As Mental Health Month comes to a close, we’d like to pay tribute to another important part of this month: National Maternal Depression Month. National Maternal Depression Month aims to raise awareness to maternal depression and other maternal mental health disorders. According to the Centers for Disease Control and Prevention (CDC), as many as 1 in 9 women experience maternal depression and this number has increased about seven times from 2000 to 2015. Maternal depression is one common Maternal Mental Health (MMH) disorders.
Maternal depression refers to depression that occurs during the perinatal period, which is the period during and after pregnancy. Thus, maternal depression symptoms can be seen both during and after pregnancy. Prenatal depression, also known as antepartum depression, refers to depression that occurs during pregnancy and can affect about 10-20% of mothers. Symptoms of prenatal depression include:
- Crying or weepiness
- Problems sleeping
- Changes in appetite
- Loss of pleasure in activities one used to enjoy
- Poor fetal attachment
Postpartum depression, or postnatal depression, occurs after pregnancy and can also encompass a milder form known as “baby blues”. Baby blues can occur in as many as 80 percent of new mothers and is characterized by crying, weeping, sadness, irritability, anxiety, exaggerated empathy, feeling overwhelmed, insomnia, fatigue, exhaustion, and frustration. It generally peaks about 3-5 days after delivery and lasts for about two weeks. Baby blues is usually able to be resolved without professional help.
If these feelings last longer than two weeks and are accompanied by additional symptoms, then it could indicate the presence of postpartum depression. Postpartum depression is more serious and usually requires professional intervention. Symptoms indicating postpartum depression include:
- Sadness that persists beyond two weeks
- Frequent crying about little things
- Poor concentration, memory, and ability to make decisions
- Feelings of worthlessness, inadequacy, or guilty
- Loss of interest in self-care
- Not feeling up to doing daily tasks
- Decreased or increased appetite
- Poor bonding or lack of interest in the baby
- Loss of pleasure in activities one used to enjoy
- Thoughts of death or suicide
Although maternal depression can strike at random, there are some possible risk factors that can increase a mother’s likelihood of developing this maternal mental condition. Some of the risk factors for maternal depression can include:
- A family history of depression, anxiety, or postpartum depression
- A personal history of premenstrual dysphoric disorder (PMDD or PMS)
- A lack of support
- Financial and/or marital stress
- Pregnancy, birth, or breastfeeding complications
- A major life event such as loss, moving, or job loss
- Mothers who birthed more than one child
- Women with an imbalanced thyroid
- Women with any type of diabetes
It is also highly important to note that women who miscarry or deliver stillborn babies are also at risk for developing postpartum depression. Currently, the CDC only recognizes postpartum depression in women who have had live births. This means that their initial estimate of 600,000 women actually means that about 900,000 women are affected by postpartum depression each year.
In reality, this number can very well be higher because the CDC’s numbers are self-reported. Some women choose not to report, or even get a diagnosis, because of the stigma that still surrounds maternal mental health. Additionally, some women choose not to report because their symptoms don’t exactly align with postpartum depression.
In some cases, this can simply be because depression manifests itself differently in every individual and there may not always be “classic” symptoms. In other cases, it can be because there are less commonly known maternal health disorders such as postpartum anxiety and postpartum psychosis.
According to the Blue Dot Project, which is a non-profit organization dedicated to maternal mental health, about 15% of women develop anxiety during or after pregnancy. Within the larger sphere of anxiety, there are a variety of anxiety disorders that can affect women including generalized anxiety disorder (GAD), obsessive-compulsive disorder (OCD), panic disorder, and post-traumatic disorder (PTSD). Symptoms indicating a possible maternal anxiety disorder include:
- Excessive worry
- Restlessness or inability to calm down
- Being hypervigilant
- Fear of being alone with the baby
- Obsessions about the baby in the form of persistent thoughts or mental images
- Compulsions that may be used to control fears
- Shortness of breath or heart palpitations
- Intrusive thoughts about re-experiencing a traumatic event
- Avoidance of anything related to a traumatic event
- Feelings of detachment
Although rare, the Blue Dot Project also estimates that about 1 woman in every 1,000-3,000 births can also develop postpartum psychosis (PPP). In most cases, women who develop PPP generally have a personal or family history of bipolar disorder or have had their bipolar disorder misdiagnosed as depression. Usually, PPP comes on quickly within the first two weeks of delivery and can include:
- Mood swings
- Feelings of hopelessness, agitation, or anger
- Anxiety or paranoia of others
- Hyperactivity, restlessness, or manic episodes
- Auditory or visual hallucinations
- Suicidal or homicidal thoughts
- Bizarre delusions or hearing “commands” to harm the baby
When a mother is affected by maternal mental health conditions, it can make it exceedingly difficult for her to function from day to day. Additionally, maternal mental health disorders can cause difficulties with bonding with the baby or responding to its needs. In cases where there is already another child in the house, it can also deprive this child of care as well.
It is often said that one must help themselves before helping others, and this is especially true when it comes to the mental health of mothers and their children. While baby blues are usually temporary and will get better with time, maternal depression, anxiety, and psychosis generally require the help of a professional to find the right treatment.
The good news is that maternal mental health issues are completely treatable and these treatments are intended to alleviate symptoms and improve mood. Some of the more common treatments can include talk therapy and medication.
Talk therapy, also known as counseling, addresses the worries and concerns of mothers by having them talk to a mental health provider. There are different variations of talk therapy, however the most common is cognitive-behavioral therapy (CBT). CBT is centered around identifying certain thought patterns and understanding their relationship towards your mood. Once you understand how negative thought patterns are influencing you, your therapist can help you change your thoughts and behaviors to get more positive results.
In some cases where symptoms are severe or are not improving with talk therapy alone, medication may be recommended. Antidepressants are typically the medication of choice and they work by affecting neurotransmitters, or brain chemicals. Depending on the antidepressant, different chemicals may be affected. Most antidepressants are safe for both the developing fetus and breastfeeding baby, however you will need to speak with a licensed psychiatrist prior to starting any medication.
Some final thoughts as National Maternal Depression Month comes to a close. If you are reading this because you are concerned about yourself or a loved one, remember you are not alone and neither are they. Thousands of women are affected by this every day and there is help out there to get you back on track. There is no shame in taking that first step and the sooner you seek treatment, the sooner you can have your life back.
If you believe you are struggling with a maternal mental health condition, schedule a consultation with one of our psychiatrists at NJ Family Psychiatry & Therapy today!