Pregnancy Mental Health Series: Mood Disorders During And After Pregnancy

While Postpartum Depression is the most common post pregnancy disorder, it is only one of six perinatal mood disorders (PMADs), each presenting with distinct symptoms that require unique attention and treatment. Pregnancy mood disorders can be categorized as:

 The BIG Five Perinatal Mood and Anxiety Disorders (PMADs)

  • Antepartum or Postpartum Depression
  • Antepartum or Postpartum Anxiety Disorder
  • Antepartum or Postpartum Obsessive Compulsive Disorder (OCD)
  • Postpartum Post Traumatic Stress Disorder (PTSD)
  • Antepartum or Postpartum Psychosis

Please note, any woman can develop a PMAD, but having a personal or family history for the disorder prior to pregnancy, or having experienced symptoms in a prior pregnancy or postpartum period increases the chance of having an episode during or after pregnancy. Please remember that ALL of PMAD’s reviewed below are readily treatable with appropriate medical intervention and support.

Antepartum or Postpartum Anxiety Disorder

Pregnancy and the postpartum period are often times fraught with some degree of anxiety. Women are given constant reminders by friends, family, physicians and books of what they should or should not be doing. What happens when you eat something while pregnant only to realize that it was on the ‘forbidden’ foods list? What about if the baby has a funny looking rash?

Anxiety, that’s what happens. However, for most women, this anxiety can be tempered and controlled, and does not overwhelm their lives. Roughly 6% of pregnant women and 10% of women during the postpartum period will develop a clinically significant anxiety disorder such that the anxiety overpowers the ability to calm down.

Symptoms of antepartum or postpartum anxiety may include, but are not limited to:

  • Constant worry
  • Feeling of dread that something bad is looming
  • Racing thoughts
  • Sleep and appetite changes
  • Inability to relax and sit still
  • Physical symptoms such as nausea, dizziness, hot flashes and weakness

Antepartum or Postpartum Obsessive Compulsive Disorder (OCD)

3-5% of new moms will experience OCD either during or after pregnancy. OCD manifesting in pregnancy and postpartum can be especially scary, as women often feel they are ‘going crazy,’ or are ‘bad mothers’ by virtue of the repetitive, sometimes violent and always disturbing thoughts and images running through their minds. These are called ‘intrusive thoughts,’ given their consistent and upsetting nature. Intrusive thoughts primarily focus on harm coming to the fetus or baby.

Examples of intrusive thoughts:

  • What if I put the baby in the microwave?
  • What if I drop the baby?
  • What if I stab my belly or the baby
  • What if I put the baby in a pot of boiling water?

These thoughts are petrifying, but having intrusive thoughts means NOTHING about a woman’s excitement about pregnancy, her ability to mother or how much she loves her baby. Having intrusive thoughts is not a risk factor for harming a child.

Some women respond to the obsessions with compulsive behaviors that function to minimize the anxiety caused by the intrusive thoughts. Examples include hiding all the knives in the kitchen, or avoiding the kitchen all together. These actions can similarly overwhelm a woman’s life and impair her ability to function.

Postpartum Post-traumatic Stress Disorder (PTSD)

1-6% of new moms will exhibit some or all the symptoms of postpartum PTSD. A woman’s perception of her delivery, rather than medical facts surrounding the delivery, dictate the risk for development of PTSD.

Symptoms of Postpartum PTSD may include (but are not limited to):

  • Re-experiencing of the perceived trauma
  • Flashbacks
  • Nightmares
  • Avoidance of people, feelings, thoughts, and places that elicit memories of the event
  • Persistent anxiety

Postpartum Psychosis

0.1-0.2%% of women who deliver will experience a postpartum psychotic episode.  Postpartum psychosis typically presents within days of delivery, and is considered a variation of bipolar disorder. Women with a history of bipolar disorder, and/or a history of previous postpartum psychotic episodes are at the highest risk for development of postpartum psychosis.

Postpartum psychosis is a true medical emergency that requires swift intervention, often including psychiatric hospitalization for the mother’s and her infants’ safety. Women with postpartum psychosis have lost touch with reality, and in that state are at risk for killing their babies (infanticide) and/or suicide. There is a 5% chance of suicide and/or infanticides for women experiencing untreated postpartum psychosis because they are acting based on delusions that they believe to be real, but are inherently irrational.

Common signs and symptoms of postpartum psychosis include, but are not limited to:

  • Hyperactivity
  • Decreased or complete lack of sleep for days without associated fatigue
  • Visual or auditory hallucinations (seeing or hearing things that do not exist)
  • Failure to appreciate what is real from what is not real
  • Mood swings
  • Communication difficulties
  • Paranoia and fear

These are not “bad” mothers or “awful” women, as they are often portrayed to be in the media; instead, these are ill women who require treatment. Given the profound seriousness of this diagnosis, anyone who may be experiencing such an episode must be evaluated by a professional immediately. Postpartum psychosis is the most dangerous illness experienced by women after pregnancy. If you feel a loved one is experiencing postpartum psychosis, please call 911.

Until next time, take care of yourself and be well.

Resources

If you or a loved one is experiencing a perinatal mood or anxiety disorder, please speak to your healthcare provider and ask for referrals to specialists in your area for treatment.

  • Various modes of therapy and medications are available to treat all of the mood and anxiety disorders related to pregnancy and the postpartum period.
  • Support groups can be very helpful, as can reaching out to friends and family.
  • Postpartum Support International (PSI) provides local referrals, support, and information. You can access the website at Postpartum.net or use the PSI warm line: 1-800-944-4PPD(4773).
  • The National Suicide Hotline and website can be beneficial if you or a loved one are experiencing thoughts of self-harm and/or of suicide: 1-800-273-TALK (8255) / www.suicidepreventionlifenet.org

Carly Snyder, M.D. is a Psychiatrist in New York City with a focus and expertise in Reproductive Psychiatry. Dr. Snyder is the Clinical Course Director for the Reproductive and Perinatal Psychiatry Program at Beth Israel Medical Center. She holds faculty appointments in Psychiatry and Obstetrics and Gynecology at Beth Israel Medical Center, and a teaching appointment at Mount Sinai Medical Center. Dr. Snyder serves on the Board of Directors for Postpartum Support International, and is a member of the Women’s Mental Health Consortium in NYC. Dr. Snyder also sees patients in her private practice located on the Upper East Side of New York City. She received her undergraduate degree from Emory University, attended NYU School of Medicine and completed residency at Beth Israel Medical Center, with additional sub-specialized elective training at Weill Cornell’s Payne Whitney Women’s Program.

Dr. Snyder treats women experiencing emotional and psychiatric challenges at any age. Her approach uses a combination of traditional psychiatric methods with integrative medicine-based treatments to optimize the whole body, mind and well-being. Dr. Snyder provides individualized treatment that focus on improving a woman’s physical and emotional health. In addition to more traditional psychiatric modalities, she has extensive experience treating patients with natural supplements, either alone or in combination with pharmacotherapy. For more information, visit Dr. Snyder’s website, blog and follow her Twitter.

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