Postpartum Disorders
What Are Postpartum Disorders?
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Postpartum disorders are mental illnesses that can occur after childbirth. They are the most common complication that occurs after giving birth.
In postpartum depression (PPD), brain response and behavior are both compromised, commonly involving feelings of sadness, hopelessness, inability to concentrate, anxiety, and suicidal ideation. Because there are many hormonal, physical, and general life changes that a person goes through during pregnancy, childbirth usually results in a large range of different emotions. Feelings of sadness, emptiness, irritability, and sleep disturbances are common in the first two weeks after giving birth, often termed “the baby blues.” If these symptoms don’t resolve after that period of time and interfere with a person’s ability to do daily tasks, they are considered PPD. People who have PPD may cry for no reason and have trouble sleeping or eating. They may not feel connected to their baby and/or like they don’t love or care for them. It’s possible for PPD to also include psychotic symptoms such as hallucinations and delusions.
Postpartum generalized anxiety disorder (GAD) is excessive worry that occurs after childbirth. It can occur in addition to PPD or on its own. While a certain amount of anxiety during this time is normal, it is considered postpartum GAD when it is excessive and debilitating. People affected by this disorder may feel as though they can’t relax or are consumed by constant dread. They may not be able to sit still, have constant dizziness, or a lack of appetite. It is common for postpartum GAD to take on the symptoms of obsessive-compulsive disorder (OCD) which includes repetitive actions and intrusive thoughts.
While these disorders typically occur within the first 6 weeks after childbirth, they can occur at any time within the first year.
About 1 in 7 mothers are diagnosed with PPD, though it’s been estimated that nearly half of PPD cases go undiagnosed due to reasons such as stigma, embarrassment, fears of abandonment, and fears of not getting support.
Postpartum GAD is estimated to occur in anywhere from 6.1-27.9% of people who have given birth in the past six months. Due to lack of screening, its incidence is difficult to say with certainty, but GAD is known to be more common in the postpartum period than it is in the general population.
A combination of genetics, hormonal factors, and psychological and social stressors are thought to play a role in the development of these disorders. In PPD, the hypothalamic-pituitary-adrenal axis (HPA), which facilitates the release of cortisol in trauma and stress, is known to play a part. Additionally, low levels of the hormones oxytocin and prolactin in the third trimester are associated with an increase in depressive symptoms after childbirth. The sudden change in hormone levels after delivery is thought to trigger symptoms in susceptible people in the same way that small changes in hormone levels can trigger mood swings before a menstrual period. Postpartum hormonal changes not only include the hormones estrogen and progesterone, but thyroid hormone levels as well.
Similarly, postpartum GAD is thought to be triggered by hormonal changes. Sleep deprivation, the responsibility of caring for a newborn, feelings of wanting to protect the baby, and a lack of support, can all be contributing factors.
Though anyone can develop postpartum disorders, there are certain factors that increase your risk:
A history of depression, anxiety, or PMS
An unplanned or unwanted pregnancy
A lack of support from family and friends
An emergency c-section or hospitalizations during pregnancy
Lifestyle factors such as eating, sleeping, and exercise habits
A history of domestic violence
Smoking during pregnancy
For PPD, a person must meet the criteria for a major depressive episode with the qualifier of having given birth within the past four weeks as it is not actually recognized as a separate diagnosis. At least five depressive symptoms, specified by the Diagnostic and Statistical Manual of Mental Disorders (DSM–5), must be present for at least two weeks. These symptoms range from insomnia, to changes in weight, to feelings of worthlessness (see https://online.epocrates.com/diseases/512/postpartum-depression#diagnostic-criteria for further details). At least one symptom of loss of interest and depressed mood must be present for diagnosis.
Pospartum GAD is typically diagnosed through screening questionnaires as a clear diagnostic tool does not currently exist.
PPD is typically treated with the use of antidepressants, which work on the chemicals in the brain to control moods, and therapy. Antidepressants can be taken while breastfeeding but typically take a couple of weeks to start working. In extreme cases, electroconvulsive therapy (ECT) can be used. It is important that PPD is treated for the sake of the parent and the baby as it can lead to issues such as poor parent-child bonding and marital discord, and ultimately ends in worse physical and psychological outcomes for the child.
Postpartum GAD requires increasing the amount of support and sleep for the parent. Support can look like getting a break from childcare or getting involved in new parent support groups. Exercise can also be helpful, as can individual therapy and relaxation techniques. Medication is used if necessary. The effects of this disorder are far-reaching as it is associated with an increased risk of PPD as well as disrupted attachment with the infant, an increased risk of infant abuse, an increased risk of childhood anxiety, and delayed development for the child.