What is a "Perinatal Mood and Anxiety Disorder?"
There are several mental health disorders that can affect women and their families during the “perinatal” period which is the time of pregnancy or anytime during the first year after birth. There is a greater occurrence of mental health disorders during the perinatal period and this is thought to be caused by the unique physical and emotional demands of pregnancy, childbirth, and new parenthood. There is an even greater vulnerability if there is a personal or family history of mental health problems or a history of traumatic experiences. Additional risk factors include financial hardship, unplanned pregnancy, and lack of social support.
Symptoms of perinatal mood & anxiety disorders
Of course some emotional changes are a normal result of the challenges of pregnancy and early parenthood. However in a perinatal mood or anxiety disorder these emotions and behaviors will be an extreme change from the person’s normal personality and causes a decreased ability to function in daily life. These intense symptoms can build slowly either during pregnancy or in the year following birth and can vary widely depending on the particular disorder. Potential symptoms include:
Frequent sadness or crying
Changes in appetite
Intense fatigue with low mood
Sleeping too much or too little
Anxiety or panic
Feelings of helplessness or despair
Lack of interest in sex
Exaggerated high or low mood
Irritability or anger
Obsessive worries or fears
Abnormal thought processes such as strange beliefs
Seeing or hearing things that other people don’t see or hear
Manic symptoms of irritability, decreased need for sleep, and poor decision making
Feeling disconnected from the baby
Difficulty concentrating, indecisiveness
Feeling overwhelmed, confused
Feelings of inadequacy or guilt
Thoughts of harming the baby or oneself
How is a perinatal mood or anxiety disorder diagnosed?
A screening tool can be used to differentiate between the normal range of emotional changes brought on by pregnancy and early parenthood and the presence of a perinatal mood or anxiety disorder. If there is cause for further investigation, a provider will conduct a full interview and history to make a diagnosis. Recognizing the importance of treating these disorders, the American College of Obstetrics and Gynecologists recommends that a screening occur at least once during the perinatal period. There are two commonly used screening tools: the Edinburgh Postnatal Depression Screening and the Patient Health Questionnaire and a score above 10 for either of these indicates a positive screen and warrants further investigation.
Treatments for perinatal mood or anxiety disorders
A perinatal mood or anxiety disorder will not typically subside without being addressed, but fortunately there are a number of well-researched and effective treatments. Approaches to treatment include psychiatric medications specific for the neurological processes of each disorder, solo or group therapy focused on perinatal mental health issues, behavioral change therapy specific to the disorder, and community support programs.
Types of “perinatal mood and anxiety disorders”
Mood and anxiety disorders occurring during pregnancy
Mood anxiety disorders that occur after childbirth
The most common disorder in the year following childbirth is “postpartum depression” which affects approximately 15% of new mothers. Many women feel sad after giving birth and have crying spells, irritability, appetite loss, or trouble sleeping. However, these symptoms shouldn’t last for more than a few days, and if they occur for longer than two weeks, it could indicate the development of postpartum depression and require professional support. It is important to be alert to a few “red flag” symptoms that require immediate action; these include: a mother’s lack of interest in the baby, feelings of hopelessness, or thoughts about hurting herself or the baby. Treatment can include obtaining support from a therapist experienced in the unique issues surrounding postpartum depression and medications that can improve and stabilize a new mother’s moods.
Postpartum psychosis carries a high risk of suicide or infanticide and should be treated as a medical emergency. It is the rarest of the perinatal disorders occurring in approximately 2 of every 1,000 deliveries. Symptoms of postpartum psychosis usually begin within 2 weeks after childbirth and can include delusions, hallucinations, or mania. Delusions are beliefs that are persistent and unrealistic and often involve paranoia; that is, a mother could believe someone is trying to harm her baby or her family. A woman could also experience auditory or visual hallucinations which means that she is hearing or seeing things that aren’t really there. In addition to delusions and hallucinations, a woman has postpartum psychosis might have symptoms of mania. This could include the symptoms of needing very little sleep, doing things that are out of character and reckless such as spending a lot of money or disregarding safety, or having unstable mood changes such as crying one minute and laughing the next. Women who have the mental health conditions of bipolar disorder or schizoaffective disorder are at greater risk for postpartum psychosis, and sometimes it is the stress of the perinatal period that first cause these disorders to become evident.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
Anxiety Disorders Association of America. (2011). Retrieved from http://www.ADAA.org.
Biaggi, A., Conroy, S., Pawlby, S., & Pariante, C. M. (2016). Identifying the women at risk of antenatal anxiety and depression: A systematic review. Journal of Affective Disorders, 191, 62–77. http://doi.org/10.1016/j.jad.2015.11.014
Dayan, J., Creveuil, C., Herlicoviez, M., et al. (2002). Role of anxiety and depression in the onset of spontaneous preterm labor. American Journal of Epidemiology, 155, 293-30.
Hahn-Holbrook, J., Cornwell-Hinrichs, T., & Anaya, I. (2017). Economic and health predictors of national postpartum depression prevalence: A systematic review, meta-analysis, and meta-regression of 291 studies from 56 countries. Frontiers in Psychiatry, 8, 248. http://doi.org/10.3389/fpsyt.2017.00248
Ko, J. Y., Rockhill, K. M., Tong, V. T., Morrow, B., & Farr, S. L. (2017). Trends in postpartum depressive symptoms — 27 states, Morbidity and Mortality Weekly, 66, 153–158.
Milgrom, J., Gemmil, A. W., Bilszta, J. L., et al. (2008). Antenatal risk factors for postnatal depression: A large prospective study. Journal of Affective Disorders, 108, 147-157.
Warren, S. L., Racu, C., Gregg, V., & Simmens, S. J. (2006). Maternal panic disorder: Infant prematurity and low birth weight. Journal of Anxiety Disorders, 20, 342-352.