Pregnancy and Mental Health: What you should be aware of.
Mental Health is an important yet often overlooked subject when it comes to having a healthy pregnancy and post-pregnancy. We asked a number of healthcare professionals as well as a mom who experienced such concerns to share insight on mental health in pregnancy. These are their answers to questions on what every parent-to-be should know about the most common mental health conditions, the symptoms to stay on the lookout for, the hereditary element, as well as the mental wellbeing of partners.
What are the most common conditions that moms-to-be need to know about?
Dr. Pritham Raj: “The most common concern is post-partum depression (that goes beyond just the baby-blues) because progressive symptoms can harm both the baby (neglect/abuse) and the mother (suicide risk). A more extreme, less common concern is post-partum psychosis which is often related to bipolar disorder.”
Bina Bird, MA, LMFT: “As it relates to pregnancy, anxiety and depression are the most common mental health issues. Perinatal Mood Disorders such as Postpartum Depression can actually begin during pregnancy, particularly in the third trimester. If the mom-to-be has a history of anxiety and depression, she is at higher risk to experience this during the perinatal period. If the mom-to-be has a history of trauma such as physical or sexual abuse, then she may be at risk since the pregnancy and birth process can be a trigger for these past issues. With the right support and planning through either therapy, a doula, and their healthcare provider, a plan can be made to help reduce and manage any possible triggers and empower the mom-to-be.”
“Perinatal Mood Disorders such as Postpartum Depression can actually begin during pregnancy, particularly in the third trimester.” Bina Bird, MA, LMFT
Dr. Nicole B Washington: “Moms need to be aware of the difference between the baby blues and postpartum depression. Baby blues is a temporary condition that affects up to 80 percent of mothers. It typically lasts up to 2 weeks and is characterized by sudden mood swings, irritability, and anxiety. Baby blues typically responds to increased support and reassurance and doesn’t require medication management. Major depressive is a serious mental health condition characterized by low mood, decreased interests, appetite changes, sleep pattern changes, loss of energy, feelings of worthlessness or inappropriate guilt, decreased concentration and/or recurrent thoughts of death or suicide. Depressive disorders that occur in the postpartum phase can be characterized by crying more than usual, oversleeping or unable to sleep when baby is sleeping, increase in physical complaints, doubting ability to care for baby, thoughts of harm to self or baby and trouble bonding with the baby. Major depressive disorder typically requires intervention by a mental health professional in the form of medication, therapy or a combination of the two.”
Crystal Clancy, MA, LMFT: “Aside from perinatal depression, research is beginning to show that perinatal anxiety may be even more prominent than depression, and they can also occur together. Sometimes, symptoms morph into obsessive-compulsive disorder during or after pregnancy. Bipolar disorder and psychosis can also occur.
Carol Lourie: “I think the area that is not addressed often enough is the constant care the newborn will need, coupled with the lack of sleep and the hormonal adjustment a woman goes through after giving birth. This can lead to a biological or physiological depression.”
What symptoms should moms-to-be stay on the lookout for when it comes to mental health during pregnancy and after?
Dr. Pritham Raj: “Symptoms to look out for: dark thoughts (suicidal ideation) is the biggest, but poor sleep is another big one (that could signal depression or mania), general symptoms of low mood (depression), and thoughts of harming the baby. Substance use is always a concern.”
Julia Rohan: “Feelings that run deeper than baby blues. Thoughts full of panic. Severe
mood swings.”
Bina Bird, MA, LMFT: “Symptoms to look out for include but are not limited to, difficulty sleeping, change in appetite (which are not attributed to the pregnancy itself) intense mood changes, lack of motivation, crying, difficulty focusing, feelings of hopelessness, loss of interest in activities that one previously enjoyed, thoughts of suicide, anxiety, intrusive thoughts, general feelings of not feeling like oneself and that something is wrong.”
“Symptoms to look out for include dark thoughts, poor sleep, general symptoms of low mood, and thoughts of harming the baby. Substance use is always a concern.” Dr. Pritham Raj
Dr. Nicole Washington: “Moms should stay on the lookout for mood changes during pregnancy. 50% of postpartum major depressive episodes actually start during pregnancy. Moms should also know that mood and anxiety symptoms during pregnancy and baby blues increase the risk of postpartum depression.”
Crystal Clancy, MA, LMFT: “To simplify, most moms will say I just don’t feel like myself or I am not enjoying pregnancy/motherhood the way that I thought I would. It goes beyond ‘this is hard’ to a feeling of hopelessness, overwhelm, and distress. Some moms are depressed, weepy and sad, while others are dealing with anxiety, panic attacks, racing thoughts, or mood swings. A big concern is when mom is not able to sleep when the baby is sleeping. Not just during the day, when baby is taking a nap, but at night, when she gets up to feed the baby, and cannot get back to sleep for several hours, or spends a large amount of time checking on the baby over and over. And, of course, if she is experiencing any thoughts about harming herself or her baby, that is time to talk to someone you really trust.”
Carol Lourie: “The first sign a woman should be concerned about is when she stops doing self-care, such as showering, washing her hair and even eating.”
Are any specific conditions hereditary – is a mom-to-be more prone to experience such issues if her mom had?
Dr. Pritham Raj: “Many mental disorders are hereditary – so it is always important to review the family history with the post-partum woman to see what she would be at risk for.”
Julia Rohan: “I think there’s truth to this theory, but I’d also add that those who suffered from anxiety and depression prior to having a baby, are also in the know when things change in any drastic way. They know the signs and signals.”
Bina Bird, MA, LMFT: “All mental health issues can be hereditary and anxiety and depression are no exceptions. Therefore, if there is a family history of anxiety, depression or other mood disorders, then mom-to-be is at higher risk.”
Dr. Nicole Washington: “One of the factors associated with postpartum depression is family history, so if a parent or sibling has a history of depression this is associated with increased risk of postpartum depression.”
Crystal Clancy, MA, LMFT: Mental health can definitely be genetic. If possible, ask your own mother what her experience was postpartum. Often, it was undiagnosed a generation or more ago. But if she struggled, she probably remembers it. If your mother (or father) had bipolar disorder, whether diagnosed or not, that is definitely something to let your provider know about. Those with a family history of bipolar or psychosis are at the highest risk of developing bipolar or psychosis postpartum. And many women who have already been diagnosed with bipolar are being told to go off of their medications, or go off of them without their doctor’s awareness, which puts them at extremely high risk of relapse. Make
sure to discuss this with your doctor, as there are medications that are safe to take during pregnancy and breastfeeding. And never quit medications cold turkey.”
“One of the factors associated with postpartum depression is family history, so if a parent or sibling has a history of depression this is associated with increased risk of postpartum depression.” Dr. Nicole Washington
Carol Lourie: “Thyroid conditions, especially Hashimoto’s Thyroiditis, is hereditary especially along the female line, and the stress of pregnancy and birth can often cause this latent condition to become active. Symptoms of this are fatigue, which is often confused with the lack of sleep that occurs naturally with a newborn, constipation, hair loss – another symptom that often occurs after childbirth, and feeling cold all the time. Postpartum depression can also be somewhat hereditary, depending on the causative factors of their mother’s depression. ”
What is the incidence of partners also experiencing mental health issues during the pregnancy?
Dr. Pritham Raj: “Not sure the incidence of partner mental illness – but stress levels are always high for partners – we tend to call this an adjustment disorder if it interferes with functioning.”
Julia Rohan: “The expression, A happy wife is a happy life sort of rings true on a partner in this case, for sure. That sadness and hopelessness can easily crossover to a spouse in-tune to their wife’s needs, especially if they’re playing a role in the overnight care. The combination of sleep deprivation and her mental health can for sure, impact the other person.”
Bina Bird, MA, LMFT: “Partners are also vulnerable to mental health issues during pregnancy. It is a time of change and transition for both members of the couple. In fact, 10% of men whose partners suffer from Postpartum Depression will also suffer from Postpartum Depression.”
Crystal Clancy, MA LMFT: “Research is very limited, so there is a range of roughly 4-10%. The main things to know about partners is that partners can experience postpartum depression and anxiety too, so it’s important that s/he is taken care of. And the partner’s risk of developing mental health issues postpartum skyrockets to 50% if his/her partner has a mental health disorder.”
“The partner’s risk of developing mental health issues postpartum skyrockets to 50% if his/her partner has a mental health disorder” Crystal Clancy, MA, LMFT
Carol Lourie: “A 2016 study in Maternal Child Health by Sipsma HL et al examined the impact of time on depressive symptoms, and showed that overall, depressive symptoms did not significantly change over time among young males, or the partners. Another study, by Perren S, published in the Journal of Psychosomatic Obstetrics and Gynaecology in 2005 found that in mentally healthy mothers and fathers depressive symptoms decreased from pregnancy to 18 postpartum. One of the determining factors was the parental mental health symptoms during pregnancy and the psychosocial stress they experienced during the transition to parenthood. Support from family and friends was found to be important in minimizing depression.”
Contributors:
Dr. Pritham Raj is Associate Professor at Oregon Health and Science University, Medical Director at Adventist Health Portland, and a father of three.
Carol Lourie is a naturopath, acupuncturist, homeopath and Functional Medicine expert, specializing in Women’s Health and has been practicing for over 30 years in Berkeley, CA.
Crystal Clancy, MA, LMFT is a perinatal health expert, as well as Executive Director of Community Engagement for Pregnancy and Postpartum Support MN, and Coordinator for the State Chapter of Postpartum Support International.
Dr. Nicole Washington is a board-certified psychiatrist. She is a practicing physician, adjunct faculty member at Oklahoma State University.
Bina Bird, MA, LMFT is a Licensed Marriage and Family Therapist specializing in Perinatal Mental Health, in Texas.
Julia Rohan’s input is based on her experience of severe depression and anxiety following the birth of her son.
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