Is It Postpartum Depression Or Something Else?

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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 have 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:

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

Dr. Sarah Allen

Dr. Sarah Allen has 25+ years of experience in private practice helping women to transition to being the mom they want to be. She is the Founding Director of the statewide non-profit Postpartum Depression Alliance of IL. She also specializes in pregnancy loss & infertility & has published research on postpartum depression and traumatic childbirth.

If you would like to work with Sarah, please phone her at 847 791-7722 or on the form below.

If you would like to read more about me and my areas of specialty,  please visit Dr. Sarah Allen Bio. Dr. Allen’s professional license only allows her to work with clients who live in IL & FL & the UK and unfortunately does not allow her to give personalized advice via email to people who are not her clients. 

Dr. Allen sees clients in person in her Northbrook, IL office or remotely via video or phone.

    What Can I Read That Helps Me While I Am Waiting For My First Appointment With Sarah?

    If you feel that you may be experiencing pregnancy or postpartum mood disorder, or worry that you may be at risk of developing it, please download my free booklets below.

    See each specific webpage to download one or many.

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    Sarah Transformed Our Family’s Sleep and Sanity

    My baby didn’t sleep. She wouldn’t sleep more than a couple of hours at night and no more than 30 minutes during the day. I was completely overwhelmed and my husband and I were at each other’s throats. I was supposed to be going back to work but was barely functioning. Sarah helped us to learn how to get our baby sleeping and then she supported me in my transition back to work. She also helped my husband and I navigate how to share childcare and running the house fairly. She is a very knowledgeable therapist and has really helped us.

    Pam. L.

    Dr. Allen Helped Me to Feel More Empowered

    Dr. Allen has really helped me find my own voice. When I began therapy I would swing between being passive and doing whatever other people wanted me to do to being angry and frustrated. I have been on antidepressants for quite a few years but it wasn’t really working. Through therapy I have learned to listen to my own needs and to speak up. I used to worry that people wouldn’t like me if I didn’t agree with them but when Dr. Allen gave me the support I needed I challenged my fears. I spend a lot less time feeling angry and depressed now and I have really widened my social network. This is how I have always wanted to be but didn’t know how to get there. Dr. Allen has a very reassuring manner and makes you challenge yourself but by using small steps so you feel ready to do it. I have really come out of my shell and would recommend anyone who is feeling depressed to come and talk with her.

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    Dr. Teresa Poprawski

    Dr. Allen is an expert in treating perinatal mood disorders.

    I refer as many patients as I can to Dr. Allen. She is an expert in treating perinatal mood disorders, and a well-trained and experienced therapist who is committed to working with her clients to develop a treatment plan designed for each individual. She exhibits genuine warmth, kindness and compassion for each of her clients. Dr. Allen has been a colleague of mine for more than 20 years, and I have great confidence when I refer patients to her.

    Leslie Lowell Stoutenburg

    I become empowered and a happier person.

    I began seeing Dr. Allen when my first child was around a year old. I had experienced a very traumatic birth, after a difficult pregnancy where I was on bed rest for a good portion of the time. The first year of my son’s life was spent worrying constantly. I also experienced flashbacks to the birth, which was an emergency C-section under general anesthesia. My son was in the NICU for several days following his birth, and I was not given very much information as to why. I remember thinking that he would die, or that something awful was going to happen.

    I experienced a great deal of anxiety that first year, and I thought that it was due to being a new mom. I wasn’t sleeping, I wasn’t eating as normal, and I remember being worried about leaving the house or taking my baby with me anywhere. I worried constantly about illness, germs, etc.

    The first day that I saw Dr. Allen, she gave me some questionnaires to fill out before we started talking. Then we sat down and talked about my experiences with my son’s birth and the early days of his life, and the year or so since then. I remember to this day the relief that I felt when she looked at me and said that I had PPD and PTSD, which was a result of the trauma I experienced during and immediately after the birth of my son. She explained how my brain had reacted to the stress of these events, and related it to why I was feeling the way that I felt. It made so much sense. Then, she described ways that I could get over the trauma, work through the feelings, and recover from PTSD and PPD. I felt so empowered, and so happy that the way I felt had a name, and that it was treatable. It also made me feel so validated in the ways that I had felt and reacted following my son’s birth. I wasn’t going crazy. My reaction was normal and natural. And with the help of Dr. Allen, and the type of therapy that she uses, I knew I could recover.

    It is over five years since that first visit with Dr. Allen, and I still use the tools that she taught me today to deal with stress. I credit her with helping me to become a more empowered, happier person.

    Elizabeth

    Overcoming PPD with Dr. Sarah’s Support

    When I had my first baby I had what I now know was postpartum depression but I didn’t get any help. It did go away after about 18mths but it was a miserable way to begin motherhood.  When I was pregnant with my second child I started to become depressed again and this time told my OB/GYN how I was feeling and she referred me to Sarah. By starting to deal with how I felt and change the way I was handling the stresses in my life, I was in a much better place when my baby was born. The second time round my PPD was much less severe and didn’t last as long. 

    Sarah was also really helpful in teaching me ways to make the transition of becoming a big sister easier for my oldest one too.   My husband came with me for some sessions and that really helped our relationship and we started working on parenting issues together.  Sarah’s counsel and support really helped our family transition to the good place we are all in today.

    Sarah C.

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