Peripartum Wellness

Overview

What is a peripartum mood disorder?

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

When can you develop peripartum mood disorders?

Peripartum 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 peripartum 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 peripartum depression. Peripartum disorders can impact any socioeconomic group, race, or age demographic.

What is a postpartum mood disorder?

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

  • Postpartum 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.
  • Postpartum 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. Postpartum depression usually occurs within the first month of delivering the newborn and usually affects 10-20% of new parents.
  • Postpartum anxiety:  This stage usually coincides with postpartum 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.  Postpartum anxiety may occur within six months of giving birth and usually affects 5-10% of new mothers.
  • Postpartum psychosis:  This type of postpartum 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 peripartum mood disorders?

Currently, the exact cause of peripartum 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 peripartum mood disorders?

Chronic stress during pregnancy is believed to play a major role in developing peripartum 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 peripartum mood disorders include:

  • Drug use
  • Alcoholism
  • Smoking
  • Being in poverty

Symptoms

What are the symptoms of peripartum mood disorder?

There are several varied symptoms associated with peripartum 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 peripartum mood disorder diagnosed?

A definitive diagnosis of peripartum 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 peripartum mood disorder may mimic other major depressive disorders, a screening test should always be performed.

What are screening tests for peripartum mood disorders?

  • Edinburgh Postnatal Depression Scale
  • Patient Health Questionnaire-9
  • Postpartum Depression Screening Scale

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

 

Treatment

How can peripartum 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 peripartum depression for mothers with a previous peripartum depression diagnosis.

What are treatments for peripartum 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 peripartum mood disorders.
  • Exercise– increased physical activity has shown a decrease in peripartum 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.

Peripartum 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 peripartum 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.).  Peripartum Mood Disorders Program. https://instituteofliving.org/programs-services/peripartum-mood-disorders

Hübner-Liebermann, B., Hausner, H., & Wittmann, M. (2012). Recognizing and treating peripartum 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 Postpartum Mood and Anxiety Disorders: How Chronic Peripartum 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 Peripartum Depression. Am Fam Physician. 93(10):852-858.

Information

Medically reviewed by:

Charles Sweet, MD, MPH

Dr. Sweet is a native Texan and attended The University of Texas at Austin for undergraduate studies. He earned his Doctor of Medicine and Master of Public Health degrees at the University of Illinois and then did residency training at the prestigious Johns Hopkins Hospital, Dr. Sweet came back to Austin, TX for specialized training in Child and Adolescent Psychiatry and has been in practice since 2009.

Dr. Sweet believes strongly in working with, and training Physician Assistants to treat the behavioral health needs of adults, children and adolescents.

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