Most people have heard of postnatal depression, but what is not very well known is that it’s quite common for women to experience depression during pregnancy. This is referred to as antenatal/prenatal depression. Perinatal depression is the term that covers both periods of antenatal/prenatal depression and postnatal depression. Some people can mistake these periods as the ‘baby blues’ and don’t seek treatment.
When it comes to ‘baby blues’, it affects approximately 85% of women. The onset occurs usually between days 7-10 post-partum (days after giving birth). Many women tend to feel teary, emotional or hypersensitive. The positive thing about ‘baby blues’ is that it generally resolves on its own and doesn’t require women to seek treatment. Women with ‘baby blues’ need understanding, reassurance and support from partners, family and friends.
However, women who experience severe ‘baby blues’ can be at a higher risk for postnatal depression. Research has shown that around 25% of women who experience ‘baby blues’ go onto develop PND.
Depression presents as feeling sad or down and/or loss of interest or pleasure in their life for most days over a period of two weeks or more. These symptoms affect the way a mother sees things, it affects how she behaves, how she feels and her ability to function. With depression there is a range of symptoms:
Many women don’t seek help until things have significantly deteriorated, therefore it’s important to check in on how they are feeling.
Studies in Australia have shown the one in ten women are likely to experience depression in pregnancy; this rate increases to one in seven in the postnatal period. For some depression started in pregnancy or pre-existed before the perinatal period.
A large study in the US was conducted on women at their 6-week post-partum check-ups. The study found that 40% had began to have episodes of depression. A third of these women had experienced depression during pregnancy and a quarter antenatally.
1 in 5 women will be diagnosed with an anxiety disorder within the first 8 months postpartum. This is often developed in pregnancy. Symptoms of anxiety in mothers include:
Typically, the symptoms are related to feeling overwhelmed, accompanied by thoughts of fear that something terrible or catastrophic will occur. This then leads to specific behaviours; such as checking for reassurance or avoiding situations.
Types of Anxiety
Anxiety symptoms are often overlooked and often attributed to pregnancy or parenthood. Things such as stomach cramps, inability to sleep, may be attributed to hormones when in fact they are signs of GAD. OCD symptoms like ritualised checking on the baby, undue focus on cleanliness or fear of germs are often dismissed as being an overprotective parenting. With PSTD (which occurs particularly after a traumatic birth), this can lead to depression and anxiety in the postnatal period. It can emerge or continue into subsequent pregnancies.
Stress and anxiety are normal from time to time. It is when these feelings take over and start to impact ones’ ability to function in everyday life that an underlying anxiety disorder may be indicative. Similarly, with depression, both are highly common and often co-exist. 40% of women with major depression have co-existing anxiety symptoms.
There is a high level of stigma and pressures around mental health and being a new parent. Many of us feel as though having a baby is meant to coincide with an instant love and connection with overwhelming happiness as portrayed by the media.
Of course, when those feelings don’t happen it often results in feelings of shame, guilt and denial. These feelings regularly lead to nondisclosure and internalising, further heightening the feelings of anxiety and/or depression. This stigma causes many women to not seek treatment and they begin to feel like they are only ones’ experiencing these feelings. This can cause the mother’s mental health to deteriorate even further and potentially last longer than the baby’s first years.
BIPOLAR DISORDER (Manic depression)
This disorder affects approximately 3% of women chances of relapse with this disorder is higher during pregnancy and postnatally; research indicates that it’s as high as 71%. Some women experience their first episodes of bipolar disorder after giving birth; this is more common for women that have a family history of bipolar disorder.
Bipolar involves periods of high and low moods. The low moods are depression. Depression can lead to having negative thoughts about pregnancy or the baby; these may include their abilities as a parent. This is contrasted by highs (elevated mood) known as mania. The mania may appear as racing thoughts, rapid speech, recklessness, grandiose ideas and increased sex drive. Women with bipolar may also have symptoms of psychosis in either depressive or manic episodes. The psychosis can cause hallucinations- hearing sounds/voices that aren’t there. She may be paranoid and experience delusions that are not based on reality.
Known as Puerperal psychosis is a rare mental health condition. It occurs in the early postnatal period. 1 in every 1000 mothers may experience postpartum psychosis. Symptoms begin usually in the first few days to 3 weeks after birth, however can occur up to 12 weeks following birth. It more commonly occurs in women who experience bipolar disorder. It is important to note it can occur for the first time out of nowhere. Postpartum has both manic and depressive episodes. These episodes have a major affect on how mum thinks and feels things. In the mania stage women can appear quite happy and then euphoric, not sleeping, not eating, over productive, overly chatty etc. The depressive signs can be mum is paranoid, suspicious, delusional and is having suicidal ideations. A mental health assessment is urgently needed in these cases.
It affects 1-100 people and relapse is high during the perinatal period. Schizophrenia is long lasting and disabling. Depression and anxiety commonly co-occur with this condition. Schizophrenia affects how a person thinks, feels and behaves. Symptoms usually start around 16-30 years of age. Women who experience schizophrenia usually have more depressive symptoms, paranoia and auditory hallucinations (hearing voices/things that aren’t there).
Symptoms are categorised into positive, negative and cognitive.
· Positive symptoms- psychotic behaviours and ‘lose touch’ with reality. Hallucinations, delusions (unusual dysfunctional ways of thinking), movement disorder-agitated movements.
· Negative symptoms- disruptions to normal emotions and behaviours. This is commonly known as the ‘flat affect’ (reduced expressions of emotions via facial expressions or voice tone). Lack of pleasure in everyday life, difficulty starting and sustaining activities, not speaking.
· Cognitive symptoms- Changes in memory or other aspects of thinking, poor executive functioning (the ability to understand information and use it to make decisions), trouble focusing or paying attention, problems with ‘working memory’ (the ability to use information immediately after learning it).
Stress can acerbate symptoms. Women who are pregnant more vulnerable due to the stress of pregnancy and again postnatally with a baby. This is because they are:
· At a greater social and economic disadvantage.
· They are more likely to experience biological and psychological shifts during the perinatal period.
Women who are schizophrenic need to be monitored closely as they can experience obstetric complications such as diabetes and pre-eclampsia as well as psychotic relapses.
The mental instability in a pregnant woman or new mother can lead to negative mother-infant interactions. If these interactions are poor it can lead to poor child and health development. The child is also at risk of future psychiatric illness.
When it comes to treatment, it will not go away without medical treatment. If you experience or see a mum with them, seek urgent help from your general practitioner or mental health service such as the CAT team. In some cases, schizophrenia can be so debilitating that it may need to be treated in a hospital especially if mum or baby’s life is at risk. This allows for mum to be safe and get medication and specialists services in the one place.
Medications will help stabilize symptoms and reduce relapse. Medications prescribed will depend on mums’ condition and symptoms. A specialised psychiatrist will take into consideration if mum is breastfeeding or currently pregnant. Advice should be sought from psychologists before stopping or changing medications. Medication shouldn’t be ceased suddenly. Cognitive behavioural therapies will help when medication elevates symptoms. Mother and infant bonding therapy can also be beneficial to support bonding and attachment.
BORDERLINE PERSONALITY DISORDER
Is a mental illness that makes it difficult for people…
· To feel safe in their relationships with other people
· To have healthy thoughts and beliefs about themselves
· To control their emotions
People with BPD can feel distressed in their jobs, families, social life and may harm themselves. BPD is not by choice but like other mental illnesses is a result of genetic and environmental factors and life experiences. People with BPD are often in emotional turmoil.
During pregnancy women with BPD tend to experience psychosocial impairment, they worry about the birth being traumatic and want to deliver early. Parental stress is high for mums with BPD. Many feel incompetent as a parent. Due to the emotional dysregulation, mums behaviours may seem ‘over the top’ or extreme in any given context. Mothers may seem insensitive, overprotective and hostile. The child may develop these symptoms as they grow. They may internalise their feelings, have depression and externalising problems, insecure attachments and emotional dysregulation. Many women with BPD have suffered significant trauma and need to feel safe.
FINAL NOTES: Mental illness is common in mums. There are treatments available and the sooner mum can have her condition assessed and treated the sooner she can recover.
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