There are an overwhelming number of terms and definitions associated with the mood changes and illnesses that can occur during pregnancy and postpartum (Baby Blues, Bereavement, Postpartum Depression (PPD), Postpartum Anxiety (PPA), Panic Disorder, Obsessive Compulsive Disorder (OCD), Postpartum Post-Traumatic Stress Disorder (PTSD), Bipolar Disorders, and Postpartum Psychosis). Here’s a breakdown of the facts and definitions, signs and symptoms, risk factors, stigma, and treatment options of Baby Blues and PMADS to help you navigate your perinatal mental health and better communicate vital information with your healthcare providers.
Facts and Definitions
Perinatal refers to any time during pregnancy through the first year postpartum (post-pregnancy).
Baby Blues are common, mild, and temporary, affecting an estimated 50 to 85% of new mothers. They are a symptom of postpartum, just like bleeding and afterbirth pains, are likely caused by shifting hormones, sleep disturbances, routine changes, and changes in roles and identity, and typically last a few days up to two weeks postpartum. Feeling overwhelmed, sad, tired, cranky, irritable, anxious, unsure of yourself, or crying over the little things are signs you may be experiencing the baby blues. Joining a new moms group, getting outside once a day, eating and sleeping well, talking to friends or family, or asking for help with household tasks may help you manage these blues until they pass.
Bereavement is severe and persistent grief or mourning in response to loss, and includes poor sleep and appetite and rumination about the loss. There is no right way to grieve, and there is no set timeline for how long the bereavement period should last. Grief is a normal reaction to a physical, symbolic, or social loss; however, when grief becomes all-consuming for a long period and impacts a person’s ability to function, a diagnosis of bereavement and/or major depression may be helpful in obtaining the best treatment interventions.
Postpartum Depression (PPD), which occurs in up to 1 in 5 new moms, is a period of at least two weeks with depressed mood or loss of interest or pleasure in nearly all activities. With PPD, there is also a clinically significant impairment in social, occupational, or other important areas of functioning. The depression can begin during pregnancy or in the months after, so the official diagnosis is major depressive disorder with peripartum onset. There has been much debate about the length of the period after birth that falls within the peripartum period. Officially, it’s 4 weeks, however many clinicians and mothers know this period should really include the first year. Sometimes, people who are depressed have thoughts of hurting or killing themselves. Having suicidal thoughts does not mean that someone will take their own life, however contacting a mental health professional who can help determine the level of risk is recommended.
Postpartum Anxiety (PPA) may be more common than postpartum depression, however the prevalence is not well known. Most likely, women who experience PPA have suffered from anxiety prior to pregnancy, have a lack of social support, a personal history of abuse, and/or posttraumatic stress disorder. There is no official diagnostic criteria for PPA, however it is sometimes tied to depression “with anxious distress” for clinical purposes, as a major depressive episode often includes severe anxiety and even panic attacks.
Panic Disorder is a recurrence of panic attacks (abrupt periods of intense fear and discomfort), followed by weeks of fear of having additional panic attacks. This fear may lead to changes in behavior in order to avoid situations where risk of a panic attack is high. People experiencing panic attacks often report to the ER with physical symptoms like heart palpitations, chest pain, or breathing difficulties, as well as sweating, shaking, nausea, numbness or tingling. A doctor will typically order a physical exam, blood tests, a heart test (e.g., EKG), and a psychological evaluation or questionnaire. If a physical condition (e.g., heart or thyroid) is ruled out, patients may be referred for counseling and/or medication to help manage their symptoms and overcome their fears. Panic attacks typically peak within minutes, and are usually over within about 30 minutes.
Obsessive Compulsive Disorder (OCD) is an anxiety disorder where unwanted and persistent thoughts, images, feelings, or urges (obsession) cause distress. Sometimes, people will behave in a particular way (compulsions) in order to reduce anxiety. There are different types of OCD and not everyone suffering from OCD is neat and tidy. Often, the behaviors that people with OCD engage in give them a sense of control over their environment -- it’s this sense of control that is satisfying since they feel powerless over their obsessions.
Post-Traumatic Stress Disorder (PTSD) can occur when it’s difficult to recover following a terrifying or dangerous event that is experienced or witnessed. It may last months or years and go away with or without treatment, or may be longer-lasting. Nightmares, flashbacks, eating and/or sleep issues, anxiety, depression and substance abuse are common symptoms of PTSD. Oftentimes, treatment includes identifying personal triggers and medication.
Bipolar Disorders (type I or II) are characterized by episodes of depression, mania (great excitement or euphoria, delusions, and overactivity), and/or hypomania (a milder form of mania, characterized by elation and hyperactivity). The postpartum period is a period of high risk for new or recurrent episodes of bipolar.
Postpartum Psychosis is rare. It may be present when thoughts and emotions are so impaired with hallucinations, delusions, bizarre behavior, confusion, and/or disorganization that contact is lost with external reality. It most often occurs in women who have been, or will be, diagnosed with bipolar disorder. Other associated disorders are major depression with psychosis, schizophrenia, and schizoaffective disorder. Postpartum psychosis requires rapid intervention.
Signs and Symptoms of PMADS
Feelings of guilt, shame, or hopelessness
Feelings of anger, rage, or irritability
Scary or unwanted thoughts
Lack of interest in your baby or difficulty bonding with your baby
Loss of interest, joy, or pleasure in things you used to enjoy
Disturbance of sleep (sleeping more or sleeping less)
Disturbance of appetite (more hungry or less hungry)
Weight gain or loss
Crying and sadness
Constant worrying or racing thoughts
Dizziness, hot flashes, and nausea
Thoughts of harming yourself or your baby/children
Mental Health Factors:
History of depression, anxiety, an eating disorder, bipolar disorder, OCD and/or PTSD
Physical Health Factors:
Thyroid imbalance, diabetes, endocrine disorders
Premenstrual syndrome (PMS)
Abrupt discontinuation of breastfeeding
Pregnancy or delivery complications, infertility, miscarriage, or infant loss
Unwanted or unplanned pregnancy
Financial stress or poverty
Lack of support from family and friends
History of abuse
Much of the stigma associated with postpartum mood and anxiety disorders is perpetuated by stories of mothers who in the midst of their severe illness, such as postpartum psychosis, have harmed themselves or their children. Andrea Yates, the mother who tragically and infamously murdered her five children, was reportedly suffering from very severe Postpartum Depression, Postpartum Psychosis, and Schizophrenia. For many years, PMADS have been referred to by the catchall term "postpartum depression." This is a disservice to all of us. Postpartum Depression is just one of the diagnosable disorders in the perinatal mental health category, and only one of the issues Andrea Yates was facing. PMADS are treatable. Yet, many moms don’t seek the help they so desperately need because they are ashamed, embarrassed, or surprised by the feelings they’re having, and are scared that if they talk to anyone, they will have their children taken away from them.
If you are feeling sad or that you just can’t connect with your baby, it does not mean that you will hurt them.
Sometimes feelings are just feelings. And feelings come and go, just as sure as the waves crash onto the sand and retreat back to the sea time and again. Sometimes feelings linger and/or increase in severity, interfering with everyday life, including taking care of yourself or your children. This is when it’s important to talk to someone about them.
Support from family and/or friends, counseling/therapy, pharmacology (medication), exercise, good sleep hygiene, a healthy diet, bright light therapy, yoga, and meditation/relaxation techniques are clinically effective treatment options for PMADS.
Hopefully this breakdown can help you evaluate your perinatal feelings a little better. And as always, if you’re not sure, or are so overwhelmed you can’t make sense of them, ask a healthcare provider who’s trained to make sense of them for you. Help is always available.