“But I don’t feel depressed.” I hear this time and time again from pregnant and postpartum women who call my clinical practice. These women are plagued by anxiety, racing thoughts, restlessness, sleep difficulties, compulsive behaviors, and other troubling symptoms, and yet they do not reach out for help. Why? Because they don’t feel depressed. They’ve read the pamphlets in their doctor’s offices; they’ve seen the media coverage; they believe they are informed about postpartum depression. And they know they don’t have it! So they suffer, often reluctant to seek support, feeling isolated in their experience.
It’s Not Just Depression: While it is encouraging to see more media attention, patient education, and screening focused on postpartum depression (in New York there is a groundbreaking initiative, spearheaded by Mayoral First Lady Chirlane McCray, to screen all pregnant and postpartum women for depression), focusing only on depression does not capture the full range of emotional experiences of postpartum women. When we talk to women about postpartum depression, we also need to them about perinatal mood and anxiety disorder, commonly known as PMADs.
Perinatal Mood and Anxiety Disorders (PMADS): So what are PMADs? PMAD is an umbrella term that refers to the spectrum of emotional challenges that may arise during the perinatal period (from pregnancy through one year postpartum). There are seven different perinatal mood and anxiety disorders including Perinatal Anxiety, Perinatal Depression, Perinatal Panic Disorder, Perinatal Obsessive-Compulsive Disorder, Postpartum Posttraumatic Stress Disorder, Perinatal Bipolar Disorder, and Postpartum Psychosis.
So what does this mean for you? Whether you are pregnant or postpartum, it is important for you and your partner to get educated on the full range of perinatal mood and anxiety disorders, so that you can get adequate support. And that goes for dads, same-sex partners, and adoptive parents as well. PMADs can affect you as well. Know your risks, know the symptoms, and know where to seek help.
Risk Factors: While some women experience their first instance of depression or anxiety during pregnancy of the postpartum period, there are several known risk factors which significantly increase your chances of having a PMAD. You are at much higher risk if you have a previous history of depression, anxiety, OCD, bipolar disorder, have experienced a PMAD before, or have a family history of mental illness. Certain medical conditions including a history of diabetes, thyroid disease, or pre-menstrual dysphoric disorder (PMDD), or having a baby with medical needs can also place you at greater risk. A history of loss (including pregnancy loss), past trauma, or a traumatic pregnancy or birth experience can also increase your chances of developing a PMAD. Life stressors including poverty, poor social support, struggles with your partner, and single parenthood, are also risk factors. While this list can look a bit scary, it is important to gauge your risk factors and proactively seek support.
Signs and Symptoms: Symptoms of PMADs vary from diagnosis to diagnosis, and from woman to woman but here are some typical symptoms of perinatal anxiety and depression, the most common of the PMADS impacting an estimated 10% and 15% of women respectively. You may be experiencing worry, physical complaints, a sense of doom or dread, disrupted sleep or restlessness. Women often report irritability, sadness, and a sense of hopelessness. While it is really common to experience these feelings once in awhile, particularly in the few weeks after giving birth, if you are experiencing several of these symptoms on a frequent basis, or if the feelings seem particularly intense, this may indicate a PMAD.
Some women experience panic attacks which may be indicative of a Perinatal Panic Disorder with symptoms including a rapid heart beat, racing thoughts, and a sense of “going crazy.” Perinatal Obsessive Compulsive Disorder is rarer, occurring in 3-5% of new moms with symptoms that include obsessive and intrusive thoughts, often of an upsetting nature, and a compulsive need to engage in behaviors such as cleaning, checking, or counting to reduce anxiety. Some women will experience postpartum post-traumatic stress disorder (PTSD) following a real or perceived trauma during delivery or the postpartum period. You are at greater risk for postpartum PTSD if you have a history of previous trauma. Perinatal bipolar disorder can be tricky to diagnose because it sometimes can mirror symptoms of depression or anxiety, but has distinct symptoms including decreased need for sleep, unstable or expansive mood, and high energy. If you have a history or a family history of bipolar illness, it is important to be properly screened.
Finally, Postpartum Psychosis is a rare but serious illness impacting .1% of postpartum women. Symptoms include seeing or hearing things that are not there, rapid mood swings, hyperactivity, inability to sleep, or feeling like you may hurt yourself or your baby. If you or your partner are experiencing any of these symptoms, or otherwise feel you or your partner are in crisis, this is a real emergency and needs to be treated as such. Please seek immediate support by calling, 911, 1800-PPD-MOMS, or going to your nearest emergency room.
Getting Support. We are lucky in New York to have a significant amount of mental health professionals with specializations in PMADs, as well as hospitals and clinics with perinatal focuses. Postpartum Support International , The Postpartum Stress Center, and the Seleni Institute maintain an excellent list of therapists who have specialized training. Your OB, midwife, or child’s pediatrician likely also has a referral list. If you are pregnant or postpartum and suffering know that you are not alone. PMADs are the most common complication of childbirth with 15%-20% of women effected so please seek support, whatever your emotional experience.
Emma Basch is a licensed clinical psychologist who maintains private practices in Manhattan and Brooklyn. She specializes in women’s mental health, with a focus on the perinatal period and has received training from the Postpartum Stress Center and Postpartum Support International. For more information, you can check out her website at dremmabasch.com