Did you know that Perinatal Mood and Anxiety Disorders (PMADs) are the #1 complication of pregnancy? They are more common than preterm delivery, gestational diabetes, pre-eclampsia and hypertension. Roughly 1 of 5 women experience a PMAD. Additionally, ⅓ of PMADs actually begin during pregnancy. This was the case for me nearly 7 years ago. Looking back now, I am able to see that many of my thoughts and behaviors leading up to my daughter’s birth were common symptoms of perinatal anxiety, but at the time I had no idea what it was--I just knew I didn’t feel like myself.
Learning about PMADs, even if you don’t think you’ll ever experience one, is a good idea. It is helpful to know how symptoms can look, to be able to identify them in yourself and others, and to have resources available if you find yourself wanting more support. The good news is that PMADs are highly treatable!
This article is an overview of PMADS, including symptoms and risk factors and suggestions for treatment and support.
Postpartum Depression
Postpartum depression is relatively common. About 15% of moms will experience depression after having a baby as well as 10% of dads.
Symptoms may include:
- Feelings of anger or irritability
- Lack of interest in the baby
- Appetite and sleep disturbances
- Crying and sadness
- Feelings of guilt, shame, hopelessness
- Loss of interest, joy and pleasure in things you used to enjoy
- Possible thoughts of harming the baby or yourself
Risk Factors:
There are certain subgroups of women who are at increased risk for experiencing perinatal mood disorders. For example, women who have had a previous episode of postpartum depression have about 50% chance of experiencing it again with a subsequent pregnancy. Also, women with a history of depression prior to pregnancy have between 30%-50% chance of experiencing postpartum depression.
Other risk factors include:
- Complications in pregnancy, birth or breastfeeding
- Babies in the NICU
- Multiples
- Traumatic childbirth
- Infertility treatment
- Endocrine dysfunction: thyroid imbalance or diabetes
- Inadequate support, marital and financial stress
- History of eating disorders & self harm
- “Type A” Perfectionist personality, high need for control and achievement
Perinatal Anxiety & OCD
Some amount of anxiety is normal for new moms. Anxiety is what drives us to keep our babies safe. But for nearly 10% of pregnant and postpartum women anxiety becomes so overwhelming and distressing that it interferes with their ability to function well.
Symptoms may include:
- Constant worry
- Racing thoughts
- Feeling agitated and irritable
- Inability to relax
- Appetite and sleep disturbances
- Dizziness, hot flashes, nausea, heart palpitations, shortness of breath
- GI disturbances; diarrhea, bloating
Postpartum Obsessive Compulsive Disorder is a type of Perinatal Anxiety Disorder. It is characterized by repetitive, intrusive thoughts and images that seem to come out of nowhere and are very frightening and often disturbing. These scary thoughts are common in the postpartum period. They are anxiety-driven. Because of the disturbing nature of intrusive thoughts, typically people experiencing them feel ashamed of them and scared to talk about them. Intrusive thoughts have very low risk of being acted upon, however, if the distress they cause feels unmanageable it is time to reach out for professional help.
Symptoms of OCD
- Obsessions, also called intrusive thoughts. Scary thoughts and images related to the baby.
- Compulsions, or actions that attempt to reduce thoughts, fears
- Feeling guilt, shame and horror about the intrusive thoughts
- Hypervigilance in protecting baby
- Moms with OCD know their thoughts are awful and do not want to act on them
Risk Factors:
- Personal or family history of anxiety or OCD
- Previous PMAD
- Endocrine disturbances such as thyroid imbalance
Post Traumatic Stress Disorder
Approximately 5-9% of postpartum moms experience PTSD, however 18-34% of women report that their births were traumatic. PTSD can develop when trauma occurs during delivery or postpartum. It is important to understand that trauma is a subjective experience and different things can be perceived as traumatic for different people. Complications during childbirth such as pre-eclampsia, postpartum hemorrhage, 3rd or 4th degree tearing are all experiences that can cause PTSD.
Other traumatic events may be:
- Unplanned c-section
- Use of vacuum or forceps to deliver baby
- NICU stay
- Feelings of powerlessness, poor communication, lack of support during delivery
- Perception of lack of care or respect from care team
Symptoms of PTSD:
- Flashbacks of the traumatic event
- Nightmares
- Insomnia
- Emotional numbing
- Dissociation
- Inability to clearly recall important aspects of the experience
- Avoidance of reminders of the event
- Hypervigilance, irritability
Risk Factors for Postpartum PTSD
- Previous trauma
- Lacking good support system
Postpartum Psychosis
Postpartum psychosis is extremely rare, occurring in 1-2 or every 1000 births. The onset is usually within the first 2 weeks postpartum.
Symptoms of postpartum psychosis may include:
- Delusions
- Hallucinations
- Agitation, Irritability
- Hyperactivity
- Paranoia
- Rapid mood swings
Risk factors for postpartum psychosis:
- personal or family history of bipolar disorder
- previous psychotic episode.
Of the mothers that develop psychosis, research suggests there is a 5% rate of suicide and 4% rate of infanticide. It is crucial that women with psychosis get treatment immediately.
How to know if you have a PMAD
Having a baby is an incredibly emotional experience so it makes sense to experience some intense mood shifts and emotional turbulence. When you’re in the throes of it, it can be especially difficult to know what’s what.
Here are some questions to consider:
- “Are you experiencing more bad days than good?”
- “Are others concerned about you?”
While PMADS are relatively common, it’s important to remember that they are temporary and they respond quickly to treatment!
The most effective intervention is a combination of therapy and medication. Counseling has been shown to be an effective treatment for postpartum depression as well as an intervention for prevention. Research suggests that counseling, specifically cognitive behavioral therapy (CBT) and interpersonal therapy (IPT) reduces the likelihood of developing perinatal depression between 39%-50%.
Other things that can be helpful for mental health support include: sleep, balanced nutrition, movement, time outside and support from family and friends.
When reaching out to a counseling or psychiatric provider in your community, make sure that they have specialized training in Perinatal Mood and Anxiety Disorders! You can use the Postpartum Support International Provider Directory to find a qualified provider.
Resources
Toll Free Warm Line- 1-888-404-7763
Postpartum Support International www.postpartum.net
National Perinatal Association www.nationalperinatal.org
Postpartum Support International www.postpartum.net
Postpartum Dads http://www.postpartumdads.org
Postpartum Progress http://www.postpartumprogress.com
The Online PPD Support Group www.ppdsupportpage.com
The Postpartum Stress Center www.postpartumstress.com
Amy Kovner MS, CN, LMHC is a Certified Nutritionist and Mental Health Counselor passionate about supporting the wellbeing of moms. Amy is the Co-founder of Mama Bar, a high quality nutrition bar created to support the increased nutritional needs during pregnancy, postpartum and breastfeeding.