Types of PMAD: Beyond Postpartum Depression
Although depression is the most common perinatal mood and anxiety disorder, other conditions can occur in addition to depression. Educating expectant parents and their support persons on the range of symptoms and when symptoms may occur can help ensure more individuals receive treatment sooner rather than later…or never.
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. Symptoms include sadness, anger, change in appetite, difficulty making decisions, fatigue, feelings of hopelessness, guilt or shame, irritability, loss of interest in normally pleasurable activities and sleep problems.
Approximately 6% of pregnant women and 10% of postpartum women develop anxiety. These disorders include generalized anxiety disorder and panic disorder (panic attack).
Symptoms of general anxiety disorder include excessive worry and fear about the baby’s health and safety including scary thoughts, feeling overwhelmed, inability to sit still, changes in appetite and restless sleep.
Those with panic disorder feel very nervous with recurring panic attacks including symptoms like shortness of breath, chest pain, claustrophobia, dizziness, heart palpitations and numbness and tingling in the extremities.
Perinatal OCD affects approximately 3-5% of pregnant and postpartum women. Symptoms include repetitive, upsetting and unwanted thoughts and mental images (obsessions) such as something terrible happening to the baby through accident or purposely. In addition, they may feel the need to excessively repeat certain behaviors (compulsions) 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.
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, and changes such as hypervigilance, problems concentrating, self-destructive or aggressive behavior and sleep problems.
Approximately 3% of pregnant and postpartum women experience symptoms of a bipolar mood disorder after pregnancy. These disorders are comprised of two cycles or phases—the lows (depression symptoms) and the highs (mania or hypomania—some symptoms include decreased need for sleep, mood much better than normal, rapid speech, delusions, impulsiveness).
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.
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.
Symptoms can include hallucinations, delusions, hyperactivity, decreased sleep, rapid mood swings, difficulty communicating at times and confusion.
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.
Postpartum psychosis is a very serious emergency and requires immediate attention. If you or someone you know may be experiencing postpartum psychosis, call your physician, your local emergency number (911 in Michigan and Iowa), the National Suicide Prevention Hotline (800.273.8255) or the Pine Rest crisis line (800.678.5500) or go to the nearest hospital emergency room.