Types of Pregnancy & Postpartum Mood Disorders

In this article, which is a chapter from my free downloadable booklet called A Guide To Pregnancy & Postpartum Stress, Anxiety & Depression, I describe the different symptoms and types of mood disorders that can happen either during pregnancy or after having a baby. The most commonly known is Postpartum Depression but there are other conditions you may be experiencing and it is important to get the correct diagnosis for treatment to be most effective.

I am a psychologist who has worked with new moms for over twenty years and we used to think that maternal depression only happens postpartum (after the baby is born) and we concentrated on treating Postpartum Depression (PPD).

But more recent research in the past decade has showed us that many women experience these symptoms during pregnancy too. Contrary to popular belief, pregnancy does not protect women from getting depressed. Approximately 15% of women experience significant emotional problems during pregnancy too.

Once studies stated looking in more depth we also realized that it is not just depression symptoms either, pregnant and postpartum women can also experience anxiety, obsessional compulsive disorder (OCD) which often focuses on some type of harm coming to the baby and post-traumatic stress (PTSD) if they have a difficult birth experience.

We now have a name that covers all the symptoms that women may experience during pregnancy and postpartum – Perinatal Mood Disorders (or PPMDs) and we know between 10 – 20 % of women can experience them.

Remember though that is only the percentage of women who are reporting it. Many women feel unnecessary guilt and shame and do not want to tell anybody how they feel, so it is probably a much higher percentage!

During Pregnancy

Women are just as likely to experience significant anxiety and/or depression in during pregnancy as they are after having a baby (approx. 15%). Read the specific sections about depression and anxiety below to find out more information on symptoms.

 

Postpartum or Baby ‘Blues’

The “blues” affects 60-80% of all new mothers and often includes frequent and prolonged crying, anxiety, irritability, poor sleep, quick mood changes and a sense of vulnerability. It usually occurs within the first three days following birth, continues for a couple of weeks and goes away on its own. Read more about the baby blues; what it is, why it happens and what helps.

Pregnancy & Postpartum Depression

Pregnancy Depression (also called antenatal or prenatal depression) and Postpartum Depression (PPD) affects between 15-20% of all new mothers.

Symptoms are characterized by lack of despondency, tearfulness and intense feelings of inadequacy, guilt, anxiety and fatigue. There may also be physical symptoms such as headaches and rapid heart rate and moms may feel disconnected from the baby.
Symptoms differ for everyone but might include any of the following:

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

These feelings can appear any time during the first few months to one year after the birth.

For more information about Pregnancy Depression read The Truth About Pregnancy During Depression and for tips for coping read 10 Tips For New Moms About Pregnancy & Postpartum Mood Disorders

Pregnancy & Postpartum Anxiety

Approximately 6% of pregnant and 10% of new moms experience anxiety. Let’s start with pregnancy. Pregnant women get a lot of advice about what they should do or not do from family, friends and social media. It can make everyone a little paranoid about what not to eat, do etc… The process of trying to get pregnant, fear of miscarriage, especially if there is a previous loss and what is going to happen to your life once this baby arrives can all cause anxiety or exacerbate pre-existing anxiety.

When the baby arrives every new parent worries that they don’t really know what they are doing and somehow, inadvertently, they may do something, or not do something, that causes harm to their baby. These little humans are totally vulnerable and now you are responsible for it! This can be scary sometimes but these worries are totally normal and everyone gets them occasionally.

But postpartum anxiety is more intense and persistent than typical new parent concerns. If you have any of the symptoms below for most of the day, you probably have postpartum anxiety.

• Racing thoughts
• Worrying
• Lack of concentration
• Restlessness
• Sleep disturbance
• Irritability
• Physical tension
• No appetite

Panic attacks are like anxiety multiplied by 10. They have a sudden onset and are accompanied by intense fear of something bad happening.

Physical symptoms include shortness of breath, chest pain, dizziness, heart palpitations (people often think they are going to have a heart attack), sweating and gastrointestinal upset.

Emotionally you may feel that you are going to somehow lose control, go crazy and may start to avoid situations where you have experienced panic attacks for fear of one happening again.

Panic attacks seem to go in waves, but it is important to know that they will pass and will not hurt you and there are techniques to calm your mind and body down.

(For a more detailed post about pregnancy & postpartum anxiety read The Facts About Pregnancy & Postpartum Anxiety)

Postpartum Post-Traumatic Stress Disorder (PTSD) Following Childbirth

When childbirth or the time frame just before or after labor is seen as traumatic, women can develop PTSD like symptoms. Affecting up to 6% of mothers, the traumas can include women feeling that either their life or the life of their baby is at risk during the labor or shortly thereafter.

Symptoms of postpartum PTSD might include 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, persistent increased arousal (irritability, difficulty sleeping, hyper-vigilance, exaggerated startle response), anxiety and panic attacks, and feeling a sense detachment.

Women who have experienced a previous trauma, such as rape or sexual abuse, are also at a higher risk for experiencing postpartum PTSD.  ​I have done research on PSTD and childbirth and worked with many women who have experienced it. It is important to recognize that this is different than Postpartum Depression so treatment can be tailored effectively.

(For a detailed post about Postpartum PTSD read When Your Childbirth Experience Wasn’t What You Hoped For)

Postpartum OCD

Postpartum Obsessive-Compulsive Disorder (OCD) is one of the scariest and under-diagnosed of the perinatal mood disorders.  It is estimated that as many as 3-5% of new mothers will experience symptoms such as obsessions (also called intrusive thoughts) which are persistent thoughts or images often relating to harm coming to the baby and compulsions to do certain things again and again to reduce her fears (called compulsions).

The thoughts, images or visions can be really horrific and seem very real. Women tend to not tell anyone they have these thoughts for fear of what others may think of them. When we keep thoughts in our head though, they grow more severe and even more frequent.

The moms with OCD know that their thoughts are bizarre and are very unlikely to ever act on them but are still fearful of being alone with the baby.

Postpartum Psychosis

Postpartum Psychosis or PPP (found in 0.1% of new mothers) is a serious, but relatively rare disorder, with reactions such as extreme confusion, refusal to eat, delusions or strange beliefs, auditory hallucinations (seeing or hearing things that aren’t there), feeling very irritated & hyper, decreased need for or inability to sleep, paranoia and suspiciousness and rapid mood swings. Most of these reactions occur within 3-14 days following the birth.

You can see that PPP is very different and much more severe than having the anxiety-provoking horrible thoughts that women with postpartum OCD have. In a psychotic state, a woman’s delusions and beliefs make total sense to her (but would be irrational to others) and feel very meaningful. Risk factors for PPP are a family history or previous personal history of psychosis or bipolar. Treatment needs to be immediate and requires hospitalization.
If you would like to read more of my Pregnancy & Postpartum related articles please click  Dr. Allen’s Pregnancy & Postpartum Blog

 

If you want to read more about maternal mental health download the FREE Guide To Pregnancy & Postpartum Stress, Anxiety & Depression. It is full of information about symptoms, different types of maternal mood disorders and advice about what to do to start feeling like yourself again.

 

Dr. Sarah Allen has 20+ years experience as a psychologist helping women transition to being the mom they want to be. She is also the Director of the Postpartum Depression Alliance of IL, a non-profit offering info and support to pregnant and postpartum moms and their families.

In her Northbrook office, in the North Suburbs of Chicago, or via telephone or online counseling she offers the most convenient way for you to access support and help.

If you have questions after reading this article or the Guide To Pregnancy & Postpartum Stress, Anxiety & Depression or have any questions about how counseling can be useful to your particular circumstances please contact me at 847 791-7722 or on the form below.

 

If you would like to read my blog posts of a variety of topics such as Anxiety, Depression, Parenting, Emotional Eating and Couples & Family Counseling click  Dr. Allen’s Blog and then go to the relevant section that interests you.

 

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There has been a growing awareness about Postpartum Depression over the past decade and doctors offices now routinely screen moms for it but I think anxiety, during pregnancy and after having a baby, is nearly as common and just as debilitating. It is time to focus on how many women are effected by anxiety and educate our community so we are all aware of the symptoms and how to access appropriate help.

Approximately 6% of pregnant and 10% of new moms experience anxiety, and remember that statistic comes from the number of women actually reporting it so imagine how many women go through anxiety and don’t mention it to their doctors or reach out for help. You are definitely not alone in going through this and treatment is available and really can help.

Pregnancy Anxiety

Let’s start with pregnancy. Pregnant women get a lot of advice about what they should do or not do from everyone and their dog. It can make you a little paranoid. The process of trying to get pregnant, fear of miscarriage, especially if there is a previous loss and what is going to happen to your life can all cause anxiety or exacerbate pre-existing anxiety. A lot of my clients say that they have always been a worrier and others say they weren’t anxious until getting pregnant.

Postpartum Anxiety

When the baby arrives every new parent worries that they don’t really know what they are doing and somehow, inadvertently, they may do something, or not do something, that causes harm to their baby. Are they getting enough milk, sleep, developing okay???

Until a baby arrives, you don’t realize how totally vulnerable a little human is and now you are totally responsible for it! This can be scary sometimes but these worries are totally normal and everyone gets them occasionally.

What we are talking about here though is something quite different, postpartum anxiety is more intense and persistent than typical new parent concerns. If you have any of the symptoms below for most of the day, you probably have postpartum anxiety. If they persist for more than a couple of weeks after the birth (the baby blues effect 80% of women but within 2 weeks mood swings typically calm down) or come on anytime in the first year and last two weeks or more, then it is important to seek support.

Symptoms of Pregnancy & Postpartum Anxiety

Racing thoughts – they go round and round in your brain with no off switch.

Worrying – it’s constant, you know the concerns are excessive but that doesn’t stop the worries and when you stop worrying about one thing, your mind jumps to another. Worries often surround the well-being of the baby or your other children, partner and yourself. Women worry they are going crazy and have a feeling of dread in the pit of their stomach.

Lack of concentration – your focus flits from one thing to another and memory is poor.

Restlessness – you are exhausted but so agitated you can’t settle or relax.

Sleep disturbance – you can’t sleep even if the baby is sleeping and when you drop off you don’t wake up energized.

Irritability – you may be able to hide it from friends, your partner will probably be getting the brunt of it.

Physical tension – your muscles are balls of tension, possibly leading to neck, shoulder and backaches.

No appetite – women want to lose the baby pounds but this isn’t the way to do it. Even though you know you should be keeping hydrated and your energy up, you have no appetite for food and may feel nauseous a lot of the time.

There are subsets of anxiety symptoms that are important to differentiate.

Panic Attacks

Panic attacks are like anxiety multiplied by 10. They have a sudden onset and are accompanied by intense fear of something bad happening.

Physical symptoms include shortness of breath, chest pain, dizziness, heart palpitations (people often think they are going to have a heart attack), sweating and gastrointestinal upset.

Emotionally you may feel that you are going to somehow lose control, go crazy and may start to avoid situations where you have experienced panic attacks for fear of one happening again.

Panic attacks seem to go in waves, but it is important to know that they will pass and will not hurt you and there are techniques to calm your mind and body down.

The Difference Between Postpartum OCD & Psychosis

OCD is the short name for obsessive compulsive disorder. Obsessions are unwanted thoughts that pop into your head totally uninvited and during pregnancy or after childbirth these thoughts typically revolve around some harm coming to the baby. The thoughts, images or visions can be really horrific and seem very real. Women tend to not tell anyone they have these thoughts for fear of what others may think of them. When we keep thoughts in our head though, they grow more severe and even more frequent.

A lot of time (but not always) the thoughts are accompanied with a compulsion (an overwhelming belief that you MUST do a certain behavior or think certain thoughts in the belief that this will stop the bad thing from actually happening).

Women worry that having these types of thoughts means they are going crazy. When stories get in to the news about postpartum women it is usually because the woman has postpartum psychosis and has done something horrific like harm her baby or driven off a bridge. Those stories are so horrible that the news media jump all over them but only 0.1% of new moms experience postpartum psychosis ( termed PPP). IT IS RARE! Furthermore, only about 4% of this 0.1% harm actually harm themselves or their baby so the likelihood that you are having a psychotic episode (i.e. are not in touch with reality) and will actually cause harm is EXTREMELY RARE but it makes headlines.

About 3 -5% of women experience postpartum OCD so although it is not talked about as much as postpartum depression, it is pretty common and the most important thing to remember is that if you know these thoughts would be a bad thing to do, you are experiencing OCD, not psychosis.

The main symptoms of PPP include delusions or strange beliefs, hallucinations (seeing or hearing things that aren’t there), feeling very irritated & hyper, decreased need for or inability to sleep, paranoia and suspiciousness and rapid mood swings. In a psychotic state, a woman’s delusions and beliefs make total sense to her (but would be irrational to others) and feel very meaningful. Risk factors for PPP are a family history or previous personal history of psychosis or bipolar. Treatment needs to be immediate and requires hospitalization. You see, it is very different from having anxiety-provoking horrible thoughts and still being in touch with reality.

PTSD After Childbirth

Postpartum post-traumatic stress disorder (PTSD) following a difficult childbirth is more common than you think. It is triggered by a real or perceived trauma during delivery and can effect up to 6% of mothers. The traumatic experiences usually leave a women feeling that either her life or the life of her baby is at risk during the labor or shortly thereafter.

Symptoms of fully fledged postpartum PTSD might include intrusive re-experiencing of a past traumatic event (which in this case may have been the childbirth itself, shortly after or events leading up to going to the hospital), flashbacks or nightmares, avoidance of stimuli associated with the event, persistent increased arousal (irritability, difficulty sleeping, hyper-vigilance, exaggerated startle response), anxiety and panic attacks, and feeling a sense detachment.

What I often see in my practice is that women who have had a difficult labor don’t necessarily have the flashbacks and nightmares but they are left with persistent anxiety and hypervigilance about potential harmful things happening in the future or guilt and regret about how labor turned out.

After reading this article do any of these feelings seem familiar? What I really want you to take away from reading this is that pregnancy and postpartum anxiety is much more common that you think it is. Many of the women you know have probably experienced the same thing but just don’t talk about it and struggle on.

Anxiety is very treatable though. You don’t need to struggle by yourself. In particular, I find that cognitive therapy is the most effective way to get on top of anxiety. Also known as CBT, it is a problem-solving type of therapy and helps you learn ways to calm down quickly, develop coping strategies and think about things in a different, more helpful way. I use CBT anxiety-reducing treatment strategies and combine them with 20 years of experience of working with new moms and the knowledge I gained raising 3 children of my own.

If you have had therapy before you might find this type of counseling to be more directive and problem-solving than you are used to but I have found to be the most effective way. No lying on my couch while I say “Hmm, how does that make you feel.”

I have two free booklets that are full of information which will be useful to you.

A Guide To Pregnancy & Postpartum Stress, Anxiety & Depression has more information about symptoms, risk factors, how to look after yourself and treatment options.

 

To get your FREE copy of the booklet click the link below

Guide To Pregnancy & Postpartum Stress, Anxiety & Depression

 

 

 

Simple Steps To Overcoming Anxiety & Worrying can be downloaded below and is full of practical tips and exercises to get anxiety more under control.

 

To get your FREE copy of the booklet click the link below

Get Simple Steps To Overcome Anxiety & Worrying

 

 

 

I see clients in my Northbrook office or for your convenience, via telephone or internet sessions

If you have any questions after reading this article or want to know more about anxiety treatment

please contact me at 847 791-7722 or

email me below

 

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