Overview

What is a perinatal mood disorder?

The Diagnostic and Statistical Manual of Mental Disorders, 5th ed. (DSM-5) states that perinatal mood disorder is a mood disorder that develops at some point either during or after pregnancy and delivery. Perinatal mood disorder includes a wide range of symptoms and depression is not always a symptom of this particular mood disorder.

When can you develop perinatal mood disorders?

Perinatal is a type of mood disorder that occurs during or after pregnancy. Symptoms can last as long as a year after giving birth.

Who is at risk of developing perinatal depression?

Women who become pregnant are at risk for up to a year after the birth of their child. Annually, there are about 1 million people who suffer from perinatal depression. Perinatal disorders can impact any socioeconomic group, race, or age demographic.

What is a perinatal mood disorder?

When the disorder or mood changes occur after childbirth, this is specifically called perinatal mood disorders. This category can be further divided into four stages:

Perinatal blues or baby blues: Symptoms during this stage range from irritability, anxiety, excessive crying, and sleep disturbances. This disorder is usually short-lived and affects 30-75% of new parents. It usually appears 3-5 days after the baby arrives and usually disappears within a week without treatment.
Perinatal depression: Symptoms during this stage usually involve a variation of decreased attachment to the newborn, lack of maternal care, high anxiety, thoughts of suicide, depressed mood, lack of interest in certain activities, and sleep and eating irregularities. Perinatal depression usually occurs within the first month of delivering the newborn and usually affects 10-20% of new parents.
Perinatal anxiety: This stage usually coincides with perinatal depression having most of the same symptoms. However, other symptoms may include neurological changes in the body, hyperhidrosis to the hands, and heightened typical anxiety symptoms. Perinatal anxiety may occur within six months of giving birth and usually affects 5-10% of new mothers.
Perinatal psychosis: This type of perinatal disorder is the most serious and only affects 0.2% of mothers. It usually occurs within the first two weeks of delivery. Symptoms for this category typically involve bipolar symptoms and severe depression with hallucinations. These cases always require hospitalization due to the potential harm to the parent and/or baby.

Causes

What causes perinatal mood disorders?

Currently, the exact cause of perinatal mood disorders is unknown. Some hypothesize that this mood disorder may be linked to the fluctuations of hormones during pregnancy. These hormones are known to be at their highest at the end of pregnancy and drop to low levels within one week of delivery.

What risk factors increase the chances of developing perinatal mood disorders?

Chronic stress during pregnancy is believed to play a major role in developing perinatal mood disorders. Researchers believe that prior history of anxiety, depression, or other types of mental illnesses may put someone at higher risk of developing this type of mood disorder. Certain environmental factors that may place a new parent at risk of developing perinatal mood disorders include:

Drug use
Alcoholism
Smoking
Being in poverty

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Symptoms

What are the symptoms of perinatal mood disorder?

There are several varied symptoms associated with perinatal mood disorders, which may include some or all of the following:

Insomnia
Emotional instability such as unexplained crying and mood swings
Sadness
Despair
Feeling alone
Excessive anxiety or worry
Unexplained increased energy
Lack of enjoyment in the activities that were once enjoyable
Thoughts of hurting yourself or the baby
Lack of bonding with your baby
Fear of being left alone with the baby
Hearing voices or sounds that others can not
Feelings of guilt or worthlessness

Diagnosis

How is perinatal mood disorder diagnosed?

A definitive diagnosis of perinatal mood disorder requires evaluation and diagnosis from a licensed healthcare provider. It is required that at least five of the above symptoms listed be present for at least two weeks. These symptoms must also be a change from previous behaviors. Because many of the symptoms of perinatal mood disorder may mimic other major depressive disorders, a screening test should always be performed.

What are screening tests for perinatal mood disorders?

Edinburgh Postnatal Depression Scale
Patient Health Questionnaire-9
Perinatal Depression Screening Scale

Most physicians use a two-step screening process to diagnose perinatal mood disorder. If any of the questions are positive, a more comprehensive screening and evaluation can be done regarding perinatal mood disorder. It is also recommended that at least one perinatal and four postnatal screenings be performed.

Treatment

How can perinatal mood disorders be prevented?

Evidence has shown that home health visits, peer support, and psychotherapy are good prevention methods. This is especially true for first-time mothers, adolescent mothers, or those who have had traumatic deliveries. Selective serotonin reuptake inhibitors (SSRIs) also show some benefit in the prevention of perinatal depression for mothers with a previous perinatal depression diagnosis.

What are treatments for perinatal mood disorders?

Psychotherapy– this is usually the first line of treatment for mild to moderate cases. Most research is on the effectiveness of cognitive-behavioral therapy.
Pharmacological– SSRIs are the gold standard for the treatment of moderate to severe perinatal mood disorders.
Exercise– increased physical activity has shown a decrease in perinatal mood disorders due to the release of endorphins that positively affects the mood.
Electroconvulsive therapy– this is usually used for severe cases if medications are not helpful or tolerated. It is safe for pregnant women.

What if treatment does not work for me?

For anyone who has thoughts of harming themselves or their baby, inpatient therapy is usually the best course of action. Also, if any of the other standard treatment modalities are not effective in improving your symptoms, inpatient treatment would be the next option.

Perinatal wellness is of the utmost importance as this disorder can impact the mother, baby, and entire family. If you would like to learn more about perinatal mood disorders, any of our healthcare professionals at the Speciality Clinic of Austin would be able to review your concerns in detail.

References

Hartford HealthCare Institute of Living. (n.d.). Perinatal Mood Disorders Program. https://instituteofliving.org/programs-services/perinatal -mood-disorders

Hübner-Liebermann, B., Hausner, H., & Wittmann, M. (2012). Recognizing and treating perinatal depression. Deutsches Arzteblatt international, 109(24), 419–424. https://doi.org/10.3238/arztebl.2012.0419

illerer, K.M., Neumann, I.D., Slattery, D. A. (2012). From Stress to Perinatal Mood and Anxiety Disorders: How Chronic Perinatal Stress Can Impair Maternal Adaptations. Neuroendocrinology; 95:22-38. doi: 10.1159/000330445

Langan, R.C. and Goodbred, A.J. (2016). Identification and Management of Perinatal Depression. Am Fam Physician. 93(10):852-858.