May is Maternal Mental Health Awareness Month. 1 in 7 women experience a perinatal mood and anxiety disorder (PMAD) during pregnancy and 1 in 5 women will experience an episode during the postpartum period. Perinatal mood and anxiety disorders are treatable and you will get better. It is important to understand what you may be experiencing and to have the language to communicate what’s happening. Postpartum Support International (PSI) has a wide range of resources, from seminars to support groups as well as an excellent 24 hour emergency hotline 1-800-273-8255.
Depression
Perinatal depression often presents with feelings of being very overwhelmed and thoughts of, “I can’t deal with this. I can’t handle this.” Women often express feeling disconnected from baby or difficulty bonding with baby. Heightened irritability and feelings of rage are common. There can be challenges maintaining basic hygiene. Somatic experiences are also common, particularly stomach issues.
Anxiety
Women will worry excessively, and notice an inability to control the worry, about their own or their baby’s well-being and safety. Anxiety often presents in a physical way and women will report back pain, stomach issues, headaches as well as feeling restless and on edge. Similar to depression, anxiety presents with increased irritability. Decreased concentration is a big part of anxiety. So much so that women will often worry they have suddenly developed ADHD.
Obsessive Compulsive Disorder
Perinatal OCD often manifests with recurrent, intrusive thoughts (the obsession part) about something dangerous or harmful happening to baby. The brain creates an image and latches on. Images can be very disturbing and mother’s will, understandably, do whatever they can to avoid harm (the compulsion part). With OCD it is often said that the obsession is followed by the compulsion. Women with Perinatal OCD often feel intense guilt and shame, constant checking on baby or calling the pediatrician.
Post Traumatic Stress Disorder
History of trauma and/or diagnosed PTSD puts women at increased risk of perinatal PTSD. Specific events which may lead to perinatal PTSD: emergency C-section, NICU admission, hyperemesis, traumatic vaginal birth, failed epidural. Women may experience flashbacks, nightmares, apathy, avoidance, feelings of detachment, extreme guilt, shame and fear.
Bipolar Disorder
If Bipolar Disorder has not been diagnosed previously, it is often misdiagnosed during pregnancy or shortly thereafter as depression. Bipolar Disorder Type 1 presents with mania. Bipolar Type 2 presents with depression and hypomania. Perinatal Bipolar Disorder poses multiple risks including: rate of misdiagnosis; lack of treatment and support; impaired functioning; psychosis.
Psychosis
Postpartum psychosis usually occurs around 2 weeks postpartum. There is often a personal or family history of bipolar disorder or psychosis. Psychosis is disturbing to family members but for individuals experiencing a psychotic episode they are not able to distinguish reality from the psychosis. Psychosis may include: hallucinations, thought broadcasting, paranoia, feelings of being controlled, rambling speech, disorientation, thoughts that baby is possessed. Massachusetts General Hospital and their Center for Women’s Mental Health has wonderful resources.
It is important to note that with any of these disorders, suicidal ideation (SI) or homicidal ideation (HI) may occur. If thoughts are developing into a specific plan, rather than more passive thinking, it is important to seek help. Telling a loved one, your OBGYN, therapist, nurse or calling the National Suicide Prevention Lifeline 1-800-273-TALK (8255) or 911 are all options to keep you and baby safe. Comprehensive treatment is paramount. Individual therapy, group therapy as well as meeting with a psychiatrist to discuss medication, which is absolutely an option, are all important steps. Perhaps most important though, if you are experiencing emotional distress you are not alone and you will get better.
I am a Licensed Clinical Social Worker (LCSW) at a group practice in Beverly Hills and maintain a private practice in the Los Feliz/Silver Lake area. I provide individual, couples and group psychotherapy to both teens and adults. My practice approaches include, but are not limited to, CBT, EMDR, psychodynamic and mindfulness therapy. I started my career at psychiatric hospital working on both the inpatient units as well as developing and running the hospital’s long-term outpatient Partial Program. I then spent five years at Kaiser Permanente’s LA Medical Center providing individual and group psychotherapy in their outpatient psychiatry department. Women’s health, in particular perinatal health, has always been a passion of mine. While at Kaiser I started their Post Partum Depression/Anxiety Group. As an alum of the Kaiser MSW Training Program, I was excited to join the training team as a clinical educator when I returned as an LCSW. I love collaborating with my patients as they identify patterns, achieve their goals, cope with change and improve their well-being.