Many new and expecting parents are familiar with Postpartum Depression (PPD). Those of us who specialize in perinatal mental health are aware that many people think that the only mental health complication of the postpartum period is PPD. While PPD occurs in 1:5 pregnancies, and can begin during or after pregnancy, it is likely that Postpartum Anxiety is even more prevalent than PPD. And that there are other categories of Perinatal Mood and Anxiety Disorders (or PMADs). (Note: for the purposes of this post, I am referring mostly to new moms. However, dads/partners also experience PMADs).
Perinatal/Postpartum Depression (PPD) is often characterized by a depressed or sad mood, though some new parents describe it more as an agitated or irritable mood versus sad or hopeless. You may see a change in appetite, a difficulty to sleep or wanting to sleep too much, detachment from her baby. She may also have suicidal thoughts or ‘escapist fantasies’, where she envisions running away. This happened to me, when I experienced PPD in 2005 following the birth of my 2nd child. I thought, at the time, that it made complete sense to take my older child and leave for six months. Fortunately, I didn’t do that. Some women who have a history of depression or bipolar disorder experience Postpartum Bipolar Disorder (PBD), and will cycle between depression and mania or hypomania, which can involve racing thoughts, risky behaviors, anger or elation, and need little to no sleep. Women who have a history of bipolar, or develop it in the postpartum period, are at particularly high risk for suicide and/or psychosis.
Perinatal/Postpartum Anxiety (PPA) can coincide with depression, or in some cases, what starts as anxiety turns into depression. These moms will often feel restless, and experience racing thoughts. They have a difficult time falling asleep, or will wake during the night, and have a hard time turning off their brain. She may also notice a decrease in appetite, shortness of breath or rapid heart rate (and sometimes panic attacks), and really struggles to stay in the moment. Many moms who struggle with PPA will describe themselves as a “Type A Personality”, and they feel compelled to appear that they have it all together. Some moms with PPA experience intrusive thoughts, which are described in the next section.
Perinatal/Postpartum Obsessive-Compulsive Disorder (PPOCD) is a close cousin of PPA. It involves the same anxious thoughts, but the thoughts sometimes become scary or disturbing (what we call ‘intrusive thoughts’, or IT). Common examples are fear that the baby has stopped breathing, will get hurt, or sick. It is especially distressing when these thoughts involve the mom herself harming her child. The key here is the word distressing- these moms do NOT want to hurt their children, and know that these thoughts are horrible. They will go to great lengths to avoid these thoughts coming true, which is why, in reality, they are at very low-risk of causing harm. To cope with these obsessive thoughts, some moms engage in compulsive behaviors to ensure that the thoughts do not happen. An example would be the mom who has IT that her baby has stopped breathing, so will check on the baby multiple times a night, at the detriment of her own sleep. Most do not talk about the thoughts they are having, and often fear that their baby will be taken away, or that they are going crazy.
Perinatal/Postpartum Post-Traumatic Stress Disorder (PP-PTSD) can occur if a woman has had a history of trauma that is reactivated during pregnancy/childbirth, or had a traumatic experience during her labor/delivery/postpartum experience. Keep in mind that trauma is in the eye of the beholder, and what may not appear traumatic to an outsider feels very different to her. Common examples are loss, a medical emergency, unexpected interventions, c-sections, and having a baby in the NICU. Watch for any signs of avoiding facing or talking about what happened, having nightmares or flashbacks, being overly aware of her surroundings or the baby, agitation or isolation. Even if “everything is fine now”, that does not mean the mom (or her partner, if applicable) have not been affected.
Perinatal/Postpartum Psychosis (PPP) is fortunately rare, occurring in 1 out of 1,000 births. However, when it does happen, it is a medical emergency. It will generally begin quickly, within the first two weeks, and often begins even in the hospital. These moms are at high risk, as they are the ones that are often shown in the media who commit suicide or infanticide. This is VERY different than PPD. Moms having a psychotic episode will be having thoughts that sound bizarre or irrational, yet to her, they make sense. They may believe that their baby is possessed by a demon (religious thoughts like these are most common), or experience visual or auditory hallucinations. They believe that what they are experiencing is real, which is why it can become dangerous.
This is a very abbreviated overview of all of the disorders that can occur in the mental health realm. There are times when they happen at the same time, where a mom feels anxious for a period of time, and that lapses into depression. The takeaway for this time is that there are a lot of different things that can be going on- and you can’t tell just by looking. You need to ask her how she’s doing, and if she needs help, offer the get her the help that she needs.
If you, or someone you love, needs help or support during or after pregnancy, contact the Pregnancy and Postpartum Support MN* HelpLine, 612/787-7776 (call or text) or firstname.lastname@example.org (email). This is NOT a crisis service, but can get you connected with therapy, psychiatry, and free peer support services. They also have a Facebook support group! You are not alone.
*PPSM is the Minnesota State Chapter of Postpartum Support International (PSI)