Everything You Want to Know About Perinatal Mood And Anxiety Disorders...but are hesitant to ask.
What is a Perinatal Mood and Anxiety Disorder (PMAD)? Is it the same as Postpartum Depression? How long does it last?
Perinatal means the period of time throughout pregnancy as well as the baby’s first year. Research suggests that between 10% and 20% of pregnant women experience a new episode of depression during pregnancy, which is called antepartum depression.
While a PMAD can begin during pregnancy, it most commonly begins after the baby is delivered. This could be as early as the first 48-72 hours after birth. There’s often a lot going on in the first 24 hours, so you may not be aware of what you’re feeling emotionally until after things slow down.
Any mood disorder that occurs in the first year of a baby’s life is considered to be a perinatal mood disorder. It’s important to note that while it’s defined as happening in the first year, it may begin during the first year of a baby’s life, not be adequately treated, and continue beyond the first year of the baby’s life. If the mood disorder goes undiagnosed or untreated during the first year of life, it is still a perinatal mood disorder.
Perinatal mood and anxiety disorders are the most common complications of childbirth, and include depression, anxiety, and/or OCD during pregnancy and/or postpartum, as well as postpartum post-traumatic stress disorder, bipolar mood disorders, and postpartum psychosis.
These disorders are different than the “baby blues” which occur in about 75-80% of new mothers and resolves on its own without medical assistance. The “baby blues” is a normal adjustment period where moms may experience mood swings and weepiness during the first 2-3 weeks after giving birth.
What causes PMADs?
There is no single cause for perinatal mood and anxiety disorders. Women who develop depression or anxiety around childbearing have symptoms that are caused by a combination of psychological, social, and biological stressors. Hormonal fluctuations can cause reactions in sensitive women. Research shows that a variety of factors can increase your risk for developing a PMAD. The most common include:
A personal or family history of depression, anxiety, or postpartum depression
Inadequate support in caring for the baby
Financial or marital stress
Complications in pregnancy, birth or breastfeeding
Mothers of multiples or whose infants are in Neonatal Intensive Care (NICU)
Mothers who’ve gone through infertility treatments
What are some of the signs that you have a PMAD?
It depends on which mood disorder you are experiencing. Below is a general list of symptoms from Postpartum Support International’s website. Remember, these symptoms can begin during pregnancy or postpartum.
Depression: feelings of anger, sadness, irritability, guilt, lack of interest in the baby, changes in eating and sleeping habits, thoughts of hopelessness and sometimes even thoughts of harming the baby or herself. PMADs and PPD are often used interchangeably and refer to the same illness.
Anxiety: extreme worries and fears, a feeling of losing control, panic attacks, shortness of breath, chest pain, and/or numbness and tingling.
OCD: repetitive, upsetting and unwanted thoughts or mental images (obsessions), and/or the need to do certain things over and over (compulsions) to reduce the anxiety.
Postpartum Post-Traumatic Stress disorder: flashbacks of the trauma with feelings of anxiety and the need to avoid things related to that event.
Postpartum Psychosis: hallucinations (seeing and hearing voices or images that others can’t), distrust of those around them, periods of confusion and memory loss, or manic behavior. This severe condition is dangerous, and it is important to seek help immediately.
How do I know if I need to get treatment?
“Depression” can be a confusing word because the symptoms often vary. Women who are struggling may show the following signs: they can’t sleep, can’t eat, can’t sit still, are afraid of everything, are agitated and jittery, and/or have postpartum OCD with intrusive thoughts of something happening to their baby. Some may have postpartum PTSD where they have terrible flashbacks of the birth, which may be real or perceived. Some women don’t feel bonded to their baby, they feel “off,” they’re angry, or they suddenly hate their partner. There are many manifestations that go from mild to severe.
If you have a PMAD it doesn’t go away on its own. Often it tends to get worse, even if it’s mild. Treatment plans are different for each woman, but might include increased self-care (such as proper rest, nutrition, exercise, and help with childcare), social support, talk therapy or counseling, and treatment of symptoms, with medication when necessary. Finally, medications are available to address both anxiety and depression.Some women treat depression and anxiety with medication, some with natural remedies, some with diet and exercise, some with counseling, support groups, or spiritual practice and support. Many use all of them. Find what works best for you, make a plan of self-care, and prioritize it. If you’re dealing with a mild illness, talk therapy and/or a support group may be enough. If it’s moderate to severe, the most successful treatment is usually a combination of medication and therapy.
How do I decide if I should take medication?
There is a lot of fear, stigma, and misunderstanding around medications, and it’s a decision best made between you and your medical professional. Several medications are available to treat the symptoms of perinatal depression and anxiety, some of which are safe for pregnancy and breastfeeding. Medications work individually with each person, so what works well for one may not work as well for another. If you have any questions about your reaction to medication, you should contact your provider and ask about it. You might experience side effects, especially in the first few weeks, but you should not feel worse on medication. If you have previously had a successful experience with medication, you might consider starting with that one. Work with your healthcare provider until you feel comfortable.
One in seven women respond physiologically to the rapid change in hormones during the pregnancy and postpartum, which affects the neurotransmitters responsible for mood that make us feel happy and stable. Think of it this way: once these neurotransmitters are out of whack, we need something to get them back in order. Diet and lifestyle habits can help, but medication is sometimes required for those suffering from moderate to severe PMAD.
Over a period of a few weeks and at the right time/dose, medication can gradually help these moms feel normal. Even for women who value natural health and non-medical solutions, medication can be important. Absolutely try nutrition and exercise, but if you can’t make it through the day (or even the next hour) without feeling sad, overwhelmed and overcome, these medications may be right for you. A good psychiatrist will know if you can try alternative treatments alone or if you will benefit from medication.
I'm the Partner, what about me?
Approximately 4% of new fathers can experience depression within the first year after the birth of a child as well. We don’t have access to similar research on LGBTQ partnerships but we know they experience the same kind of struggles. As the main support in a relationship, a new baby and the changes your partner is experiencing can impact your mental health.
Depression is a serious medical condition that affects your whole body, your mood, and your thoughts. Everyone in your family needs you to be healthy. When you take care of yourself, your spouse will feel better, your baby will feel better, and YOU will feel better. If you are worried about the way you are feeling, ask for help so you can receive the treatment you need to get back on track.
For more information on how a new baby impacts dads and additional ways to support your spouse check out A Note To Dads.
Source: Whole Mamas Club
Images courtesy of Karen Kleiman and Molly McIntyre Good Moms Have Scary Thoughts 2019