Perinatal Mood and Anxiety Disorders

 

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

  • Emotional numbness

  • 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

  • Depression in Pregnancy Disorder

    • “Depression in pregnancy disorder” is the most common mood disorder occurring during pregnancy and affects about 20% of pregnant women.  It is characterized by feelings of sadness, low self-esteem, and lack of interest in things that would normally be enjoyed.  It would be especially concerning if a women was ignoring prenatal care, using drugs or alcohol, or had thoughts of hurting herself.  Some other symptoms of depression also commonly occur in pregnancy which can often cause the depression to often go unrecognized.  These include: changes in sleep pattern and low energy level, appetite, and sex drive.  A pregnant woman is at greater risk for depression if she is also experiencing anxiety, significant stress, intimate partner violence, or if she has poor social support, an unplanned pregnancy, or a history of depression.  It is important to investigate symptoms of depression in pregnancy because it can negatively affect the health and safety of the mother and fetus, and it is the single most important risk factor for postpartum depression.

 

  • Anxiety in Pregnancy Disorder

    • “Anxiety in pregnancy disorder” is the second most common mood disorder in pregnancy and can also be a serious concern.  While about half of expectant mothers experience anxiety, about 10% of women will have symptoms severe enough to qualify as an anxiety disorder. Symptoms range from mild to severe and include being stressed or feeling worried most of the time, having negative thoughts that won’t go away, having panic attacks, or not being able to sleep well.  Risk factors are similar to depression in pregnancy and include lack of a partner or social support, history of abuse, previous mental illness, unplanned pregnancy, and past or present pregnancy complications or loss. It is important to treat this disorder because of its effects on the mother and fetus.  When experiencing anxiety, the mother’s body responds by producing “adrenalin-type” hormones called glucocorticoids.  An excessive amount of anxiety produces an excessive amount of glucocorticoids which may affect the development of the fetal nervous system and contribute to the risk of preterm labor, low birth weight, and lower Apgar scores.  In addition, untreated anxiety in pregnancy disorder increases the risk of postpartum depression

 

 

Mood anxiety disorders that occur after childbirth

  • Postpartum Depression

    • 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 Panic Disorder

    • Anxiety is commonly experienced by new parents after childbirth.  In fact, studies have shown that most new parents will be 4 to 5 times more reactive to sounds.  However, sometimes this natural biological response becomes over-activated and results in “postpartum panic disorder”.  Symptoms include intense anxiety and nervousness, unrelenting fear and worry, and recurring panic attacks.  A panic attack happens suddenly and involves overwhelming feelings of impending danger accompanied by uncontrollable physical responses that can include shortness of breath, chest pain, and heart palpitations. Women who have a personal or family history of anxiety or are experiencing high levels of stress are at greater risk for experiencing “postpartum panic disorder”.  Treatment interventions can include supportive talk therapy and psychiatric medications that will target both the neurological causes of the anxiety and the physiological responses to the anxiety.

 

  • Postpartum Obsessive-Compulsive Disorder (OCD)

    • 5% of new mothers will experience this often misdiagnosed disorder that can include obsessive thoughts and/or actions.  The thoughts that occur in “postpartum OCD” are disturbing and unrelenting and are focused on fears surrounding the baby’s safety.   These include fears of exposing the baby to germs or chemicals, making a careless mistake that causes the baby harm, or being an inferior parent.  These obsessive fears are often accompanied by compulsive actions that are illogical but are nonetheless repeated indefinitely in order to reduce anxiety.  Mothers with postpartum OCD will often hide sharp objects, avoid feeding the baby due to fear of contaminants, or continually replay their actions in their mind to look for potential dangers.  Treatment interventions include behavior modification therapies and psychiatric medications that target the neurochemistry contributing to obsessive thoughts and compulsive actions.

 

  • Postpartum Posttraumatic Stress Disorder (PTSD)

    • A person who has PTSD has experienced a traumatic event and has not recovered from the distress.  In PTSD symptoms such as flashbacks, nightmares, irritability, avoidance of reminders, hyper-vigilance, and sleep problems continue for more than a month and cause disruption to a person’s normal functioning.  “Postpartum PTSD” is PTSD that occurs following childbirth, and it is experienced by about 3% of new mothers.  Postpartum PTSD will usually be related to a traumatic birth experience, but it could also be connected to an event that happened months or even years before.  Treatment includes supportive talk therapy and psychiatric medications that can address both the emotional and physical responses that occur in PTSD.

 

  • Postpartum Psychosis

    • 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.

 

 

 

References

 

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.

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