Perinatal Mood Disorders
Written by: Penelope Hatter, LMFT
Earlier this year, I became certified in perinatal mental health. This area is a passion of mine, as I struggled with postpartum anxiety after having my daughter. During this time, my eyes were really opened toward the lack of support and awareness around perinatal mood disorders. I was surprised to see very little information about mental health in my OBGYN’s office and surprised there weren’t recommendations given to me during my postpartum appointments to seek mental health services, as my anxiety was out of control. It seemed once I had my daughter, the focus was on her and I got lost in the shuffle. I never knew what was “normal” or what wasn’t. So as you can imagine, my anxiety just spiraled out of control trying to figure out if my pregnancy was “normal,” if everything was okay with her. After taking her home, the anxiety only worsened as I feared something would happen to her and I still didn’t quite understand what was “normal” for a newborn and what wasn’t.
Perinatal mood disorders is an area that is often not spoken about when people start their journey of trying to have children. Perinatal mood disorders are more prevalent than most people realize and they do not discriminate. One in five women and one in ten men will experience a perinatal mood disorder. As we all live in society where social media has a strong presence, we tend to believe there is something wrong with us if our journey to having children looks different from “the norm.” And when we believe something is wrong with us, it becomes more challenging to talk about it and seek help. I want to take this time and space to talk about perinatal mood disorders and the challenges people face during pregnancy, childbirth and postpartum.
Symptoms of a perinatal mood disorder can begin anytime during pregnancy and/or in postpartum, up to a year after delivery. There are a lot of hormone changes that occur during this time period that can explain changes in mood, but there are several other disorders and symptoms that can impact both partners after having a child. So how do we know if it is hormones, baby blues, or a perinatal mood disorder?
After delivery, new parents often experience changes in mood, an increase in stress, and a decrease in sleep which can all contribute to labile mood, tearfulness, reactivity, exhaustion and more. The term “baby blues” is often what people hear about postpartum mood changes. If symptoms last longer than two weeks, it is NOT baby blues. A lot of women continue to suffer with their symptoms because they think it is normal to feel this way after having a baby and feel their symptoms can be justified by the chaos of life and parenting. People also feel pressure to “hold it together” and have the appearance that everything is fine as we fear judgement from others or fear something is wrong with us.
Parents can begin to feel disconnected from themselves, who they are as individuals, and who they are outside of their role as a parent. Grieving life before children is also common for new parents as they notice their day to day looks very different with new added responsibilities and self care/alone time is hard to come by.
This life change can also cause stress between couples. Feeling guilty if you are not available 100% for your partner or child/children can start to cause a decline in self care. Resentment toward our partner can build as we start to feel pressure to show up 100%. When our cups start drying out, we can start to develop a negative narrative in our head, causing us to spiral and internalize instead of expressing our needs and wants.
Parents might also start to notice parenting differences and stronger opinions coming out after they have a baby. This can lead to increased conflict and feeling judgement by your partner. As parents start to feel the burn out, they tend to start “keeping score” about who is doing what. And we all know that is a nonstop trip straight to resentment. When we find ourselves “keeping score,” it is usually a good indicator that we are not getting our own needs met.
We often think about the birthing parent as the parent who will be at risk to develop a perinatal mood disorder, but the non-birthing partner is also at risk for developing a mood disorder as their life has significantly changed as well. They may experience pressure to financially provide, feelings of isolation or loneliness as the attention and time has shifted to the baby, and feeling trapped. Males also have a more challenging time asking for help because they may feel embarrassed about what they are feeling due to the stigma of males and emotions/mental health.
I have outlined some of the perinatal mood disorders below, but just because you don’t feel like you are “bad enough” to fit any of these descriptions, doesn’t mean you shouldn’t reach out. If there are any distressing symptoms you are experiencing as the birthing person or non-birthing person, please reach out for help. Untreated perinatal mood disorders cause more damage in the long run and it’s not fair to yourself to continue to suffer.
Below are some of the perinatal mood disorders that can present during pregnancy or postpartum period.
Postpartum Depression is probably the perinatal mood disorder most referenced or discussed. And some people think in order to have postpartum depression, they need to see a significant decline in functioning or have thoughts to harm themselves. Due to that belief about PPD, a lot of women might not seek help because they don’t think it is “bad enough.” Depression may present as feeling overwhelmed, inability to cope, isolating/withdrawing, agitation/irritability, inability to care for self or family members, not feeling connected to the baby, loss of interest in activities, sleep changes, appetite changes, poor concentration, low self worth, and more. Some women experience thoughts of not wanting to be here, thoughts their baby is better off without them, or suicidal thoughts.
Perinatal anxiety disorder can present as excessive worry about one’s own health or baby’s health, difficulty managing racing thoughts, worry, restlessness, poor concentration, poor sleep, Panic disorder includes episodes of extreme discomfort/fear, shortness of breath, chest pain, rapid heart rate, excessive worry or fear, fear of going crazy or losing control. There are three major fears associated with panic disorder: fear of dying, fear of going crazy, and fear of losing control.
Perinatal obsessive-compulsive disorder can present with intrusive, disturbing thoughts. Most of these thoughts are relating to harm coming to the baby. Perinatal OCD causes severe guilt/shame regarding the intrusive thoughts, spirals into “what if” thinking, and includes recurrent and persistent thoughts, urges, or impulses that are intrusive and unwanted. Common themes of these thoughts are fears of harming the baby, fears of contamination, fears of accidental harm, ordering/arranging, religious thoughts, and excessive checking/re-checking. More serious symptoms will present as psychosis where the mother may experience delusional beliefs about the baby, herself, others, or the world.
Post Traumatic Stress Disorder can occur after a traumatic pregnancy or birthing process. The birthing person may experience helplessness, fear, loss of control, and traumatic birth interventions or complications may lead to symptoms of PTSD. Some of those symptoms include flashbacks, nightmares, somatic symptoms, social withdrawal/isolation, apathy, emotional numbing, avoidance, sleep disturbance, poor concentration, agitation. Some themes that can present during postpartum PTSD include feeling abandoned, being stripped of dignity, feeling a lack of support, feeling helpless/powerless.
Perinatal Bipolar Disorder can present with manic episodes- decreased need for sleep, euphoria, racing thoughts, increased productivity, pressured speech, increased energy, agitation, disorganized thinking- followed by depressive episodes and symptoms; both mania and depressive episodes impair functioning.
Perinatal Psychosis is a medical emergency. The onset of perinatal psychosis is usually within the first two weeks. Symptoms can include agitation, disorientation, poor concentration, labile mood, lack of self care, emotionally distant, impaired sensorium, rambling, delusions, auditory/visual/tactile hallucinations, command auditory hallucinations telling the person to harm themselves or others, paranoia.
If there is any presentation of thoughts of self harm, suicide, harming others, or symptoms of psychosis, go to the ER or call 911/988 immediately as those are medical emergencies.
If you are questioning whether or not you have a perinatal mood disorder or are just not feeling like yourself, please reach out for help and seek treatment. When you are searching for a therapist or psychiatrist, look for someone who is certified in Perinatal Mental Health. Providers who have this certification have specific knowledge and training with perinatal mood disorders. If they are certified they may have “PMH-C” listed as one of their credentials. Some of the evidence-based modalities used to treat Perinatal Mood Disorders include Cognitive Behavioral Therapy (CBT) and Interpersonal Psychotherapy (IPT). In CBT, you will focus on the connection between your thoughts, emotions, behaviors. You will work on identifying and restructuring negative automatic thoughts and thinking patterns that are causing distress. Mindfulness, psychoeducation, and learning healthier coping skills is also a big part of treatment. Interpersonal Psychotherapy is an attachment based modality that focuses on improving interpersonal relationships to relieve symptoms. Both individual therapy and couple’s therapy is helpful in treatment for perinatal mood disorders. Emotionally Focused Therapy is another attachment based modality used in couples and individual therapy. In EFT you will work to strengthen the connection between yourself and your partner through identifying and changing negative interactions and processes that cause distress within yourself and your relationships.
Postpartum Support International is an amazing resource. They offer a wide variety of free online support groups, lists of locally trained providers, mentor programs, hotlines, and more. On the site you can do a search for a mental health provider who is trained in perinatal mood disorders in your area https://www.postpartum.net/
At Love Story Therapy I work with both individuals and couples, incorporating the modalities listed above. My passion is to help you reconnect with yourself and your loved ones throughout your healing journey. If I am not the right fit, I will give you resources to find the best fit for you and your healing. You can reach me at penelope@lovestorytherapy.com