Perinatal Mood and Anxiety Disorders

Depression during Pregnancy or Postpartum

The most common of pregnancy and postpartum mood disorders is Postpartum Depression (PPD). Your doctor, midwife, or doula may have told you that it’s normal to experience “baby blues” for days or weeks following the birth of your child. However, if you’re still feeling symptoms more than a couple weeks later, and those symptoms remain consistent in intensity, it may be PPD. Fathers, or other partners, experience hormonal changes during the pregnancy and birth as well, so it’s possible for them to experience PPD and should also receive the right care and treatment.

Symptoms are not necessarily immediate, and can start anytime during pregnancy or the first year postpartum. They differ for everyone, and might include the following:

• Depression mood and severe mood swings

• Feelings of anger, rage, or irritability

• Lack of interest in the baby

• Difficulty feeling connected with the baby

• Appetite and sleep disturbance

• Isolating, or withdrawing from family and friends

• Feelings as though your family and baby would be better off without you

• Crying and sadness

• Feelings of guilt, shame, worthlessness or hopelessness

• Loss of interest, joy or pleasure in things you used to enjoy

• Possible thoughts of harming the baby or yourself

• Recurrent thoughts of death or suicide

If you are experiencing thoughts of suicide or need immediate support, please call the National Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-8255) or use their webchat on suicidepreventionlifeline.org/chat

Anxiety During Pregnancy or Postpartum

While it’s normal to experience a certain amount of worry as you welcome your new baby home, you may find yourself worrying excessively, or uncontrollably. If your anxiety seems out of control, has you on edge most of the time, or keeps you up at night, you may have more than the new-parent jitters.

The symptoms of anxiety during pregnancy or postpartum might include:

• Constant, uncontrollable worry

• Feeling of dread that something bad is going to happen

• Racing thoughts

• Disturbances of sleep (Yes, you may be sleepless because you have a newborn frequently waking during the night. This is more like lying awake at night with anxiety and racing thoughts while your baby is sleeping soundly)

• Disturbance of appetite

• Restlessness, Inability to sit still

• Somatic symptoms like dizziness, hot flashes, fatigue, heart palpitations, and nausea

Some parents may develop Postpartum Panic Disorder. This is very similar to the symptoms of regular panic attacks, but are centered around concerns of being a new parent. Symptoms include:

• Shortness of breath

• Chest pain

• Claustrophobia

• Dizziness

• Heart palpitations

• Numbness and tingling in the extremities

Postpartum Obsessive Compulsive Disorder (PPOCD)

Often misdiagnosed as PP Anxiety, PPOCD is differentiated by repetitive, upsetting and unwanted thoughts or mental images (obsessions), and enacting behaviors designed to reduce the anxiety caused by those thoughts. These parents find these thoughts disturbing, and are extremely unlikely to act on them.

Symptoms of Postpartum Obsessive Compulsive Disorder include:

• Obsessions (intrusive thoughts or images) which are persistent, repetitive, and related to the baby. These thoughts or mental images are very upsetting to the parent

• Compulsions, where the may enact certain behaviors over and over again in an effort to reduce her fears and obsessive thoughts. This may include things like checking that the baby is breathing many, many times throughout the night

• A sense of horror about the obsessions

• Fear of being left alone, or leaving anyone else alone, with the infant

• Hypervigilance in protecting the infant

• Moms with postpartum OCD know that their thoughts are bizarre and are very unlikely to ever act on them.

Postpartum Post Traumatic Stress Disorder (PPTSD)

PPTSD is often caused by a difficult pregnancy or frightening childbirth experience. It is possible for the physical experience of giving birth to be triggering of a previously experienced trauma as well. Everyone plans for a safe and joyous birth experience, but if childbirth didn’t go as planned, it may have a lasting impact on your mental health. PPTSD can often develop from having a pregnancy or birth experience starkly different from the one they’d planned or dreamed about. When, for example, a parent experiences a preterm labor requiring NICU, unexpected c-section, severe tear or hemorrhage, or home birth that turned into a hospital birth, they may have difficulty coming to terms with all that occurred.

Symptoms of postpartum PTSD can include:

• Intrusive re-experiencing of a past traumatic event (which in this case may have been the childbirth itself)

• Flashbacks or nightmares

• Avoidance of stimuli associated with the event, including thoughts, feelings, people, places and details of the event

• Persistent increased arousal (irritability, difficulty sleeping, hypervigilance, exaggerated startle response)

• Anxiety and panic attacks

• Feeling a sense of unreality and detachment

Risk Factors

You may be at a higher risk of developing a perinatal mood or anxiety disorder if you have:

• A personal or family history of depression, anxiety, OCD or postpartum depression

• Hormonal changes

• Premenstrual dysphoric disorder (PMDD or PMS)

• Inadequate support in caring for the baby

• Financial stress

• Marital stress

• Complications in pregnancy, birth or breastfeeding

• A major recent life event: loss, house move, job loss

• Mothers of twins multiples

• An infant in Neonatal Intensive Care (NICU)

• Mothers who’ve gone through infertility treatments

• Women with a thyroid imbalance

• Women with any form of diabetes (type 1, type 2 or gestational)

• Miscarriage or other previous loss