It’s not Just Postpartum Depression – Perinatal Mood and Anxiety Disorders
Congratulations – you’re pregnant! Perhaps you’ve spent years seeking fertility treatment, are pregnant after a loss or relied on a gamete donor or gestational carrier, or maybe conceiving without intervention was simple for you. You’ve scheduled your OB or midwife appointment and are diligently taking your prenatal vitamins. But are you taking care of your emotional health? While we are all familiar with the trope of a hormonal pregnant person weeping over a television commercial, the truth is that pregnancy is a time of incredible psychological vulnerability. In fact, most pregnant people who experience mental health symptoms postpartum note that their symptoms began during pregnancy.
While you may have heard of postpartum depression or postpartum anxiety, perinatal mood and anxiety disorders often emerge during pregnancy.
Given the high rate of emotional distress during pregnancy, it’s concerning that we are not giving this issue more widespread attention. There are several reasons for this. First and foremost is shame. The way we talk about pregnancy, with language full of “shoulds” and “musts,” makes it very difficult for pregnant people to admit how different their emotions are from the expectations of others or from their own expectations of themselves. Stigma within the health care field and stigma surrounding mental health concerns only exacerbate this.
Another challenge is that many of the symptoms associated with depression or anxiety during pregnancy are very similar to experiences typical of pregnancy. For example, sleep problems, changes in appetite, difficulty concentrating and fatigue are all typical during pregnancy. However, when these experiences happen with great frequency or intensity, and/or are coupled with additional symptoms such as loss of interest in things you used to enjoy, anxiety or feelings of guilt or hopelessness, they may indicate depression or anxiety. For this reason, many pregnant people dismiss their own symptoms, or have their symptoms dismissed by their health care provider.
Fear
Both on the part of care providers and in pregnant people, can also prevent patients from asking for help or getting appropriate treatment. In my experience, some pregnant people are afraid of seeking mental health treatment such as medication or therapy out of a concern that it will negatively impact their pregnancy. At times, this fear is mirrored back by health care providers who are either uninformed or afraid of prescribing medication or recommending mental health treatment to a pregnant patient.
Unfortunately, what is not considered is the risk of not treating depression, anxiety or other mental health concerns during pregnancy. Research consistently shows that untreated mental health concerns during pregnancy are associated with risks to the pregnant person, as well as to the developing fetus. For example, untreated depression during pregnancy increases the risk of substance abuse, poor compliance with prenatal care and inadequate weight gain during pregnancy, and substantially increases the risk of poor mental health postpartum. Additional risks include an increased chance of preterm labor, a higher likelihood of having small-for-gestational-age baby or babies and a higher chance of infant health complications after birth requiring a NICU stay.
Given all the risks
It is of vital importance to take care of your mental health during pregnancy and to be aware of your risk factors. For example, you are at much higher risk for perinatal depression or anxiety if you have a previous history of mental health concerns, have experienced a perinatal mood or anxiety disorder before or have a family history of mental illness. Certain medical conditions –including a history of diabetes, thyroid disease or premenstrual dysphoric disorder (PMDD) – can also increase your risk. A history of loss (including pregnancy loss), past trauma or a traumatic pregnancy are significant risk factors. Systemic stressors including poverty, poor social support, struggles with your partner and single parenthood are also risk factors. While this list can look a bit scary, it is important to gauge your risk factors and proactively seek support.
If you know you may be at risk for perinatal depression or anxiety, or have a history of mental health concerns, talk to your OB or midwife before getting pregnant. If you are not in therapy, get connected with a therapist who specializes in perinatal mood and anxiety disorders so that you have support in place, or so that you know where to turn if you need help. If you are or have been on medication to treat any mental health concerns, schedule a consultation with a psychiatrist who specializes in working with pregnant patients, so you can be fully informed about your medication options during pregnancy.
I also suggest getting educated on signs and symptoms of depression and anxiety.
Common symptoms of anxiety can include:
- Worry
- Physical complaints
- A sense of doom or dread
- Disrupted sleep or restlessness
Depression symptoms often include:
- Irritability
- Sadness
- A sense of hopelessness
Every person’s experience of depression or anxiety is different, so if you are feeling unlike yourself, or starting to notice familiar symptoms creeping up, it’s a good idea to get connected to care right away. If you can, include your partner or family member in your care plan by letting them know what signs and symptoms to look out for. If you ever feel suicidal or have thoughts of hurting yourself, seek immediate care. Recent studies suggest that the prevalence rates of suicidal thoughts and self-harm during pregnancy and postpartum are higher than previously estimated and may be increasing.
Most importantly, know that you are not alone.
Perinatal depression and anxiety are common but are very treatable. Here in the D.C. area, we have many excellent mental health professionals who specialize in perinatal mental health. In addition, there are excellent support groups and community and hospital-based programs all centered around perinatal health. There is support and there is hope.
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