even a short stay at a hospital or in-patient facility all may be considered.
Working with your doctor or therapist to find the best treatment for you may take time and patience. The same is true of medications, as some, but not all, are compatible with breastfeeding.
Can you prevent perinatal mood and anxiety disorders?
Unfortunately, there’s no definitive way to prevent depression or mood disorders that develop during pregnancy and in the postpartum period. But you might be able to reduce your risk and possibly lessen the severity of certain symptoms by trying some of the following:
- Take your meds. If you’re already on a pregnancy-safe medication for depression or a mood disorder, stay on it. And check with your doctor in case the dose needs to be modified. Not sure if a medication is pregnancy-safe? Check with your practitioner — most antidepressants are now considered low-risk during pregnancy.
- Ask for help. Setting up a support network before you really need it can help you avoid feeling overwhelmed and exhausted after giving birth. Friends and family may be available to help do the dishes, burp and change the baby, and cook dinner, giving you the opportunity to put your feet up and take a break.
- Eat right and exercise. A healthy diet and regular movement can do wonders for your mood. Stock up on good-for-you snacks plus fruits and veggies, and try to walk, dance or stretch every day (after your practitioner clears you for exercise).
- Let it go. Yep, the unmade bed, the smudged kitchen counters, and the dust under your bed. Set realistic goals around the house so you don’t feel pressure to be perfect.
What should you do if you suspect you have a perinatal mood or anxiety disorder?
Being diagnosed with depression, anxiety or another condition is never your fault and shouldn’t be a source of shame or guilt. If you feel out of sorts and sad, or you think your partner, a family member, or friend may be experiencing symptoms, seek help from a medical professional right away.
It’s especially important to be seen if your baby blues last longer than two weeks, your symptoms of depression worsen, or you find you can’t care for your baby or yourself. And get help immediately if you have thoughts of hurting yourself or your child.
The following resources offer more information and support should you or someone you know be suffering from a perinatal mood and anxiety disorder:
- Office on Women's Health (800-994-9662)
- National Library of Medicine, Medline Plus
- Postpartum Support International (800-944-4PPD)
- National Alliance on Mental Illness (800-950-NAMI)
Reaching out to one of these organizations or seeking professional help through your provider is a first step in the right direction toward the self-care and treatment you deserve.
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