Pregnancy, childbirth, and parenting are amazing experiences that often involve dramatic changes to our hormones, bodies, and lives. These ups and downs can feel like an emotional and physical roller coaster. Since the beginning of the COVID-19 pandemic, some risk factors for psychological stress have worsened with social and physical isolation, producing a general increase in depression and anxiety. So how can you tell if the emotional changes you’re experiencing during pregnancy and the postpartum period are a sign of a more serious condition?
If you have any mental health challenges related to pregnancy or otherwise, it is not your fault.
Perinatal depression includes depression that starts during pregnancy (prenatal) and depression that develops after delivery (postpartum). Perinatal depression and other postpartum mental health disorders are thought to be caused by a combination of genetic and environmental factors. Perinatal mood and anxiety disorders (or PMADs) encompass prenatal and postpartum depression, anxiety, psychosis, and obsessive-compulsive disorder.
If you develop perinatal depression, anxiety, or any other postpartum mental health disorders, it is not your fault. Read that again: If you have any mental health challenges related to pregnancy or otherwise, it is not your fault. You are also not alone. According to the Children’s Hospital of Philadelphia (CHOP), one in seven women are affected by PMADs, and the CDC’s research shows that approximately one in eight women in the United States experience postpartum depression. This applies to dads, too. According to a 2010 study, approximately 4 percent of dads experience depression in the first year after their child’s birth. While postpartum mental health disorders are quite common, the good news is that they’re also very treatable. It’s important to know what to watch out for and how to seek help if you determine that you need it.
Perinatal depression and anxiety
First, what are depression and anxiety? According to the Mayo Clinic, “Depression is a mood disorder that causes a persistent feeling of sadness and loss of interest,” and people with anxiety disorders “frequently have intense, excessive and persistent worry and fear about everyday situations.” While feeling blue or anxious on occasion are normal experiences of being human and being a parent, clinical depression and anxiety often interfere with individuals’ daily lives and last for a long time. Depression and anxiety can crop up both during and after pregnancy.
It’s very normal to experience some worry, anxiety, sadness, and mood changes during this time period, but if you notice that you’re continuing to struggle beyond the first couple weeks, it might be time to see if you’re experiencing something else.
You have probably heard the phrase “baby blues.” The baby blues refers to the often tumultuous first two weeks home with your baby. Suddenly, you are home with a new baby to take care of, while recovering from childbirth, awash in massive hormone fluctuations, and adjusting to a major life change—all while getting very little sleep. It’s very normal to experience some worry, anxiety, sadness, and mood changes during this time period, but if you notice that you’re continuing to struggle beyond the first couple weeks, it might be time to see if you’re experiencing something else related to postpartum mental health, possibly postpartum depression or anxiety.
Symptoms of perinatal depression can include depressed mood, severe mood swings, overwhelming fatigue, difficulty bonding with your baby, intense irritability, and thoughts about suicide or harming your baby. For a full list of symptoms from the Mayo Clinic, click here.
Symptoms of perinatal anxiety can include intense worry or dread, racing and intrusive thoughts, trouble falling asleep or sleeping too much, restlessness, or inability to sit still. Texas Children’s Hospital has a great post about recognizing postpartum anxiety here.
Perinatal psychosis and obsessive-compulsive disorder
Perinatal depression and anxiety are extremely common. They also can sometimes go hand in hand with other postpartum mental health and perinatal mood disorders like postpartum psychosis and obsessive-compulsive disorder (OCD), which are much less common.
CHOP says that around 1 in 1,000 women will develop a very rare but serious disorder called perinatal or postpartum psychosis. Symptoms of postpartum psychosis can include being extremely confused, refusing to eat, distrusting other people, seeing or hearing things that are not there, and thinking of hurting yourself, your partner, or your baby. According to CHOP, “Women who have been diagnosed with a bipolar disorder, schizophrenia or other psychiatric challenges may have a higher risk for developing this form of mood disorder. Women who have experienced perinatal or postpartum psychosis in the past have a 30 percent to 50 percent recurrence risk, so please inform your provider if this is a part of your medical history.”
There are many effective treatments for PMADs. The first step is seeking help.
Postpartum OCD affects around 3–5 percent of new mothers. This disorder is characterized by repeated intrusive thoughts or images. Symptoms include obsessive thoughts (often relating to the baby), fear and concern about the obsessive thoughts, heightened alertness and focus on protecting the baby, fear of being alone with the baby, and compulsive behaviors around reducing fears (can include cleaning, checking, counting, etc.). Individuals experiencing postpartum OCD are often aware that their thoughts are irrational and concerning. You can learn more about differentiating the intrusive thoughts of postpartum OCD from other PMADs here.
Risk factors
There are many risk factors associated with PMADs. Many of these are entirely out of your control, and some (like challenges accessing social support) have been exacerbated by COVID-19. Being aware of your personal risk factors and personal and family health history can help you assess your risk, and knowledge about symptoms can help you, your partner, and your family know what to be watchful for.
Some risk factors:
- Personal or family history of depression, anxiety, or mood disorders/mental illness
- Depression during pregnancy
- Difficult pregnancy, labor, or delivery
- Previously untreated postpartum depression
- Difficulty breastfeeding
- History of trauma including physical, sexual, and emotional abuse
- Stressful life events
- Lack of social support
- Unplanned pregnancy
- Twins, triplets, or other multiple birth
- Health challenges for mom or baby
When to seek help
Generally speaking, the Mayo Clinic advises that if your mental health symptoms meet any of the following criteria, it’s time to seek help:
- Don’t diminish or improve after two weeks
- Worsen with time
- Make it hard for you to care for your baby
- Make it hard to complete everyday tasks
- Include thoughts of harming yourself or your baby
Your providers should be screening you for PMADs both during and after your pregnancy. Be honest when answering questions and thinking about how you are feeling. If things start to feel off between appointments, don’t hesitate to reach out to your provider. If you find yourself in the midst of a mental health crisis, the national SAMHSA helpline is 1-800-662-HELP (4357). The helpline is free, confidential, and available 24/7 365 days a year to provide information and referrals. You can also find a provider here.
Treatment
Now, for some good news: There are many effective treatments for PMADs. The first step is seeking help. You can start by talking to your OB or a therapist. Different types of psychotherapy (also called counseling or talk therapy) and a variety of medications can help immensely. Lifestyle choices can also have an impact: Try to stay connected with others as best you can, make time for yourself when you are able, set realistic expectations, and ask for help when you need it. Again, postpartum mental health challenges are common and are related to a variety of factors that aren’t your fault. But with the right treatment and support system, they can be managed and you can start to feel better.