The general public tends to believe that pregnancy and having a baby is a time of emotional well-being for women and their families. Although this is true for most, a substantial number of women will experience distressing symptoms that can make pregnancy and motherhood one of the most frightening times in their lives. New data available suggest that 7.5% of women develop a new episode of major depression during pregnancy and that 6.5% develop a new episode during the first 3 months postpartum. (Lusskin, Pundiak, Habib)
Although the term “PPD” is used frequently as a term relating to the mood changes a mother may have after having a baby, a more accurate term may be Perinatal Mood Disorders. This term allows for the great variability of symptoms which often include more than depression alone and acknowledges that mood disorders can occur during pregnancy as well as after having a baby.
A New Awareness
Having a baby is a major life change for any woman and her family. Perinatal Mood Disorders are temporary and are treatable. They can affect any woman who:
Is pregnant
Has recently had a baby
Has ended a pregnancy or has miscarried
Has stopped breast-feeding
As the public awareness of perinatal depression has grown, the recognition of perinatal anxiety disorders has received more attention. The range of disorders includes: anxiety disorder, obsessive compulsive disorder, panic disorder, and posttraumatic stress disorder. Each of these disorders may occur in conjunction with symptoms of depression. The diagnosis of bipolar spectrum disorders is also included under the umbrella of perinatal mood disorders. As health care professionals are better able to identify these subtypes, they will be able to design specific treatment programs for you, so that you may more quickly recover from and control your symptoms.
Why is this happening to me?
If you are asking yourself this question, please remember “it is NOT your fault.” During pregnancy, hormone levels are increased to assist in creating an environment for the growing infant. In the postpartum period the mother’s body experiences further dramatic changes in hormonal level. Within 24 hours after birth, the progesterone and estrogen levels drop to a level lower than before conception. The body’s reaction to this sudden drop in hormone levels is further intensified by the complex changes the mother’s body undergoes to prepare for milk production. Many other psychosocial stressors such as financial problems, difficult partner relationships, poor health, preterm delivery, and a history of other mood disorders are also thought to increase risk. With the common addition of broken sleep cycles, the stress on the mother’s physical functioning is often overwhelming. Thus, new mothers are at risk for developing a postpartum depression (PPD) or, more correctly, a perinatal mood disorder.
When Is It More Than Just the Blues?
Up to 80% of new mothers cry easily or feel stressed following the birth of a baby. When this happens within the first two weeks following birth, it is called “baby blues.” However, some women experience a deep sadness that doesn’t go away or comes and goes. For other women, these feelings sometimes occur months after childbirth. In any case, it is important to recognize the warning signs. These signs are different for everyone, but include:
Difficulty sleeping, even when the baby is sleeping
Sleeping too much
Appetite changes
Feeling irritable, angry, or nervous
Feeling exhausted
Lack of ability to enjoy life as much as in the past
Lack of interest in the baby
Lack of interest in friends and family
Lack of interest in sex or even being touched
Feeling guilty or worthless
Feeling hopeless
Crying for “no reason”
Feeling as if you are a bad mother
Difficulty concentrating or focusing
Thoughts of harming self or the baby
Postpartum Anxiety
It is estimated that 8.5 to 11 % of pregnant women will experience moderate to severe symptoms of anxiety or a mixture of anxiety and depression during their pregnancy. Following birth, these symptoms may begin or persist and usually require specific interventions. These women may be troubled by unpleasant thoughts (intrusive thoughts) about harming their babies, or extreme concern about the baby’s health. Shakiness, nausea, and inability to sleep are symptoms that may occur in this disorder.
Along with the anxiety, a mother may experience symptoms of a postpartum panic disorder. Postpartum panic disorder occurs in up to 11 % of new mothers. The three most common fears that occur during a postpartum panic episode are: fear of dying, fear of losing control, and fear of going crazy.
Postpartum Obsessive Compulsive Disorder
This disorder is one of the most under-recognized and under-treated types of perinatal mood disorders. It occurs in approximately 3 to 5 % of new mothers, yet it can be most alarming for a new mother. The symptoms include intrusive and persistent thoughts or mental images and a sense of horror about the thoughts/images. The thoughts are typically accompanied by behaviors to reduce the overwhelming anxiety that accompanies the thoughts. These compulsive, ritualistic behaviors often include checking baby frequently, obsessively searching for information on the internet/books, etc. For example, a mother may have an irrational fear that she is going to drop the baby down the stairs. Consequently, she may avoid using the stairs or even going near a staircase. These mothers are NOT in danger of harming their infants and are disturbed by these troubling thoughts.
Postpartum Traumatic Stress Disorder
An estimated 1 to 6 % of women will experience a postpartum traumatic stress disorder. The primary symptoms of this disorder include: trauma re-experienced (through dreams, thoughts, etc.), avoidance of stimuli associated with the event (thoughts, feelings, people, places, details of the event, etc.), and persistent arousal (irritability, difficulty sleeping, hypervigilance, and an exaggerated startle response).
Postpartum Psychosis
Occasionally, a woman may have a more severe disorder which is know as postpartum psychosis. There is a 10% infanticide/suicide rate associated with Psychosis and thus immediate treatment is imperative. This disorder occurs in 1 to 4 of every 1000 babies born (Gaynes et al., 2005). For more information, click on the link to postpartum psychosis.
What To Do
All of these feelings are upsetting, so it is important to remember that it is not your fault and that you will feel better. Whether symptoms are mild or severe, with proper treatment, most mothers can quickly recover from PPD or perinatal mood disorder. If you think you or someone you know may have PPD, find someone you know and trust to talk with about how you are feeling. There are healthcare providers and licensed counselors who can help a woman find the treatment that is best for her. This treatment includes finding the right therapy, the right medication, and the right support group.
“The positive aspect of my getting help for PPD is that I am a stronger woman now.” Elizabeth Roebling, NJ.
(Adapted from Speak Up When You Are Down, a postpartum recovery program in New Jersey).
Postpartum Psychosis
The onset is usually sudden, with symptoms including: delusions (strange beliefs) and/or hallucinations; feeling very irritated, hyperactive and unable to sleep; significant mood changes; and using poor judgment in making decisions. Women who are more vulnerable are individuals who have a previous history of psychiatric disorders, previous postpartum mood disorders, or a family history of psychiatric disorders. Women who display any of these symptoms should contact their health care provider immediately. Family members should be alert for these symptoms as well, since they are often able to recognize serious symptoms sooner than the mother does.
Canadian Journal (August, 07), Perinatal Depression: Hiding in Plain Sight
Shari I Lusskin, MD1; Tara M Pundiak, MD2; Sally M Habib, MD2, Vol. 52, No. 8.
Need Help? Access the PSI Social Support Network