About Maternal Mental Health Disorders

What are maternal mental health disorders & how often do they occur?

Moms are the anchors of the home … and when mom isn't well, everyone suffers.  According to the American Academy of Pediatrics, depression and anxiety disorders are one of the most common, yet most under-diagnosed, obstetrical complications in the country. Research suggests that 15-20% of the approximately 4 million U.S. women who give birth each year will be affected by a maternal mental health disorder, which occur during pregnancy and up to one-year postpartum. 

Despite the high prevalence, many doctors and other medical professionals remain unfamiliar with the signs of maternal mental health concerns and it is estimated that only about 15% of those women will get the help and treatment they need.

Maternal mental health disorders are not the “baby blues,” which impact up to 80% of women and includes unexplained tearfulness resulting from sharp changes in hormones.  The blues resolve naturally within two weeks.

While many women feel stigmatized by asking for help, disorders like postpartum depression are a legitimate medical concern with biological influences and generally require treatment. They may make it difficult for women to care for themselves or their family and put them at a significantly higher risk of suicide. In extreme cases of psychosis (which affects .1 to .2% of all new mothers), in which a woman may become delusional and paranoid, it can result in a mother taking her child’s life (infanticide).

However, there is effective treatment and women do not need to suffer in silence.  The earlier a woman seeks professional help, the greater the likelihood of physical and emotional recovery.

What causes maternal mental health disorders?

These disorders do not have a single cause, but likely result from a combination of physical, psychiatric and environmental risk factors. Postpartum depression does not occur because of something a mother does or does not do.

Immediately after childbirth, the levels of hormones (estrogen and progesterone) in a woman’s body quickly drop. This leads to chemical changes in her brain that may trigger mood swings. In addition, many mothers are unable to get the rest they need to fully recover from giving birth. Constant sleep deprivation leads to physical discomfort and exhaustion, which can contribute to the symptoms of postpartum depression.

Maternal mental health disorders can affect any woman regardless of age, race, ethnicity or economic status. However, some women are at greater risk for developing postpartum depression because they have one or more identified risk factors, such as:

·       Personal and/or family history of a mood or anxiety disorder.

·       Symptoms of depression during or after a previous pregnancy.

·       Fertility issues and/or previous pregnancy loss.

·       Mixed feelings about the pregnancy, whether it was planned or unplanned.

·       Relationship and/or financial stress.

·       Recent big life changes such as moving, a new job or loss of a job, getting married, personal illness, death of a loved one or domestic violence.

·       Medical complications during childbirth or traumatic childbirth.

·       Having a baby in the NICU or a special needs baby.

•       A lack of strong emotional support from spouse, partner, family or friends.

•       Alcohol or other drug-abuse problems.

·       Sudden discontinuation of psychotropic medication.

How can a woman tell if she has a maternal mental health disorder?

Only a healthcare professional (medical doctor or licensed therapist, psychologist or psychiatrist) can diagnose a woman. Because symptoms are broad and may vary among women, a healthcare provider can help a woman figure out whether the symptoms she is experiencing are a maternal mental health disorder or attributable to other issues.

Before diagnosing a mood or anxiety disorder, healthcare professionals should first rule out physical disorders, such as hypothyroidism or hyperthyroidism.

Symptoms of a maternal mental health disorder may include:

·       Feeling sad, hopeless, empty or overwhelmed.

·       Crying more often than usual or for no apparent reason.

·       Excessive worry, anxiety or fear.

·       Feeling moody, irritable or restless.

·       Oversleeping or being unable to sleep, even when her baby is asleep.

·       Having trouble concentrating, remembering details and making decisions.

 ·       Experiencing anger or rage.

·       Losing interest in activities that are usually enjoyable.

·       Suffering from physical aches and pains, including frequent headaches, stomach problems and muscle pain.

·       Eating too little or too much.

·       Withdrawing from or avoiding friends and family.

·       Having trouble bonding or forming an emotional attachment with her baby.

·       Persistently doubting her ability to care for her baby.

·       Experiencing intrusive thoughts about harming herself or her baby.

Why aren’t more mothers screened for maternal mental health disorders?

Pregnant and postpartum women are not routinely screened for maternal mental health disorders, though there are validated, free and easy-to-use screening tools.  This is due in part to a shortage of qualified healthcare professionals who can provide specialized treatment, creating a lack of appropriate resources for screening providers.

While we have a long way to go, there has been progress. In January 2016, the United States Preventative Services Task Force (USPSTF), which sets forth guidelines around preventive and diagnostic screening, recommended screening for depression in the general adult population, including pregnant and postpartum women, noting screening should be implemented with adequate systems in place to ensure accurate diagnosis, effective treatment and appropriate follow-up. This was the first time in its history that the USPSTF specifically mentioned maternal mental health disorders in its depression screening recommendations.

Congress recently passed the 21st Century Cures Act which authorizes $5 million for the Screening and Treatment for Maternal Depression and other Maternal Mental Health Disorders, as authorized by Section 10005.  You can help urge congress to allocate funds by contacting your congressional representative and asking them to support this important bill by linking at https://2020mom.salsalabs.org/21stcenturycuresactlettertocongress/index.html.

And there are showcase resource programs being launched, like the Massachusetts Child Psychiatry Access Program (MCPAP for Moms) and Washington, D.C.’s Mental Health Access in Pediatrics (DCMAP), two initiatives that work and should be emulated by others. MCPAP for Moms and DCMAP promote maternal and child health by building the capacity of providers serving pregnant and postpartum women and their children (up to one year after delivery) to effectively prevent, identify and manage depression.

How are the “baby blues” different from postpartum depression?

The “baby blues” is a term used to describe the feelings of stress and fatigue that many women experience after having a child. Babies require a lot of care, so it’s normal for mothers to be worried or tired from providing that care. The baby blues, which affects up to 80% of mothers, includes feelings that are fairly mild, last a week or two and go away without intervention.

With postpartum depression and mood disorders, feelings of sadness and anxiety can be extreme, may interfere with a woman’s ability to care for herself or her family and generally requires treatment. The condition may begin shortly before or any time following childbirth. It most commonly begins between a week and a month after delivery, but can manifest up to a year postpartum.

How is postpartum depression treated?

There are a variety of effective  treatments for postpartum depression, which may be recommended singularly or in combination.  A woman’s health-care provider can help her choose the best treatment for her, which may include:

Social Support Groups: There are hundreds of free, ongoing social support groups for pregnant and new moms throughout the country. These groups are run by women who have experienced maternal mental health disorders themselves and/or who are heathcare professionals. In the support group setting, women have an opportunity to experience normalization and validation of their experience, while obtaining useful advice and making important interpersonal connections with other new mothers.

Counseling/Talk Therapy:  Involves talking one-on-one with a mental-health professional (counselor, therapist, psychologist, psychiatrist or social worker). The two types of counseling shown to be particularly effective in treating postpartum depression are:

·       Cognitive behavioral therapy (CBT):  Helps people recognize and change their negative thoughts and behaviors.

·       Interpersonal therapy (IPT):  Helps people understand and work through problematic personal relationships.

Adjunct and Complimentary Therapies: Omega-3s, lightbox therapy, acupuncture and massage have all been shown to assist in recovery from perinatal mood and anxiety disorders.

Medication: Antidepressant medications act on the brain chemicals that are involved in mood regulation. Many antidepressants take a few weeks to be most effective. While these medications are generally considered safe to use during breastfeeding, a woman should talk to her health-care provider about the risks and benefits to both herself and her baby.

What is postpartum psychosis?

A smaller number of women (1-2 out of every 1,000 births) suffer from a severe maternal mental health disorder called postpartum psychosis. Women who have a personal or family history of bipolar disorder or a history of a psychotic episodes are at higher risk for postpartum psychosis.

The onset of symptoms is usually sudden, within the first month following birth, and can include:

•    Delusions or strange beliefs.

•    Hallucinations (seeing or hearing things that others do not).

•    Severe irritability.

•    Hyperactivity or its opposite, physical retardation or catatonia.

•    Significantly decreased need for sleep or inability to sleep.

•    Paranoia.

•    Rapid mood swings.

•    Difficulty communicating.

If a pregnant woman or new mother is experiencing these symptoms, she requires immediate intervention. Postpartum psychosis is considered a medical emergency due to the potential for a mom to harm herself or her baby.

How can family and friends help?

Family members and friends may be the first to recognize symptoms of mood or anxiety disorder in a pregnant woman or new mother.  Encourage her to speak with a health-care provider, offer emotional support and assist with daily tasks such as caring for the baby or the home.

To locate help in your area:  Contact the Postpartum Support Inernational (PSI) warmline at: 

800-944-4PPD (4773)

If you or someone you know is in crisis or thinking of suicide, get help quickly, by:

•       Calling your doctor.

•       Calling 911 for emergency services or go to the nearest emergency room.

•       Calling  the toll-free, 24-hour National Suicide Prevention Lifeline at:

800-273-TALK (8255) or TTY: 800-799-4TTY (4889).

 What about dad?

Though fathers don't experience the same physical changes as women do through pregnancy and childbirth, they are exposed to some of the same stressors, such as significant sleep changes, which can trigger depression or anxiety.  A research analysis published in 2010 noted that roughly 10% of fathers suffer from depression in the first year after having a new baby. Young fathers (25-34) are at higher risk for suffering from depression. [“Prenatal & Postpartum Depression in Fathers & its Association With Maternal Depression,” May 19, 2010, Journal of American Medical Association]

 

Need help or know someone who does? 

Call the PSI helpline at 800-944-4PPD (4773)

 

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