Perinatal Mood & Anxiety Disorder: More Than Just “Baby Blues”

Many women can relate to the emotional roller coaster that dominates the first few weeks after a baby is born. Who wouldn’t be a mess? Sore, sleep deprived, in a totally new role (even if this is not your first child), hormones are unbalanced and little time to take care of yourself.

Experiencing the baby blues is common. Perinatal mood and anxiety disorders (PMADs) are common…but require treatment. So how do you know if you or a loved one is experiencing something more serious than the baby blues?

Baby Blues

Nearly 80% of women experience “baby blues” — those mild mood swings that usually begin a few days postpartum and last about three weeks. Symptoms include moodiness, tearfulness, anxiety, inability to concentrate and sadness. These feelings come and go but the predominant mood is actually happiness.

Perinatal Mood & Anxiety Disorders (PMAD)

PMADs have an onset any time during pregnancy until one year after the baby is born and symptoms last longer than three weeks. The highest time of risk is six months after childbirth. Symptoms can include excessive worry about the baby’s health, sadness, guilt, hopelessness, anger, difficulty bonding with baby, sleep problems (even when baby is sleeping), fatigue, loss of interest in normally pleasurable activities, change in appetite, irritability and difficulty making decisions.

Although depression is the most common perinatal mood and anxiety disorder (PMAD), other conditions can occur in addition to depression. Expectant parents and their support persons should become familiar with the range of symptoms and when symptoms may occur can help ensure more individuals receive treatment sooner rather than later… or never.

Depression

Depression during and after pregnancy is the most common PMAD, affecting approximately 15% of women. Certain risk factors, such as previous depression or anxiety, can increase the likelihood of depression.

Common symptoms include:

• Sadness
• Anger
• Irritability
• Guilt
• Shame–sometimes about the ability to be a good parent

Other symptoms, such as fatigue, sleep problems and changes in appetite might be harder to notice as these are often expected in the postpartum period. It’s important to monitor those symptoms along with changes in mood to determine if you are experiencing postpartum depression.

Anxiety Disorders and Symptoms

Approximately 6% of pregnant women and 10% of postpartum women develop anxiety. These disorders include generalized anxiety disorder and panic disorder (panic attack).

Generalized Anxiety Disorder

Excessive worry and fear about the baby’s health and safety often resulting in…

• Scary thoughts
• Feeling overwhelmed
• Inability to sit still
• Changes in appetite
• Restless sleep

Panic Disorder (Panic Attack)

Very nervous with recurring panic attacks including symptoms like:

• Shortness of breath
• Chest pain
• Claustrophobia
• Dizziness
• Heart palpitations
• Numbness and tightening in the extremeties

Obsessive-Compulsive Disorder (OCD)

Perinatal OCD affects approximately 3-5% of pregnant and postpartum women. Symptoms include:

• Obsessions: Repetitive, upsetting and unwanted thoughts and mental images such as something terrible happening to the baby through accident or purposely. 
• Compulsions: In addition, they may feel the need to excessively repeat certain behaviors like hiding sharp objects, repeatedly asking family members for assurance and avoiding feeding, changing or bathing the baby out of fear of harming the infant

Post-Traumatic Stress Disorder (PTSD)

Occurring in approximately 1-6% of pregnant and postpartum women, PTSD is often caused by trauma during or following childbirth (such as unplanned C-section, baby going to NICU, prolapsed cord or feelings of powerlessness during the delivery), complications or injury related to pregnancy or childbirth (such as unexpected hysterectomy, severe preeclampsia\ eclampsia, postpartum hemorrhage or cardiac disease) or by a previous trauma (such as rape or sexual abuse).

Symptoms can include:

• Flashbacks or nightmares
• Intrusive thoughts or re-experiencing of the trauma
• Feeling alienated or unable to feel positive emotions
• Changes such as:
  • Hypervigilance
  • Problems concentrating
  • Self-destructive or aggressive behavior
  • Sleep problems
• In instances where the trauma was related to pregnancy or childbirth, a symptom can also be avoiding reminders of the trauma, one of which could be the new baby.

Bipolar Mood Disorder

Approximately 3% of pregnant and postpartum women experience symptoms of a bipolar mood disorder after pregnancy. Bipolar mood disorders can look like a severe depression or anxiety, so it is essential to get experienced professional help to make a correct diagnosis. Current research suggests a bipolar mood disorder places a woman at much higher risk for postpartum psychosis.

These disorders are comprised of two cycles or phases:

• The lows: depression symptoms
• The highs: mania or hypomania. Symptoms can include:
  • Decreased need for sleep
  • Mood much better than normal
  • Rapid speech
  • Delusions
  • Impulsiveness

Postpartum Psychosis

Extremely rare, psychosis occurs in approximately 1 to 2 out of every 1,000 deliveries. The onset of symptoms is usually sudden, most often within the first two weeks after delivery. Most women who experience postpartum psychosis do not harm themselves or anyone else (of the women who develop postpartum psychosis, there is a 5% suicide rate and a 4% infanticide rate); however, there is always risk of danger because of delusional thinking and irrational judgment. For that reason, it is extremely important to seek help immediately.

Symptoms can include:

• Hallucinations
• Delusions
• Hyperactivity
• Decreased sleep
• Rapid mood swings
• Difficulty communicating at times
• Confusion