As a clinician whose practice focuses on all aspects of maternal mental health, I was motivated to write June’s blog after reading a tragically resounding story that recently made national news. Among other reactions I had, this story reminded me that the information I hold as a specialist in this area is not common knowledge for the majority of women in this country. As such, through this month’s blog I hope to educate, normalize, and destigmatize a disorder that affects so many American mothers and their loved ones.
Arianna Sutton had a history of postpartum depression after the birth of her first child. But after her second pregnancy, her symptoms returned more quickly and stronger. Nine days after giving birth to twins, Arianna died by suicide. Tragically, Ariana’s story is not uncommon. Moreso, it underscores the importance for awareness of and knowledge about the most common pregnancy related complication: perinatal mood and anxiety disorders (PMADs).
What are PMADs?
PMADs include a variety of disorders and symptoms that a woman may experience during both her pregnancy and the year following birth. Postpartum depression is the most commonly known among them, but it is just one experience that fits under the PMAD umbrella. Specifically, additional disorders include anxiety, panic disorder, postpartum bipolar disorder, obsessive compulsive disorder, post-traumatic stress disorder, and postpartum psychosis.
According to Postpartum Support International, approximately 15 to 20% of women (or approximately one in seven) will experience symptoms consistent with PMADs. Additionally, women with a history of clinical depression or anxiety are at a significantly greater risk for developing PMADs, and those who have experienced PMADs during pregnancy are more likely to experience recurring symptoms in subsequent pregnancies. But important to also note is that a woman can be diagnosed with PMADs even if she did not experience symptoms during previous pregnancies.
Although it captures most of the PMAD-related headlines, postpartum psychosis is a rare experience that occurs in 0.1% of women with onset two to four weeks postpartum (Postpartum Support International). Symptoms include, elated high mood, overactivity, racing thoughts, confusion, mania, suicidal or homicidal thoughts/actions, hallucinations and delusions. Though postpartum psychosis is a medical emergency that often requires hospitalization and medication, with early intervention, symptoms can typically resolve within weeks (Postpartum Support International).
In contrast, the so-called “baby blues” is a very common postpartum experience that occurs within two weeks of birth and whose symptoms include weepiness, fatigue, anxiety, and difficulty sleeping. Though the baby blues are typically resolved with simple self-care practices, if symptoms persist beyond three weeks postpartum, a diagnosis of PMADs may be considered.
Additional PMADs symptoms to be aware of include
Feeling sad or depressed
Irritability or increased anger
Difficulty bonding with your baby
Feeling high or elated above and beyond what is typical
Reduced need/desire for sleep
Anxiety of feeling panicky
Upsetting thoughts that you can’t get out of your mind
Feeling as if you are “out of control” or “going crazy”
Feeling like you should never have become a parent
Worries that you might hurt your baby or yourself
Treating PMADs
As many women feel shame, struggle to ask for help, minimize their symptoms, are fearful that they will lose their babies, or have limited support and awareness of PMADs, they often suffer their symptoms in silence. Fortunately for those affected, with proper intervention, PMADs are in fact highly treatable and have a favorable prognosis, often with a combination of medication management and psychotherapy.
Cognitive-behavioral therapy (CBT) is a highly effective form of psychotherapy treatment for PMADs, as it empowers sufferers to work in the “here and now” - as opposed to focusing on family of origin dynamics that are likely not helpful to the crisis at hand - to experience symptom relief. CBT works with the interplay of a patient’s mood, thoughts, and actions, to provide a patient with alternative perspectives and experiences of her situation, healthy practices that can support her mood, as well as providing immediate coping strategies to the patient.
At CTWPS, the specialized training our practitioners have into the specific challenges of women with PMADs makes us uniquely qualified to work with affected individuals. We strive to not only provide our patients with effective symptom reduction strategies, but also to normalize, educate, decrease shame, and improve their quality of life. If you, or someone you know, may be experiencing a PMAD, we at CTWPS are here to help and provide support. Reach out today!
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