Perinatal Mood and Anxiety Disorders. How to identify them and cope.

What are Perinatal Mood and Anxiety Disorders? (PMAD)

Motherhood is a special time in a woman's life often bringing about emotions of love, joy, happiness, and satisfaction. Mothers spend so much time during pregnancy preparing their bodies, their homes, and their hearts for the incredible addition of their child, and at times can neglect to prepare mentally for the changes that are to come. The postpartum period, also known as the fourth trimester, presents a unique set of challenges to a new mother and her family, and this article serves to educate moms and their partners on specific diagnoses (signs and symptoms), and possible coping mechanisms to be utilized if these symptoms present themselves.

Perinatal Mood and Anxiety Disorders (PMADs) is the term used to describe distressing feelings that occur during pregnancy (perinatal) and throughout the first year after pregnancy (postpartum). The most referred to diagnoses under this term are postpartum depression and anxiety and these can be mild, moderate, or severe. There has been a noticeable societal shift from hiding in the dark when it comes to PMADs, to making a point to have these discussions out in the open. This shift provides opportunities for advanced training and education around these topics and normalizing the experiences for all moms.

Postpartum Depression (PPD)

This diagnosis is the most frequently reported and the one that tends to get the most attention in the media and medical practices. After the birth of a baby, a mother experiences a wide range of emotions that are typical in the first few weeks, and these can impact her mental health, ability to sleep, and activities of daily living. These can easily be misinterpreted as “baby blues” but the symptoms are more intense and last longer. One of the most common emotions is depression because it can be seen by others close to the mother and is recognizable by the pattern it displays.

Some of the signs associated with depression are moms will appear withdrawn from usual activities, more labile in their mood, distracted, sleeping more, or less, not presenting as joyful or hopeful, and not as engaged with the baby as they would have hoped to be. The symptoms mothers have reported associated with postpartum depression are feeling overwhelmed, unable to cope with their new role, agitated/irritable, and increased somatic issues (headaches, GI, distress, etc.). It is important to note that experiencing some of these symptoms does not result in a diagnosis of PPD. You can experience some symptoms related to a diagnosis without being professionally diagnosed.

Postpartum Anxiety (PPA)

The prevalence of postpartum anxiety symptoms ranges from 8%- 20% of the birthing population. This diagnosis tends to be underreported specifically because the signs are not as great as the symptoms. Mothers are experiencing symptoms such as excessive fear and worry about their health or the health of their baby, difficulty controlling their worry (ruminating thoughts), agitation, and restlessness. These are not something that would be noticeable by her support system but rather something she would need to share with someone, and research has shown that this is not the case. Mothers will likely keep these symptoms to themselves, further provoking the fear and worry associated with PPA. Mothers report an increase in somatic tension such as muscle spasms, palpitations, GI issues, and teeth grinding.

PPA and Sleep Issues

The topic of sleep for a new mom tends to be a triggering event because she is not getting much of it. Lack of sleep significantly contributes to the onset of PMADs and if left underreported and untreated could lead to psychosis in the postpartum period. Sleep disturbances for individuals experiencing PPA result in unsatisfying sleep and mothers have reported being physically exhausted and craving sleep but unable to fall asleep organically and stay asleep.

Effectively Coping

Having a baby is a huge life event that creates shifts in your physical and mental health. Having appropriate information, support, and education around these topics increases the likelihood that you will transition effectively and safely into the fourth trimester. You do not have to wait until you experience any of these symptoms to seek guidance and information about coping and recovering from PMADs. Here are some helpful tools utilized by mothers across the country when managing the effects and impact of PMADs on their mental health:

• Journaling: Getting the feelings and emotions out of your mind and onto paper. This can be a helpful resource you can use to effectively communicate what you are experiencing to your partner, support, or therapist.
• Seek Professional Help: Talk openly with your doctor, midwife, coach, doula, etc. and trust that they can refer you for more intensive services to assist in your recovery. For more information on how to find professional support, check out this article.
• Get Outside: These can-do wonders to shift your mood immediately especially if you are experiencing depression.
• Deep Breathing: This can be helpful in the moments when excessive fear or worry begins to consume you. Box breathing approaches have been shown to be successful grounding techniques for people experiencing panic. (Deep breath in for 4 counts, hold for 4 counts, exhale for 4 counts, hold for 4 counts, repeat 4 times.)
• Exercise/Physical Movement: Moving your body whether it’s a ten-minute stretch routine before bed, going for a walk, or strength training, has been positively associated with reducing depression and anxiety symptoms when coupled with other effective treatments. You need to take care of your body in the postpartum period as it continues to do a lot of work for you and your baby.
• Prayer and Meditation: Life is busy with a new baby, and you will find yourself craving a bit of time that does not involve taking care of someone else. Being able to unplug and focus on your own emotional and mental health will allow you to regain some control over your anxiety, enhance your mood for the time being, and allow you to present the best version of yourself to your baby. By drawing inward you can quiet your mind, set intentions for the day/week ahead, and focus on your own emotional and mental health.

Reminders:

Consider snapping a picture of these gentle reminders, sharing them with another postpartum mom, or writing them down and posting them somewhere you often look.

• Although you may feel lonely, you are never alone on this journey.
• Speak up for yourself just as you would for your baby. You are your best advocate.
• If things don’t feel right that is OK. There are professionals designed to assist you through this period.
• With early intervention and treatment, these feelings will subside and be rectified.You must be honest about what you are experiencing.
• You did nothing to cause yourself to feel these things and your baby is happy with you.
• You deserve to be healthy, happy, loved, and here for your baby. They are not better off without you.
• Prioritize rest. You can do anything after a good night/days’ rest. A lot of what you are feeling is maximized due to sleep deprivation.