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Perinatal Mood and Anxiety Disorders

Most of us expect pregnancy and the period after we give birth to be a sort of magical, tranqil experience.  Unfortunately, this is not the reality for many women.  It is estimated that around 1 in 7 women will experience some sort of depression or anxiety disorder either during pregnancy or in the year following childbirth.   To feel our absolute worst at the very time that we expected to feel our best can be heartbreaking!  Simple everyday tasks can feel overwhelming, much less the strain of taking care of a crying newborn.  We might feel like we're not ourselves, shocked by the intensity and unpredictability of our emotions and thoughts.  We might feel overwhelmed by intense guilt or shame, feeling like we're failing to be the sort of mother that we always thought we'd be.  

It is so important that you know that this is not your fault, and there is a path forward!!  

Perinatal Mood and Anxiety Disorders is an umbrella term for a variety of different conditions that can occur during pregnancy and in the first year following childbirth.  This term can include any of the following:

Pregnancy/Postpartum Depression - PPD is longer and more intense than the typical 'baby blues'.  Many women feel intense sadness or a feeling of numbness or detachment, irritability or anger. These emotions can often affect how they feel about their baby or their bond with one another.   The discomfort of this emotional roller coaster causes many women to isolate from the most important people in their lives (including their partners).   Women with PPD also tend to feel very overwhelmed, have low energy and motivation, difficulty concentrating, and either sleep and eat too little or too much.   

In some cases, women with PPD may have suicidal thoughts or feel like their baby would be better off without them. If you are having these sorts of thoughts, it is EXTREMELY important that you reach out, either to us, or another mental health provider in your area!!    

Pregnancy/Postpartum Anxiety or Panic Disorder - Pregnancy and Postpartum Anxiety is less well-known than PPD, but can feel just as overwhelming.  Women might feel highly agitated, be unable to sit still, or have thoughts that are scary to them (such as thoughts or fears of something bad happening to their baby, themselves or other family members).   They may be excessively concerned with the health and welfare of their baby, which can lead to constant worry, racing thoughts, feeling like they're always on 'high alert', and often having somatic signs of anxiety like shortness of breath, heart palpitations or nausea.  

For some women, these anxiety episodes can become so intense that they start having panic attacks.  Panic attacks are periods of intense anxiety with rapid heart racing, shortness of breath, tingling or numbness in extremities, trembling or restlessness. Panic attacks can hit at any point during the day (even waking you out of your sleep).  They are extremely frightening and uncomfortable -  many people think that they are dying, having a heart attack, losing control or 'going crazy'.  

Pregnancy/Postpartum Obsessive Compulsive Disorder - Some mom's anxiety about the well-being of their baby, and their feeling of being overwhelmed or 'out of control' can lead them to develop symptoms of OCD.  In some cases, women may have intrusive and horrifying thoughts about harm coming to their baby.  They find these thoughts to be highly disturbing and tend to experience intense guilt and shame.   They may try to reduce their distress and gain a sense of control over these thoughts by engaging in ritualistic and repetitive behaviors like compulsive over-cleaning or disinfecting, checking on their babies an excessive amount of time,  organizing or other similar behaviors.  These behaviors provide momentary relief from anxiety, but moms often find that the anxiety or distressing thoughts return soon after.

Due to intense news media coverage of moms who have harmed their babies, many moms are reluctant to share their scarier thoughts with others due to fear that people will think that they will carry out these thoughts.  In other cases, moms may also be afraid that the fact that they are having these thoughts mean that they might be 'losing it', and may one day act on them.  THIS IS NOT THE CASE!  It is very important that these moms know that the fact that they find these thoughts disturbing is an important sign that they are experiencing a Perinatal Anxiety disorder, rather than a different condition that is typically linked to these news stories, known as Postpartum Psychosis. 

Postpartum Psychosis - Postpartum Psychosis is  a condition that is extremely rare (1-2 out of every 1,000 new moms), and generally occurs within 3 weeks after the birth of their baby.  In this disorder, women begin to lose their sense of reality, and develop delusional beliefs or hallucinations.  A small percentage of women with Postpartum Psychosis may end up harming themselves or their babies.  However, due to their psychosis, they are not troubled or distressed by thoughts of harming their babies; in fact, most frequently, their delusional thoughts lead them to believe that they are actually helping or saving their baby.  Women with Postpartum Psychosis often do not realize that anything is wrong with the way that they are thinking or acting.  This is quite different from the far more common experience of scary thoughts that many moms with Perinatal Anxiety experience!  

Post-Traumatic Stress Disorder Due to Traumatic Childbirth - Anyone who has had medical complications with themselves or their babies during childbirth can likely attest to the fact that these sorts of experiences can be truly traumatic.  Some moms find the transition into motherhood after having a traumatic childbirth and/or a child with medical issues to be extremely difficult.  Our brains have a very specific way of processing and encoding traumatic events.  Unfortunately, the stress that comes with a new baby (particularly one who is in the NICU or has other medical needs) can often prevent us from being able to emotionally recover and naturally heal from the trauma in the way that we might otherwise.  Some moms find themselves experiencing intrusive thoughts or nightmares about the childbirth, along with intense anxiety anytime that they think about or are reminded of these experiences.  This may lead these moms to avoid anything that reminds them of these painful experiences, including their babies.  They may find themselves isolating from others around them, and feel detached or numb.  The may also find that they are hyper-aware of their surroundings and always feel 'on guard'.   

Perinatal Bipolar Disorder - Many people believe Bipolar Disorder to simply be intense moodiness.  However, true Bipolar Disorder is quite different from this.  Someone with Bipolar Disorder experiences alternating periods where they experience intense depression, followed by periods in which they experience mania.  Manic episodes are characterized by intense euphoria, the overwhelming need to speak constantly (known as pressured speech), a decreased need for sleep, racing thoughts, excessive energy and impulsive or risky behaviors.   It is quite common for moms who have been previously been diagnosed with Bipolar Disorder to have a recurrence of a bipolar episode at some point during their pregnancy due to all of the hormonal changes (particularly if they discontinued taking mood stabilizing-medication when they became pregnant).  Other women who have not had Bipolar Disorder before may have their first episode during the postpartum period.  

If any of these sound familiar, the good news is that all of these conditions are treatable!  Perinatal Depression and Anxiety, OCD, and Post-Traumatic Stress Disorder all can be treated through psychotherapy aimed at reducing your distress, improving your sense of well-being, and teaching you strategies that reduce upsetting thoughts.   Our providers use the techniques that have been demonstrated to be most effective in treating Perinatal Mood and Anxiety Disorders.


While Postpartum Psychosis and Perinatal Bipolar Disorder require psychomedication as a primary treatment component, psychotherapy can also be helpful in keeping moms on track with their treatment, and improving their ability to cope with and reduce the stressors in their lives.

We can help!!

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