Perinatal Mood Disorders

Consider the symptoms below, as any of these may indicate that you are struggling with a form of perinatal mood disorder, including postpartum anxiety or depression. Perinatal mood disorders are related to mood and anxiety symptoms that occur during pregnancy or up to one year postpartum and often longer when treatment is delayed.

• Do you feel sad and depressed?
• Are you more irritable or angry with those around you?
• Do you feel distant or that you are having difficulty bonding with your baby?
• Do you feel anxious, panicky, or worried all the time?
• Are you having problems with eating or sleeping?
• Are you having upsetting and intrusive thoughts that you can’t get out of your mind?
• Do you feel as if you are “out of control” or “going crazy”?
• Do you feel like you never should have become a mother or that you are not good enough in this role?
• Are you worried that you might hurt your baby or yourself?

It is natural for women to experience changes in their feelings and mood during pregnancy, the “baby blues” including feeling more tired, irritable or worried. However, while mild mood changes during pregnancy are common, 15%-20% of women have mood symptoms that can sometimes become severe enough to require treatment by a health provider. There are effective and well researched treatment options to help you recover. You should not suffer. You are not alone, you are not to blame and with help you will get well.

While Postpartum Depression is the term most used there are actually many forms of perinatal mood disorders that women experience over the course of pregnancy, birth and new motherhood.

Depression that occurs during pregnancy or within a year after delivery (or longer when treatment is delayed) is called perinatal depression. Researchers believe that depression is one of the most common complications during and after pregnancy. Factors that may increase the likelihood of depression during or after pregnancy can include; history of depression or substance abuse, family history of mental illness, inadequate support from family and friends, anxiety about the fetus, problems with previous pregnancy or birth, marital or financial problems, young age (of mother or newborn). Tiredness, problems sleeping, stronger emotional reactions, hormonal changes, and changes in body weight normally occur during and after pregnancy, but these symptoms may also be signs of depression.

• Feeling sad, depressed, and/or crying a lot
• Diminished interest in becoming a mother
• Feeling worthless or guilty, especially about not being a good mother
• Strong anxiety, tension, and/or fear either about your future child or other things
• Sleep problems (not being able to sleep despite feeling very tired or sleeping more than usual but not feeling rested)
• Thoughts of wanting to be dead or wanting to kill yourself
• Having low energy
• Loss of or increase in appetite or weight
• Trouble focusing, remembering things, or making decisions
• Feeling restless or irritable
• Having headaches, chest pains, heart palpitations, numbness, or hyperventilation

Experiencing miscarriage at any point in pregnancy can be a shocking and devastating event. Many women struggle with physical and emotional pain and grief that is powerful and overwhelming. Miscarriage can leave women feeling numb, helpless and isolated from others. Common reactions to miscarriage are sadness, anger, and guilt and depression.

Infertility occurs in 10-15% of couples of reproductive age. Struggling to have a child can be traumatic and a complicated grief process. There are no road maps and people often don’t talk about it so individuals and couples are often left feeling that something is fundamentally wrong with them and very alone. Moving through this grief and loss can bring on a “life crisis” that can tax a couple’s existing problem-solving resources as a couple and as an individual causing intense sadness, depression, anxiety, grief and trauma.

Many women have a variety of mood symptoms in the aftermath of delivery. 50-85% of women feel Postpartum Blues or “Baby Blues” for a short time, usually 1-3 weeks after delivery. Common symptoms of “Baby Blues” can be mood instability, depressed mood, weepiness, sadness, irritability, anxiety, lack of concentration and feelings of dependency. These symptoms are often self-limited and are to be distinguished from a more severe condition often called Postpartum Depression (PPD) which is more intense and has a longer duration of symptoms. Postpartum Depression typically develops over the first 2-3 months after childbirth but may occur at any point after delivery.

Symptoms of Postpartum Depression

• Feeling sad, depressed, and/or crying a lot
• Irritability
• Intense anxiety
• Having intrusive scary thoughts, rumination, obsessions (See Postpartum Anxiety Disorders below)
• Loss of interest in usual activities
• Feeling numb, lack of feelings for the baby, not looking forward to the future
• Feeling alone
• Feeling ashamed
• Feelings of guilt, worthlessness or incompetence (this has a lot to do with a woman feeling that her symptoms are evidence of her worth as a mother)
• Fatigue, irritability, sleep disturbance
• Change in appetite
• Poor concentration
• Excessive worry about baby’s health
• Suicidal thoughts

Anxiety and Obsessive Compulsive Disorder OCD

Postpartum anxiety disorders such as panic disorder, obsessive compulsive disorder and generalized anxiety disorder appear to be as common as postpartum depression and even coincide with depression.

Symptoms of Perinatal Anxiety

• Panic attacks
• Hyperventilation
• Excessive worry
• Restless sleep
• Repeated thoughts or images of frightening things happening to the baby

Another form of Postpartum Depression is Postpartum Psychosis. Postpartum Psychosis is a serious illness that can be severe and life threatening and requires immediate evaluation and treatment. This is much more rare, occurring in 1 in 1000 new mothers compared to PPD which can occur in 1 in 8 new mothers.

Postpartum psychosis symptoms include delusions (thoughts that are not based in reality), hallucinations (hearing or seeing things that aren’t there) or disorganized thinking. Often mothers who develop postpartum psychosis are having a severe episode of a mood disorder, usually bipolar (manic-depression) disorder with psychotic features and it is critical for women to get evaluation and treatment immediately.

PPTSD is often caused by a traumatic or frightening childbirth or past trauma, and symptoms may include flashbacks of the trauma with feelings of anxiety and the need to avoid things related to that event.