The term "Postpartum Depression" or PPD can be somewhat misleading. It is an umbrella term used to describe an group of distinct mental illness associated with pregnancy and the postpartum period. Unfortunately this term can give the false impression that each of these disorders are limited to the period just after childbirth, and that they are all characterized by what we think of when we hear the word "depression." This is simply not true.
Today we know that pregnancy-related mental illnesses are not limited to the postpartum period. They can develop anytime during the perinatal period, which lasts throughout pregnancy and the first year postpartum. We know that nearly 1 in 4 women in the perinatal stage will develop a depressive disorder and/or an anxiety disorder. Very few (1 in 1000) women in the perinatal period develop Postpartum Psychosis, a separate disorder (and a psychiatric emergency requiring hospitalization) that is not the result of a pregnancy-related mood or anxiety disorder.
These days when reading about Postpartum Depression, you might encounter the term "Perinatal Mood and Anxiety Disorders." This term has developed as our understanding of perinatal mental health issues has improved. It is meant to encompass all of the mood and anxiety disorders associated with pregnancy and the postpartum period. Here you will find brief descriptions of common experiences and true disorders associated with the perinatal and postpartum period (adapted from Therapy and the Postpartum Woman, by Karen Kleiman):
- Baby Blues: Up to 85 percent of women will experience what we call the Baby Blues. It is a period of emotional fragility (fatigue, tearfulness, feeling overwhelmed, etc.) that usually resolves on its own. The symptoms are often identical to those experienced during Postpartum Depression, but the Baby Blues should resolve within the first 2-3 weeks postpartum. If symptoms persists beyond 3 weeks postpartum it may indicate a more serious disorder that may require treatment.
- Postpartum Depression: Up to 20 percent of postpartum women will develop Postpartum Depression. Symptoms can range from mild to severe, and can include tearfulness, insomnia, fatigue, agitation, feelings of hopelessness, irritability, suicidal thoughts, intrusive thoughts, panic, impaired concentration, and guilt.
- Postpartum Anxiety: Anxiety is characterized my marked agitation, excessive worry, nausea, gastrointestinal disturbances and sleep problems. Women with this disorder may experience sudden feelings of dread, panic, and terror. It is estimated that up to 11 percent of new mothers will experience panic during the postpartum period.
- Postpartum Obsessive-Compulsive Disorder: This disorder can be particularly scary for postpartum women and their family members because it can include persistent and graphic unwanted thoughts (obsessions) about harming the baby. Some women may feel a need to distance themselves from their baby, or create a highly controlled environment (compulsions) in order to reduce the anxiety and intrusive thoughts. It is important to note that the woman's distress about the intrusive thoughts is an important indicator that she is not experiencing psychosis and is therefore not at elevated risk of harming her baby.
- Postpartum Post-traumatic Stress Disorder (PTSD): Women who experience a traumatic birth experience (unforeseen complications, unplanned interventions such as a cesarean section, or an experience in which she had no control) can lead to symptoms of PTSD, which include hypervigilance, flashbacks, panic, nightmares, and avoidance of anything that might remind her of the event, and therefore trigger feelings of anxiety.
- Postpartum Grief: Women who have experienced a pregnancy loss (miscarriage or stillbirth), the death of an infant (to SIDS or other unforeseen causes) or who have given birth to a child with a birth defect will likely experience a normal period of grief. These women are at increased risk of developing clinically significant Postpartum Depression and should be monitored carefully.
- Postpartum Bipolar Disorder: Bipolar disorder is characterized by periods of mania (rapid speech, racing thoughts, decreased need for sleep, agitation) that can occur by themselves, or followed by periods of clinical depression. It is estimated that up to 67 percent of women with Bipolar Disorder will experience a disturbance in mood within one month of childbirth.
- Postpartum Psychosis: The most rare of perinatal mental illnesses is Postpartum Psychosis. It affects .1 percent of women (1 in 1000) and always requires hospitalization. Symptoms of Postpartum Psychosis can include visual or auditory hallucinations (seeing or hearing things), delusions (examples: thoughts that the baby is evil, the neighbors are talking about how bad of a mother you are, etc.) detachment from reality, bizarre speech (statements that make no sense, incorrect use of words and phrases), bizarre thinking and behavior, distractibility and confusion. Psychosis is a true psychiatric emergency that always requires inpatient treatment (hospitalization) because of the significantly increased risk of infanticide or suicide.
Anyone can develop a Perinatal Mood or Anxiety Disorder. Anyone.
Women of every race, ethnicity, and socioeconomic group can develop PPD or a related disorder. Women who have no history of mental illness; women who are single, divorced, or happily married/partnered; women who are prepared and looking forward to the birth of their child or who did not intend to get pregnant; women who are socially isolated or women who are well connected and supported; even adoptive mothers can develop PPD.
Although PPD can happen to anyone (regardless of their background) there are specific risk factors associated with Perinatal Mood and Anxiety Disorders:
According to Postpartum Support International:
There is no one cause for perinatal mood and anxiety disorders. Women who develop depression or anxiety around childbearing have symptoms that are caused by a combination of psychological, social, and biological stressors. Hormonal fluctuations cause reactions in sensitive women. Risk factors do include a personal or family history of mood or anxiety disorders such as depression, anxiety, bipolar disorder (manic-depressive), or schizophrenia, and sensitivity to hormonal changes.I Think I May Have a Perinatal Mood or Anxiety Disorder. What Should I Do?
First of all, we're glad you're here! There is enormous hope for you: Research has shown that Perinatal Mood and Anxiety Disorders are very common, and respond very well to treatment. Remember that you are not alone! Almost 25 percent of pregnant and postpartum women share your experience. Please visit our Getting Help section for more information on support and treatment options.