Perinatal Mood Disorders

By Mary McGuinness, a Consultant Clinical Psychologist who specializes in patient and community service for women who develop mood disorders in the perinatal period. She is currently undertaking a large internet study exploring women’s thought processes in pregnancy.

Nobody wants to develop mental health problems when they are having a baby. No one deserves to. Unfortunately some women do and for them what should be the most wonderful experience of their lives is overshadowed by that experience. Fortunately, there are effective treatments and early intervention can make all the difference, so, if you choose to read on and feel you are affected by any of the issues raised, please seek professional advice as soon as possible.

What is a perinatal mood disorder?

For most women, having a baby is one of the most important experiences of our lives. Being pregnant, giving birth and becoming a mother is also an emotional rollercoaster; thrilling and exciting at times, terrifying and stressful at others, and in-between dominated by exhaustion and sheer hard work.

Many physical and emotional changes occur when we are pregnant and after we give birth. For most women this period of our lives is characterized by mixed and often contradictory feelings, which gradually settle down as we find our feet and adapt to our new role. Some women, however, are not so fortunate and find themselves becoming more and more emotionally disturbed, anxious, sad, depressed, panicky, frustrated and sometimes confused. When these symptoms persist and a mood disorder develops then professional help is often necessary.

Between 10 to 20% of women develop a mood disorder during the perinatal period; the time period which includes pregnancy and up to one year after delivery. Mood disorders affect women of all ages and all racial, cultural and economic backgrounds. They range in severity from the mild and transient ‘baby blues’ experienced by up to 80% of women to puerperal psychosis; a serious condition which affects less than 1% of women and almost always requires hospitalisation.

By and large, women in the antenatal or postpartum period are vulnerable to developing the same range of mental health problems as any other adult. What is different, however, is the context. With the exception of bipolar disorder, there is little evidence that the course or prognosis of disorders that develop during this period are different that at any other time.

Mood disorders cause significant personal distress as well as adversely affecting daily functioning, personal relationships but if left untreated can have long-term adverse effects on the baby. At particular risk are women who have had previous episodes of a mood disorder as well as those with little support who are experiencing significant social stress. In view of the potential impact on infants, siblings and partners early intervention is essential. So what is a perinatal mood disorder?

During pregnancy

Contrary to popular belief pregnancy doesn’t protect women from developing mood disorders and up to 15% of women experience significant anxiety and/ or depression in pregnancy. Common symptoms include overwhelming sadness, feelings of hopelessness, excessive worry and rumination, feelings of being overwhelmed, extreme changes in appetite, sleep and concentration.

After Delivery - The ‘Baby Blues’

Often referred to as a mood disorder, but in reality this is a normal reaction experienced by the majority of women in the hours and days immediately after childbirth. Up to 80% of women report experiencing unpredictable mood swings, feeling tearful, irritated, anxious, restless and frustrated during this period. The blues may last only a couple of hours or as long as a couple of weeks after delivery. In most cases the unpleasant symptoms go away quickly and professional help is not needed.

Post partum depression

The most well known of the perinatal mood disorders affecting approximately 10 to 15% of newly delivered women. Most common in the first 3 months though duration is affected by severity. It can develop after the birth of any child, not just the first child. Why women develop post partum depression is unclear and there are many different theories. Despite considerable research no single causative factor has been found, but a previous history of depression, anxiety or depression in pregnancy, stressful life events, relationship conflict, and a lack of social support have consistently been found to increase the risk of PPD.

Common symptoms include low mood, despair, tearfulness, anxiety, irritability, feeling worthless or guilty, being afraid of hurting the baby or yourself, no interest or pleasure, difficulty sleeping even when baby is asleep, lack of motivation, appetite disturbance, difficulty concentrating and getting organized. Some of the symptoms are similar to the baby blues but with PDD the symptoms are more intense and do not disappear after a few hours or days. PPD can be mild, moderate or severe and the particular treatment required will spend on how severe your symptoms are.

Postpartum anxiety

This is a general term which includes panic disorder, obsessive compulsive disorder and post traumatic stress disorder. Although the symptoms vary between the disorders typical symptoms include feelings of extreme anxiety, excessive worry, trembling, palpitations, shortness of breath, sensations of choking, restlessness, agitation, fear that you are going crazy or will lose control, terrifying thoughts or images about harming the baby, excessive checking of the baby to ensure safety, nightmares and/or reliving past traumatic events.

Postpartum psychosis

The rarest but the most serious perinatal mood disorder affecting around 2 per thousand newly delivered women. Symptoms usually develop very quickly, sometimes within hours of giving birth, though usually within the first three months. Symptoms can include extreme confusion, hearing and seeing things that are not really there, bizarre beliefs and behaviours, extreme agitation, irritation and restlessness, not being able to sleep, paranoia, feelings of being watched or controlled by external forces. Risk factors for post partum psychosis include a previous diagnosis a severe mental illness such as bipolar disorder, puerperal psychosis or schizoaffective disorder or a family history of puerperal psychosis. Women with a postpartum psychosis need medical treatment right away and almost always require hospitalization and pharmacological (medicines) treatment because of the increased risk of harming themselves or others.

Treatment for mood disorders

There is emerging evidence that untreated mental health problems in pregnancy or post partum period are associated with poorer long-term outcomes for children beyond the immediate postnatal period. Perinatal mood disorders are treatable, and a range of pharmacological (medicines), psychological (talking therapy) and social therapies (support groups) have been validated as effective treatments for the range of perinatal mood disorders. The type of treatment will depend on the severity the condition.

Pharmacological treatments work as effectively in the perinatal period as at any other time but many pregnant or breastfeeding women are reluctant to take medication because of concerns about the impact of medication on the fetus or developing baby. Careful consideration needs to be given to each woman’s situation balancing the risks and benefits of treatment against the risks of untreated illness. Each woman should be given the opportunity to discuss the pros and cons of the various treatment options with her healthcare provider who should be well informed about the various treatment strategies.

What can I do to help myself?

Seek professional advice if you are at all concerned. Do not let fear or shame put you off. Remember you are not to blame, many women have similar experiences.

Have hope. These days the treatment on offer is very effective. If you are worried the sooner you seek help the better. There is light at the end of the tunnel.

Talk to your husband, partner, family or friends about how you are feeling. Don’t bottle your feelings up.

Don’t try to be super woman. She doesn’t exist – only on adverts! Ask for help when you need it.

Get as much rest as you can, sleep when the baby is asleep. If friends or family offer help, accept it.

Don’t compare yourself to other women. Spend time with women who are honest and supportive and with whom you can share your real feelings. Join a support group – it helps to talk to other women having similar experiences.

Go online. Many of the online pregnancy and mother and baby forums are a fast and efficient way to make contact with other women to talk to about your worries. It will help you to put things in context. Just make sure the forum is moderated and supportive.

Exercise – a natural form of anti depressant. Phone another mom and go out for brisk walk pushing your prams. Free, effective and tones up the body.

Try to get out and about. Start modestly but as your confidence increases try to get out most days even if it only for a short walk. Try not to spend long periods alone at home.

And finally, learn to appreciate dust and the necessary chaos of family life. There are plenty of years ahead when you will have time to restore your home to its pre-baby state.

Written by Mary McGuinness, a Consultant Clinical Psychologist who specializes in patient and community service for women who develop mood disorders in the perinatal period. She is currently undertaking a large internet study exploring women’s thought processes in pregnancy.

WOMEN VOLUNTEERS WANTED FOR ONLINE RESEARCH STUDY

Aged 18 – 45? Never been pregnant? Pregnant now (last trimester)? Had a baby in the last 3 months? Would you be willing to give up half an hour or so of your valuable time to participate in an online research study which aims to help other women?

I am a qualified NHS clinical psychologist working in a Mother and Baby Unit and a mother myself. I am carrying out an internet study exploring how pregnancy and motherhood might affect women’s thought processes and their assessment of risk. My ultimate aim is to use this information to develop more effective psychological treatments for women who develop mental health problems in pregnancy and after childbirth.

Please note this is a serious research study. Although there are quite a few questions most are multiple-choice and are therefore easy to answer.

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