Perinatal mood and anxiety disorders is a condition characterized by a combination of mood and anxiety disorders, that can affect women during pregnancy and postpartum period. It can include depression, anxiety, obsessive compulsive disorder, post traumatic stress disorder, and postpartum psychosis.
- What Is Perinatal Mood And Anxiety Disorders?
- Types Of Perinatal Mood And Anxiety Disorders In Women
- Are Men Affected By Perinatal Mood And Anxiety Disorders?
- Causes Of Perinatal Mood And Anxiety Disorders
- Treatment For Perinatal Mood And Anxiety Disorders
- Self-help Strategies For Perinatal Mood And Anxiety Disorders
- Recovery From Perinatal Mood And Anxiety Disorders
What Is Perinatal Mood And Anxiety Disorders?
Perinatal Mood and Anxiety Disorders are a group of conditions experienced during and post pregnancy characterized by symptoms of sadness, loss of pleasure, difficulty concentrating, changes in energy, mood changes, or anxiety. A recent 2020 study 1 explains, “Perinatal mood and anxiety disorders (PMAD), which encompass depression and anxiety, are among the most common conditions identified during pregnancy and the postpartum period.” The anxiety disorder associated with this condition can include panic attacks, excessive worry, or irritability. These disorders are associated with depression and anxiety that are common conditions identified during and the postpartum period. Research 2 indicates that women experience a range of mood and anxiety disorders during pregnancy and through the first year after giving birth. Many women may experience mild mood swings while pregnant or after delivery. However, some women tend to experience extreme mood swings and mood disorders, where medical intervention is required.
This condition entails mental, emotional, and behavioral disorders that substantially impact the daily life of the individual. If left untreated, mental health conditions in the perinatal period may lead to adverse outcomes for the mother as well as the baby, that includes preterm birth and maternal suicide. It is important to seek medical attention if the mother experiences feelings of sadness, emotionlessness, or loneliness for more than two weeks during or after the delivery. According to the US Department of Health and Human Services (HHS), 3 )) almost 13% of women and new mothers experience depression during or after giving birth. Some research 4 )) suggests that both pharmacological and nonpharmacological treatments for perinatal women are associated with positive and negative outcomes. Studies 5 have found that the prevalence of Perinatal Mood and Anxiety Disorders increased from 18.4% to 40.4% between 2006-2007 and 2014-2015.
Types Of Perinatal Mood And Anxiety Disorders In Women
Even though postpartum depression is the most common term that is used to describe the mood swings that occur during and after pregnancy, there are different forms of mood and anxiety disorders experienced by women during this period as well. They are as follows:
1. Normal Postpartum Adjustment
Sometimes parents may experience difficulty adjusting to parenthood. This is considered normal. The normal postpartum adjustment may involve similar symptoms as baby blues, such as feelings of exhaustion, irritation, or sadness. New mothers experience it during the first few months of childbirth 6. In case these symptoms are interfering with the mother’s normal coping abilities, functioning, or parenting, it may be a sign of Perinatal Mood and Anxiety Disorders. This transition to parenthood is referred to as a normal “life crisis”.
2. Baby blues
It’s absolutely normal to experience feelings of sadness, irritability, and exhaustion after delivery. Reports 7 suggest that 60% to 80% of women experience “baby blues” that involves feelings of exhaustion, irritation, or sadness after giving birth. For many women baby blues feels like an “emotional roller coaster” and they can’t seem to stop feeling that way. The symptoms of baby blues include:
- Feeling extremely sad
- Excessive crying
- Feeling moody or cranky
- Having issues sleeping, eating, or making decisions
- Feeling overwhelmed that you can’t do a good job taking care of the baby
- Feelings of loneliness
The symptoms tend to begin from day one to three days post-delivery and can last between two to fourteen days. It is important to contact a healthcare professional if the symptoms persist for more than two weeks since it may be a sign of Perinatal Mood and Anxiety Disorders.
3. Postpartum Depression
Studies 8 suggest that more than 15% of women experience postpartum depression. Women who have given birth in the last 12 months can be given the diagnosis if they experience the following symptoms:
- Low mood, sadness, or tearfulness
- Loss of interest, joy, or pleasure in the things they used to enjoy
- Agitation or anxiety
- Lack of energy
- Difficulty in concentrating
- Appetite or sleep problems
- Feelings of guilt, shame, or worthlessness
- Possible thoughts or feelings of harming the baby or themselves
- Trouble bonding with the baby
- Aches or pains
- Digestive problems
The Federal Food and Drug Administration (FDA) has approved one medication called brexanolone to specifically treat postpartum depression. A 2019 study 9 displayed the effectiveness of brexanolone in treating patients with postpartum depression. The advantages include its novel mechanism of action, larger effect size and quicker response, and remission compared to conventional treatments. This drug is to be administered in a hospital. It works to relieve depression by restoring the levels of these hormones.
4. Postpartum Anxiety
New mothers often get extremely anxious when their new baby arrives. These feelings of anxiety tend to interfere with the overall functioning of the mother. Like most of the PMADS, postpartum anxiety is rather common. Reports 10 suggest that 1 in every 10 women endures postpartum anxiety after giving birth and 6% of women tend to experience it while pregnant. The symptoms of this condition include:
- Constant worry
- Feeling that something bad is going to happen
- Feeling like you can’t turn your brain off
- Disturbance of sleep and appetite
- Heart palpitations
- Shortness of breath
- Chest pain
If the mother is experiencing the symptoms within the past 12 months of birth it is important to seek medical attention.
5. Postpartum Obsessive Compulsive Disorder
Sometimes a lot of mothers experience postpartum OCD without having any previous diagnosis of anxiety disorders. Reports 11 suggest that 3% to 5% of mothers report feeling that they can’t escape these intrusive, irrational, and upsetting thoughts unless they engage in a repetitive act. The mother may experience the following symptoms within 12 months of giving birth:
- Persistent intrusive or repetitive thoughts, or mental images regarding the baby.
- Persistent compulsions involve the mom doing certain things over and over again to try and reduce her fears and obsessions. This can include cleaning constantly, checking things, or counting or reordering things
- A sense of fear about these obsessions
- Afraid of being left alone with the child
- Hypervigilance in protecting the infant
It is important to keep in mind that mothers with this condition understand the nature of their thoughts and are quite disturbed by them. So it is essential to seek professional assistance to ease the symptoms of this condition.
6. Postpartum Psychosis
Postpartum Psychosis occurs when the mother is having delusions or hallucinations or having highly unusual thoughts regarding themselves or the child. This condition is rare affecting only 0.1 to 0.2% 12 of all births. It is a serious condition so it requires immediate medical intervention. The symptoms of this condition include:
- Delusions or strange beliefs that are not real
- Hallucinations or seeing or hearing things that are not there
- Feeling confused
- Feeling disconnected from reality
- Decreased need for or inability to sleep
- Paranoia and suspiciousness
- Difficulty in communication
Acts of harming oneself or the baby are fairly uncommon. Women suffering from this condition may tend to do things that they may not do in their right mind. Therefore it is of utmost importance to seek professional help in order to keep them and the baby safe.
Are Men Affected By Perinatal Mood And Anxiety Disorders?
Even though men are less affected than women by PMAD statistically, they are still at risk of developing these conditions. Men’s hormone also fluctuates when their female partner is pregnant and after childbirth. In case they are involved in the child’s life, they may experience drastic lifestyle changes, sleep deprivation, and social pressure just like women. Men with family histories, genetic risks, and previous diagnoses of mood disorders are more likely to develop this disorder. However studies 13 found that men are less likely to seek professional mental help to cope with their emotional problems. Research 14 shows that there is also a lower intention to recommend professional help for postpartum depression when compared to women. Some of the symptoms that men may experience are:
- Violent behavior
- Avoidance behavior
Research 15 on men experiencing these mental health disorders is still in progress. It is important to keep in mind that men can also display any of the symptoms in the first year or two of their child’s life. So they may require therapy or medication just like women. Studies 16 have found that 1 in 10 new fathers develop PMAD.
Causes Of Perinatal Mood And Anxiety Disorders
The exact cause of this condition is still unknown. Some evidence 17 suggests that women with a positive history of depression are more susceptible to hormonal changes. The factors that may contribute to developing this condition are as follows:
- History of depression 18 or substance abuse
- Family history 19 of mental illness
- Inadequate support 20 from family and friends
- Anxiety about fetus
- Problems with previous pregnancy or birth 21
- Marital 22 or financial problems 23
- Becoming a mother at a young age 24
- Parenting stress 25
- Hormonal changes 26 during pregnancy
- High oxytocin levels 27 during mid pregnancy
- Lifestyle changes 28 that involves changes in food intake patterns, sleep cycles,or exercising routines
Treatment For Perinatal Mood And Anxiety Disorders
Treatment for this condition is crucial to maintain the health of the mother and the baby. Treatment is proven to be effective in almost all cases. With treatment, most mothers feel better and their symptoms tend to improve. This condition can be treated with a combination of therapy and medications. According to a 2007 study 29 , nonpharmacologic and pharmacologic treatment for patients can offer both “positive and negative outcomes” as no treatment option has been observed to be “risk-free.” The study explains “Women with perinatal depression and anxiety disorders require timely and efficient management with a goal of providing symptom relief for the suffering mother while simultaneously ensuring the baby’s safety.”
Some of the most effective treatment options include the following:
The two most effective psychotherapies that are used are cognitive behavioral therapy and interpersonal therapy. The treatment methods that are usually followed are:
A. Cognitive Behavioral Therapy (CBT)
Talk therapy or counseling has been found to be helpful in most cases. CBT has been helpful in treating patients with anxiety and mood disorders. In this therapy, people learn different ways of thinking, behaving, and reacting to different situations. People are taught to challenge and change unhelpful thoughts and patterns as a way of improving their depressive or anxious feelings and emotions. Cognitive behavioral therapy can be conducted in groups or individually. This therapy also helps to develop coping strategies to ease the symptoms of this disorder. A 2020 study 30 reported significant reductions in the anxiety levels as a result of CBT.
B. Interpersonal Therapy
This therapy is based on the idea that interpersonal and life events impact mood and vice versa. The goal of this therapy is to help people to improve communication skills within relationships, to develop social support and realistic expectations. This allows them to deal with the crisis and other issues that may be a contributing factor to their condition. A 2014 study 31 reported that patients with major depressive disorder in primary care prefer psychotherapy over antidepressant medication.
Women with these conditions are often prescribed antidepressants and anti-anxiety medications. These medications help to ease the symptoms of the condition. Antidepressants and anti-anxiety drugs help to improve the way the brain uses certain chemicals that control moods and stress. Women who are breastfeeding or pregnant must consult their doctors before taking antidepressants. A report suggested that a doctor will only prescribe medications that have minimal exposure to the child to avoid risks after birth. Antidepressants 32 usually take 6 to 8 weeks to work. Some symptoms such as sleep, appetite and concentration problems tend to improve with the usage of medications.
Self-help Strategies For Perinatal Mood And Anxiety Disorders
The support of friends and family and your significant other are of utmost importance in getting out of this phase. Here are some other things that you can do to ease the symptoms:
- Asking someone to care for the baby while you can sleep
- Exercising or going for a walk daily
- Eating balanced and nutritious meals every day
- Talking about how you feel and experience with your partner or a friend
- Giving yourself permission to do less and let others help you
- Practicing self-care and hygiene
Recovery From Perinatal Mood And Anxiety Disorders
After birthing a child, women experience a drop in the hormonal levels which can cause a huge rush of emotions associated with mood and anxiety. It is important to offer emotional assistance to the mother in order to ensure a successful recovery. With therapy and medication, it is possible to recover from this disorder.References:
- McKee, K., Admon, L. K., Winkelman, T., Muzik, M., Hall, S., Dalton, V. K., & Zivin, K. (2020). Perinatal mood and anxiety disorders, serious mental illness, and delivery-related health outcomes, United States, 2006-2015. BMC women’s health, 20(1), 150. https://doi.org/10.1186/s12905-020-00996-6
- Maternal mental health. WHO | World Health Organization. https://www.who.int/teams/mental-health-and-substance-use/maternal-mental-health
- how common is depression during and after pregnancy (( Postpartum depression. (2019). womenshealth.gov. https://www.womenshealth.gov/mental-health/mental-health-conditions/postpartum-depression
- Treatment of perinatal mood and anxiety disorders: a review (( Misri S, Kendrick K. Treatment of perinatal mood and anxiety disorders: a review. Can J Psychiatry. 2007 Aug;52(8):489-98. doi: 10.1177/070674370705200803. PMID: 17955910.
- Perinatal mood and anxiety disorders, serious mental illness, and delivery-related health outcomes, United States, 2006–2015
- Normal Postpartum Adjustment and PMADs: Understanding the Difference
- Stewart, D. E., Robertson, E., Dennis, C. L., Grace, S. L., & Wallington, T. (2003). POSTPARTUM DEPRESSION: LITERATURE REVIEW OF RISK FACTORS AND INTERVENTIONS. https://www.who.int/mental_health/prevention/suicide/lit_review_postpartum_depression.pdf
- Feeser, R., & Nenninger, S. Perinatal Mood Disorders. Dickinson College. https://www.dickinson.edu/download/downloads/id/5233/perinatal_mood_disorders.pdf
- Scarff J. R. (2019). Use of Brexanolone for Postpartum Depression. Innovations in clinical neuroscience, 16(11-12), 32–35.
- Depression in pregnant women and mothers: How children are affected. (2004). Paediatrics & child health, 9(8), 584–601. https://doi.org/10.1093/pch/9.8.584
- Miller, E. S., Chu, C., Gollan, J., & Gossett, D. R. (2013). Obsessive-compulsive symptoms during the postpartum period. A prospective cohort. The Journal of reproductive medicine, 58(3-4), 115–122.
- VanderKruik, R., Barreix, M., Chou, D., Allen, T., Say, L., Cohen, L. S., & Maternal Morbidity Working Group (2017). The global prevalence of postpartum psychosis: a systematic review. BMC psychiatry, 17(1), 272. https://doi.org/10.1186/s12888-017-1427-7
- Holzinger A, Floris F, Schomerus G, Carta MG, Angermeyer MC. Gender differences in public beliefs and attitudes about mental disorder in western countries: a systematic review of population studies. Epidemiol Psychiatr Sci. 2012 Mar;21(1):73-85. doi: 10.1017/s2045796011000552. PMID: 22670415.
- Branquinho M, Canavarro MC, Fonseca A. Knowledge and attitudes about postpartum depression in the Portuguese general population. Midwifery. 2019 Oct;77:86-94. doi: 10.1016/j.midw.2019.06.016. Epub 2019 Jun 26. PMID: 31276960.
- Scarff J. R. (2019). Postpartum Depression in Men. Innovations in clinical neuroscience, 16(5-6), 11–14.
- About postpartum depression (PPD). Mass.gov. https://www.mass.gov/service-details/about-postpartum-depression-ppd
- Bloch M, Daly RC, Rubinow DR. Endocrine factors in the etiology of postpartum depression. Compr Psychiatry. 2003 May-Jun;44(3):234-46. doi: 10.1016/S0010-440X(03)00034-8. PMID: 12764712.
- Lee DT, Yip AS, Leung TY, Chung TK. Identifying women at risk of postnatal depression: prospective longitudinal study. Hong Kong Med J. 2000 Dec;6(4):349-54. PMID: 11177155.
- Mathisen SE, Glavin K, Lien L, Lagerløv P. Prevalence and risk factors for postpartum depressive symptoms in Argentina: a cross-sectional study. Int J Womens Health. 2013 Nov 21;5:787-93. doi: 10.2147/IJWH.S51436. PMID: 24294009; PMCID: PMC3839840.
- Landman-Peeters KM, Hartman CA, van der Pompe G, den Boer JA, Minderaa RB, Ormel J. Gender differences in the relation between social support, problems in parent-offspring communication, and depression and anxiety. Soc Sci Med. 2005 Jun;60(11):2549-59. doi: 10.1016/j.socscimed.2004.10.024. Epub 2004 Dec 21. PMID: 15814180.
- Gaillard A, Le Strat Y, Mandelbrot L, Keïta H, Dubertret C. Predictors of postpartum depression: prospective study of 264 women followed during pregnancy and postpartum. Psychiatry Res. 2014 Feb 28;215(2):341-6. doi: 10.1016/j.psychres.2013.10.003. Epub 2013 Nov 6. PMID: 24370337.
- Ludermir AB, Lewis G, Valongueiro SA, de Araújo TV, Araya R. Violence against women by their intimate partner during pregnancy and postnatal depression: a prospective cohort study. Lancet. 2010 Sep 11;376(9744):903-10. doi: 10.1016/S0140-6736(10)60887-2. Epub 2010 Sep 6. PMID: 20822809.
- Miyake Y, Tanaka K, Sasaki S, Hirota Y. Employment, income, and education and risk of postpartum depression: the Osaka Maternal and Child Health Study. J Affect Disord. 2011 Apr;130(1-2):133-7. doi: 10.1016/j.jad.2010.10.024. Epub 2010 Nov 4. PMID: 21055825.
- Silva R, Jansen K, Souza L, Quevedo L, Barbosa L, Moraes I, Horta B, Pinheiro R. Sociodemographic risk factors of perinatal depression: a cohort study in the public health care system. Braz J Psychiatry. 2012 Jun;34(2):143-8. doi: 10.1590/s1516-44462012000200005. PMID: 22729409.
- Leigh B, Milgrom J. Risk factors for antenatal depression, postnatal depression and parenting stress. BMC Psychiatry. 2008 Apr 16;8:24. doi: 10.1186/1471-244X-8-24. PMID: 18412979; PMCID: PMC2375874.
- Aishwarya S, Rajendiren S, Kattimani S, Dhiman P, Haritha S, Ananthanarayanan PH. Homocysteine and serotonin: association with postpartum depression. Asian J Psychiatr. 2013 Dec;6(6):473-7. doi: 10.1016/j.ajp.2013.05.007. Epub 2013 Jun 14. PMID: 24309856.
- Neumann ID, Landgraf R. Balance of brain oxytocin and vasopressin: implications for anxiety, depression, and social behaviors. Trends Neurosci. 2012 Nov;35(11):649-59. doi: 10.1016/j.tins.2012.08.004. Epub 2012 Sep 11. PMID: 22974560.
- Chatzi L, Melaki V, Sarri K, Apostolaki I, Roumeliotaki T, Georgiou V, Vassilaki M, Koutis A, Bitsios P, Kogevinas M. Dietary patterns during pregnancy and the risk of postpartum depression: the mother-child ‘Rhea’ cohort in Crete, Greece. Public Health Nutr. 2011 Sep;14(9):1663-70. doi: 10.1017/S1368980010003629. Epub 2011 Apr 11. PMID: 21477412.
- Misri S, Kendrick K. Treatment of perinatal mood and anxiety disorders: a review. Can J Psychiatry. 2007 Aug;52(8):489-98. doi: 10.1177/070674370705200803. PMID: 17955910.
- Green SM, Donegan E, McCabe RE, Streiner DL, Agako A, Frey BN. Cognitive behavioral therapy for perinatal anxiety: A randomized controlled trial. Aust N Z J Psychiatry. 2020 Apr;54(4):423-432. doi: 10.1177/0004867419898528. Epub 2020 Jan 20. PMID: 31957479.
- Stuart S. (2012). Interpersonal psychotherapy for postpartum depression. Clinical psychology & psychotherapy, 19(2), 134–140. https://doi.org/10.1002/cpp.1778
- InformedHealth.org [Internet]. Cologne, Germany: Institute for Quality and Efficiency in Health Care (IQWiG); 2006-. Depression: How effective are antidepressants? [Updated 2020 Jun 18]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK361016/