Beyond the Baby Blues
Pregnancy and the postpartum period can bring varying emotions and feelings for most women while they adjust to the exciting changes in their lives. Traditionally, this is a time of great joy for many women. And for many this can be a point at which mood or emotional issues arise for the first time.
According to the American Congress of Obstetrics and Gynecology (ACOG), depression is seen in 14% to 23% of women during pregnancy and in 5% to 25% of women in the postpartum period.
Many women have heard of “baby blues,” which often occurs in the first two weeks after childbirth and affects 50% to 80% of women. Symptoms that may be present with baby blues include fatigue, sadness, insomnia, poor concentration, tearfulness or crying for no reason, irritability, anxiety or mood changes. Fortunately, baby blues usually lasts two weeks or less and generally resolved without further intervention.
Recognizing Perinatal Mood Disorders
It is important to be able to identify other perinatal mood and anxiety disorders, which are defined as mood or anxiety disorders that occur during pregnancy or in the postpartum period. These disorders include postpartum depression, anxiety, postpartum psychosis and obsessive compulsive disorder (OCD).
Postpartum depression differs from baby blues in that it persists longer than two weeks, and symptoms often interfere with the ability to carry out daily activities. Symptoms can include fatigue, mood swings, guilt, isolation, problems sleeping, loss of appetite, sadness and more. In moderate to severe depression, thoughts of wanting to harm yourself, your baby or others may occur. If they do take place, you should seek medical help immediately.
Anxiety is often a mood disorder that arises during the perinatal time period for women. Symptoms include irritability, excessive worry, decreased concentration, poor sleep or the inability to fall asleep. Other signs such as stomach problems, body aches and pains, or headaches can also be present.
Postpartum psychosis is very rare, but in women with a family history of bipolar disorder the risk is increased. With this disorder, symptoms such as confusion, severe mood swings, hallucinations (seeing things or hearing voices that are not there) and delusions may be present. There may be a strong feeling that the baby is bad or there may be thoughts of wanting to harm the baby, which moms may want to act on if they do not seek help. Postpartum psychosis is a psychiatric emergency, for which medical assistance should be sought immediately.
OCD is often made worse of first appears during the perinatal period. During pregnancy, obsessions can include thoughts of contamination and the need to clean things over and over. However, during the postpartum period, women can find themselves feeling upset or frightened due to intrusive feelings of harming the baby — which may or may not be accompanied by cleaning rituals. In OCD, moms do not want to act out on thoughts of harming their babies. Moms may also be overprotective and very vigilant of their children.
The following are risk factors for perinatal mood disorders: a history of a previous mood or anxiety disorder, prior mood issues relating to hormonal changes (i.e., menstrual cycle), pregnancy or delivery complications, an unplanned pregnancy, a poor support system, life stressors, a recent loss, a history of trauma and more.
The great news is that there are treatment options for all of the mood disorders discussed here. If you experience any of the symptoms above, please know that you are not alone. There are many women experiencing similar symptoms, and it is okay to seek help. Speak to your healthcare provider so that he or she can promptly evaluate and assist you.
The best thing you can do is to ask for assistance. If you experience any thoughts of wanting to harm yourself or your baby, call 911 or go to the nearest emergency department to seek help. For more information:
Shermeeka Hogans-Mathews, MD, is an assistant professor at Florida State University College of Medicine, Tallahassee, specializing in family medicine with research interests in perinatal mood disorders.