Perinatal Mood Disorders
What's My Risk?
IIf you are a new or expectant mother, you have probably heard the term postpartum depression. For the last few years, increased discussion among women, healthcare providers, legislators, and in the media have brought these common, easily treated disorders into focus because they too often go unrecognized and untreated causing mothers needless suffering during the perinatal period (pregnancy and after delivery).
While it is true that up to 1 in 5 mothers may experience a pregnancy related mood disorder, the majority face depression or anxiety that begins to resolve once prompt and appropriate treatment is initiated. How do you know if you are at risk? And what should you do if you suspect it is present?
Identifying Perinatal Mood Disorders
It's perfectly normal to have emotional ups and downs during pregnancy and the postpartum. Being a bit more reactive at times is no cause for alarm. Even after delivery, up to 80% of new mothers develop the baby blues—a period of heightened emotion or irritability that may manifest as tearfulness, anger, sleeplessness, or exhaustion. The baby blues will go away by itself generally within 2 – 4 weeks.
Perinatal mood disorders, however, encompass more intense and longer lasting symptoms that often worsen. These symptoms can include tearfulness, agitation, repetitive thoughts, excessive worry, insomnia, anger, lack of feeling for the baby, disharmony with loved ones, and feeling that something is very wrong. These feelings can start during pregnancy or after delivery. You may keep checking the baby over and over, stay up late trying to clean the house, alienate those who offer help, resent those who aren't there for you, or feel like it's too much effort to get out of bed and comb your hair. You may long for your pre-baby life and wonder if things will ever be the same.
Loneliness can increase, as you do not recognize the person you've become and feel alienated from your partner. You may have irrational fears or obsessions. In very rare instances, some mothers think about ending their lives or that of their baby. If these thoughts occur, you need immediate, emergency medical assistance. Thankfully, these extreme symptoms are unlikely, and occur in less than half of one percent of women.
A more common scenario of these illnesses is the mother who may feel horribly depressed or anxious but tries to put these feelings aside. She prays for relief and wonders if it will end. She compares herself with other moms out at Gymboree every day and thinks she must be the worst mother in the world. She puts on a fake smile, trying to pretend that all is well because reaching out for help seems like a huge defeat. How can she let others know that motherhood has not brought the expected joy? She feels the failure is hers and suffers alone.
What Causes Perinatal Mood Disorders?
First of all, these are medical illnesses. Nothing you did caused this. Perinatal mood disorders are not a reflection of character, strength, or endurance. Would we ever judge a diabetic or cancer patient for becoming ill and needing treatment? Would we expect a person with a broken leg to walk a mile? Perinatal mood disorders are no different.
It is thought that the combination of hormonal shifts, biological predispositions, and psychosocial factors can exacerbate these disorders. Some women who are more sensitive around the time of their period are also more sensitive to the hormonal fluctuations of pregnancy and delivery. You may have a family history of a mood or anxiety disorder. You and your partner might be struggling with financial, employment, healthcare or marital issues. There may have been recent death or illness in the family that has caused sadness or separation. All of these issues can place additional stress on the very systems that support physical and mental health.
Remember, these are risk factors, not predictive of developing the illness. Some women with multiple risks are just fine, while others with none of the above present with symptoms. A proactive approach is the best prevention. Talk to your doctor if you have the above risk factors and let him know how you are feeling! You are the best diagnostician of how you are feeling! If it doesn't feel right, speak up! And then go and talk to a mental health professional who has had specialized training in perinatal mood disorders.
Awareness and Treatment of Perinatal Mood Disorders
Our society is beginning to recognize this public health crisis, which will affect 800,000 women this year. Some states, like New Jersey and Illinois have laws that require facilities to offer screening to new mothers or give them educational materials about postpartum depression. Legislation at the federal level, called The Melanie Blocker Stokes MOTHERS Act, has recently been introduced in the U.S. Senate and calls for more education, public service announcements, professional training, and grants for services.
More OB/GYN and pediatric practices offer screening and assessment for perinatal mood disorders. If detected, psychotherapy, social support, good nutrition, sleep, and sometimes medication are the most common forms of treatment. Complementary treatments such as massage, exercise, bright light therapy, and vitamin supplements may also support recovery. Many communities offer support groups or hotlines.
If you or a pregnant/new mother you love seems to be struggling, please reach out! Give her this article or other informational supports so she can find the help she needs. These are highly treatable illnesses—that's the good news! You will be well again. But recovery can't start until treatment begins!