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Pregnancy and Postpartum Depression and Anxiety


While we often associate pregnancy and the birth of a baby with feelings of joy and the fulfillment of lifelong dreams, these can also be times of increased stress and emotional vulnerability.  The truth is that the transition to parenthood is a significant emotional and psychological life adjustment for the mother, the partner and the entire family.  New and expectant moms often have high expectations for themselves, and worry about what others expect of them.

It is no surprise, then, that a pregnant or postpartum woman who finds herself distressed, depressed and anxious often feels alone. She may feel ashamed, alienated, inadequate and guilty. She may wonder why she is not experiencing feelings of joy like other women. She may wonder how she could possibly feel this bad when she loves her baby and was so looking forward to pregnancy and motherhood.


You are not alone – You are not to blame

If you are having any of these thoughts and feelings, please know that they are symptoms. They are not a definition of who you are as a person, a woman, or a mother.  You are not alone—this is not your fault.  With treatment, you can feel better.


Baby Blues

Up to 80% of women experience the baby blues – mild mood fluctuations, tearfulness, irritability and anxiety after giving birth. This is quite common and resolves in about two weeks. If symptoms last longer than two weeks or become more intense, this could be a sign of a more serious condition.


More than the Blues

Between 10% and 20% of women experience perinatal distress serious enough to interfere with their everyday functioning and to require treatment. In fact, Perinatal Mood and Anxiety Disorders (PMADs) are the most common complication of pregnancy and childbirth. 


Perinatal Mood and Anxiety Disorders

Postpartum depression is often used as an umbrella term for a wide range of mood disorders that are also known as Perinatal Mood and Anxiety Disorders (PMADs).  “Perinatal” refers to the time during pregnancy and after birth. PMADs can occur at any time during pregnancy, following miscarriage or stillbirth, and up to one year after delivery.  They include a spectrum of disorders: depression during pregnancy, postpartum depression, perinatal anxiety (generalized anxiety, panic disorder, obsessive-compulsive disorder, PTSD), and postpartum psychosis* (a condition that occurs in about 1-2 out of every 1000 births or deliveries).


What you might be experiencing

Symptoms of depression and/or anxiety, prenatal and postpartum, can be mild to severe and vary for each individual. They can include:


  • Sadness, crying

  • Feeling overwhelmed and unable to cope

  • Excessive and constant worry, nervousness (this is often a prominent feature in perinatal depression)

  • Difficulty concentrating or making decisions

  • Intrusive or scary thoughts (especially about the baby) that are inconsistent with who you know yourself to be

  • Feelings of guilt

  • Irritability, anger, short temper

  • Changes in appetite

  • Feeling hopeless, worthless

  • Withdrawal from family and friends

  • Lack of interest in your baby, or not feeling connected to your baby

  • Lack of interest or pleasure in general

  • Insomnia: difficulty falling asleep, staying asleep, not being able to sleep when the baby sleeps

  • Sleeping too much

  • Rapid heartbeat, nausea, feeling hot or cold

  • Thoughts of harming yourself or your baby


What causes Perinatal Mood and Anxiety Disorders?

Unfortunately, we don’t know the exact cause. And while anyone may develop PMADs, even without known risk factors, there are factors that can increase the risk of developing PMADs. These factors include:


  • Personal or family history of depression, anxiety, bipolar disorder

  • Personal or family history of postpartum depression or anxiety

  • Depression or anxiety during pregnancy

  • Sensitivity to hormonal changes, history of PMS or mood problems with oral contraceptives

  • Lack of social, emotional, or practical support

  • Relationship stress

  • History of trauma

  • Previous miscarriage or stillbirth

  • Medical complications or traumatic birth

  • Unplanned (even if not necessarily unwanted) pregnancy


Treatment can be very effective

Though the exact cause of PMADs is not known, we do know that treatment can be very effective.  Treatment varies depending on individual symptoms and needs, and can include psychotherapy, increased self-care, social support, and in some instances, medication.


As a psychotherapist, I work collaboratively with psychiatrists who specialize in maternal mental health and can make referrals as needed.  If you are feeling depressed and anxious, you need not suffer alone.  Seeking help is not a sign of weakness.  It is a sign of courage and strength.

*Postpartum psychosis occurs in about 1-2 out of every 1000 births or deliveries. It is a medical emergency and requires immediate treatment.  Symptoms of postpartum psychosis can include but are not limited to seeing or hearing things that are not there, suspiciousness, decreased need for sleep, rapid mood changes, strange beliefs, and delusions/commands (sometimes to harm the baby or yourself). Postpartum psychosis is very treatable.  It is not your fault. If you or your loved are experiencing these symptoms, please call the doctor, 911 or go to your local emergency room to get immediate care.

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