Understanding Perinatal Mood and Anxiety Disorders
The spectrum of perinatal emotional complications are referred to as Perinatal Mood and Anxiety Disorders (PMADs). They can begin during pregnancy or after birth. Mothers, fathers, and adoptive parents also can experience mood and anxiety disorders during pregnancy and/or the postpartum period.
Many of us refer to emotional complications after birth as “postpartum depression” or just “postpartum”. However, we know that perinatal emotional complication are not just depression and that many women experience emotional changes that begin during pregnancy- this is why we refer to them as a spectrum that includes many different responses to the changes we are experiencing.
Perinatal Emotional Complications can interfere with a family’s joy over a new baby and interrupt the parent-infant bonding process. They can appear as late as a year postpartum and during significant hormonal changes such as weaning from the breast or the return of menstruation.
The following list of symptoms can be applied to both pregnant and postpartum parents.
Nearly 85 percent of all new mothers experience the baby blues after giving birth. Baby blues will only last 2-3 weeks and will improve with self care such as eating and sleeping. Anything after this 2-3 week period could indicate something other than baby blues.
• Feelings of despair/hopelessness
• Crying, tearfulness
• Anger and irritability
• Sleep disturbances (too much/little)
• Loss of energy and interest
• Physical symptoms (clumsiness, slowed speech, etc.)
• Suicidal thoughts
• Frightening thoughts about self, baby or other family members
• Weight loss or gain
• Feelings of guilt, shame, inadequacy
• Hypochondria, excessive worries
• Muscle tension
• Chest pain
• Shortness of breath; choking sensation
• Hot/cold flashes
• Tingling hands/feet
• Fear of dying
• Fear of going crazy
• Fear of being alone, fears about baby’s health, agoraphobia
• Feeling trapped, immobilizing guilt
• Racing heartbeat
Obsessive Compulsive Disorder
• Recurring, persistent and disturbing thoughts, ideas or images (scary images of accidents, abuse, harm to baby)
• Ritual behaviors done to avoid harming baby (e.g., put away knives) or to create protection for baby (e.g., don’t leave the house), constantly checking the baby, house, etc.
• Intrusive thoughts, fears, images
• Person cannot control thoughts
• Person understands that to act on these thoughts would be wrong
• Hypervigilant (e.g., can’t sleep for fear that something will happen to baby/ constant “fight or flight” mode)
• Post-Traumatic Stress Disorder (usually occurs soon after birth)
• Previous trauma (recent or in the past – abuse, accident, etc.)
• Feeling of anxiety when exposed to situations similar to the trauma
• Sensations of “being in the trauma” now
• Emotional numbing/detachment
Formerly referred to as Manic-Depressive Disorders, Bipolar Disorders are not technically classified as Postpartum Mood Disorders per se. However, about half of all women who have Bipolar Disorder are first diagnosed postpartum.
Bipolar Disorder has two subcategories, Type I and Type II. Bipolar Type I presents periods of depression and mania in which the patient may experience psychotic episodes and lose touch with reality. Bipolar Type II differs in that the patient remains lucid throughout the swings of depression/mania and the manic times are often characterized as very productive, high energy moments when the patient feels quite good. Bipolar Type II can easily be misdiagnosed as depression, as the manic times feel so normal and good.
If a bipolar condition is misdiagnosed and treated as depression, the resulting medical treatment of prescribing only antidepressants can potentially have serious consequences by causing a rapid-cycling manic episode which may require hospitalization in some cases. Thus, it is critical that the patient reviews her own as well as her family history for Bipolar Disorder, as well as seeing a professional that is very well trained in Postpartum Mood Disorders and Bipolar Disorders.
Mania (part of Bipolar Disorders)
• Feel great/high energy
• Decreased need for sleep/insomnia
• Feeling “speedy”
• Easily distracted
• Mind racing, cannot shut off thoughts
• Pressured, fast speech
Psychosis (rare, and requires immediate treatment, often including hospitalization and medication)
• Delusions (often about baby)
• Irrational thoughts
• Refusal to eat
• Poor judgment
• Lack decision making abilities
• Break with reality
• Severe insomnia
• Higher risk if Bipolar Disorder in self or family