Perinatal Mood Disorders: What You Need to Know

Fifteen to twenty percent of women will suffer some sort of pregnancy-related mood disorder either during pregnancy, or in the twelve months following birth. Postpartum depression, the most commonly known of the perinatal mood disorders, affects an estimated 15% of women. Prenatal depression and postpartum anxiety disorder affect one in ten. And recent studies and clinical work are now recognizing the prevalence (3-6%) of disorders like prenatal anxiety, postpartum obsessive-compulsive disorder (OCD), and postpartum post traumatic stress disorder (PTSD). (The highly media-attended extreme of these disorders, postpartum psychosis, affects less than 1% of women.)

In 2010, an article was published in the Archives of General Psychiatry (Grote, et al) which described a serious link between untreated prenatal depression and pre-term birth (birth prior to 37 completed weeks of pregnancy), intrauterine growth restriction and low birth weight. That same year, the American College of Obstetricians and Gynecologists released a statement, urging maternity care providers to screen all their patients for pregnancy-related mood disorders—both pre- and post-birth.

Many theories abound as to why these psychological disorders occur in relation to pregnancy. Hormonal fluctuations, increased stress and underlying, chronic inflammatory processes are all vying for attention and, thankfully, are finally receiving it. In no event, does a perinatal mood disorder represent “bad parenting,” “inadequacy for motherhood” or other judgments against the woman, herself.

Until researchers unlock the mystery to perinatal mood disorder causation we, as a culture, need to stand up and take note. Observation of symptoms that may indicate the presence of a perinatal mood disorder warrant immediate attention by a qualified care provider. The following is a list of symptoms associated with each perinatal moor disorder, taken from Postpartum Support International’s website:

Perinatal Depression:

• Feelings of anger or irritability
• Lack of interest in the baby
• Appetite and sleep disturbance
• Crying and sadness
• Feelings of guilt, shame or hopelessness
• Loss of interest, joy or pleasure in things you used to enjoy
• Possible thoughts of harming the baby or yourself

Perinatal Anxiety:

• Constant worry
• Feeling that something bad is going to happen
• Racing thoughts
• Disturbances of sleep and appetite
• Inability to sit still
• Physical symptoms like dizziness, hot flashes, and nausea

Postpartum OCD:

• Obsessions, also called intrusive thoughts, which are persistent, repetitive thoughts or mental images related to the baby. These thoughts are very upsetting and not something the woman has ever experienced before.
• Compulsions, where the mom may do certain things over and over again to reduce her fears and obsessions. This may include things like needing to clean constantly, check things many times, count or reorder things.
• A sense of horror about the obsessions
• Fear of being left alone with the infant
• Hyper vigilance in protecting the infant 

Postpartum PTSD:

• 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, hyper vigilance, exaggerated startle response)
• Anxiety and panic attacks
• Feeling a sense of unreality and detachment

Postpartum Psychosis:

• Delusions or strange beliefs
• Hallucinations (seeing or hearing things that aren’t there)
• Feeling very irritated
• Hyperactivity
• Decreased need for or inability to sleep
• Paranoia and suspiciousness
• Rapid mood swings
• Difficulty communicating at times

The good news is that all of these disorders are treatable with medication, counseling, or both. Additionally, lifestyle adjustments and some non-pharmacologic remedies show promise in the treatment of perinatal mood disorders. Depending on the type of medication prescribed, it may need to be taken for at least six months and often accompanied by counseling to exact complete treatment and healing. The woman undergoing treatment for a perinatal mood disorder additionally benefits from extra help and support from friends and loved ones, including tasks around the home and childcare.

Kimmelin Hull has been a Lamaze Certified Childbirth Educator since 2005 and is the Community Manger for Lamaze International’s Science & Sensibility research blog site. She is a physician assistant and is the author of A Dozen Invisible Pieces and Other Confessions of Motherhood. Kimmelin has also written freelance articles for regional and international parenting magazines, and maintained her own blog site, Writing My Way Through Motherhood and Beyond since 2008. A member of Montana Childbirth Collective, Kimmelin has participated in numerous community education, normal birth and gentle parenting advocacy events. A mother of three, Kimmelin and her husband raise their family in the beautiful Rocky Mountain town of Bozeman, Montana.