What Are Perinatal Mood Disorders, and How Can They Be Treated?

Mood disorders are the most common form of mental health struggle in the United States. These conditions are typically triggered by an imbalance in brain chemistry, which may be caused by a combination of genetics, life stress, trauma, drug abuse, and family history.  Types of mood disorders include:

• Major depressive disorder
• Bipolar disorders I and II
• Seasonal affective disorder
• Cyclothymic disorder, which is similar to bipolar disorder
• Premenstrual dysphoric disorder (PMDD)
• Perinatal or postpartum mood disorders
• Persistent depressive disorder (dysthymia)
• Depression from grief
• Substance-induced mood disorder

Depression and bipolar disorder are often associated with anxiety disorders, but they are not exactly the same. Perinatal mood disorders include a combination of depression and anxiety symptoms associated with changes to brain chemistry that take place after the birth of a new baby. While many new mothers and fathers experience higher stress and lower mood in the first weeks after their child is born, the “baby blues” can, in some cases, continue for months or years. The sadness, numbness, or exhaustion may get worse, not better, as one’s routine includes the baby. New symptoms, including persistent thoughts of suicide, self-harm, or harming the child, may begin. Untreated, perinatal mood disorders can lead to trauma, worsened symptoms, and even addiction to drugs and alcohol.

Essentially, perinatal mood disorders are specific conditions that occur during pregnancy or up to one year after the birth of the child. The category of perinatal disorders includes:

• Depression during pregnancy
• Grief from losing the pregnancy
• Grief from infertility
• Postpartum depression (PPD)
• Postpartum anxiety disorders (PAD)
• Postpartum psychosis

There are many potential conditions that can persist or get worse during and after pregnancy. One in five women will develop a perinatal mood disorder, so it is important to understand what these conditions look like and how to get help.

Types of Perinatal Mood Disorders and How They Affect New Parents

Perinatal
mood and anxiety disorders can be triggered by the rapid hormone changes that occur after childbirth, but they are more likely to occur in those who have a history of mood disorders, a genetic or family history of these disorders, or a history of substance abuse or addiction. Further stresses from parenthood, including sleep deprivation, worry about the infant, feeling overwhelmed, or failing to meet personal expectations can contribute to worsening perinatal mood disorder symptoms. In addition to environmental stresses from parenting and biological factors, a lack of social support and cultural expectations around motherhood and fatherhood can also contribute to symptoms getting worse if they are not addressed.

About one-third of perinatal mood disorders begin during pregnancy, but these typically manifest as anxiety rather than depression. Early postpartum mood changes begin with a serotonin deficiency alongside decreased tryptophan. Hormones, including cortisol, estradiol, and progesterone, all contribute to neurotransmitter production, especially serotonin, which is closely associated with mood changes. Both estrogen and progesterone in women decrease rapidly after childbirth. Studies have shown that some men experience a drop in testosterone and androgen, too, during their female partner’s pregnancy and childbirth, which may contribute to men’s risk of perinatal mood disorders.

• Depression: Symptoms of depression during pregnancy or after the child’s birth may include feeling dark, gloomy, or down; feeling numb or no longer experiencing pleasure in hobbies; suicidal ideation, plans, or intention; low self-esteem, guilt; sleep disruptions; chronic fatigue, unable to rest enough; and changes in appetite leading to weight changes, either up or down.Suicide is the leading cause of death in new mothers, with rates increasing 44 percent in the postpartum year. Between 15 percent to 20 percent of women develop postpartum depression, meaning after birth; and about 10 percent of women develop a mood disorder during pregnancy.
• Anxiety/panic: Symptoms of anxiety or panic disorders during or after pregnancy include agitation, hypervigilance, racing thoughts, weight loss, stomach or intestinal pain or upset, trouble falling and staying asleep, shortness of breath, heart palpitations, diarrhea, excessive or unrealistic worries, episodes of intense panic, chest pain, feelings of choking, dizziness, hot or cold flashes, tremors, rapid heartbeat, extreme restlessness, catastrophic thinking, and fearing loss of control, dying, or going crazy. Around 6 percent of pregnant women and about 10 percent of postpartum women develop an anxiety disorder, which may be associated with depression.
• Postpartum psychosis: This condition is associated with either bipolar I or schizophrenia, and it can seem very sudden if the pregnant woman or new mother has not received a prior diagnosis for either of these disorders. Symptoms include delusions or strange beliefs, especially of grandeur or paranoia; hallucinations; hyperactivity; feeling agitated and irritated; decreased need for sleep and inability to sleep; suspiciousness or paranoia; rapid mood swings; and trouble communicating at times due to jumbled speech or tangled thoughts.While untreated postpartum psychosis correlates with a 54-67 percent increased risk of attempted suicide, 4 percent of women who develop this condition will attempt to kill their children regardless of how they feel about the child. About one or two out of every 1,000 deliveries, or about 0.1 percent of births, will trigger postpartum psychosis in the mother.
• Obsessive-compulsive disorder (OCD): About 9 percent of new mothers develop this condition, which is frequently misdiagnosed as postpartum psychosis. Like psychosis, perinatal OCD involves intrusive, obsessive, and often frightening thoughts, which cannot be controlled. This leads to massive guilt and shame on the mother’s part, although she rarely acts on the frightening, violent thoughts. Instead, rituals like counting, cleaning, and creating protection around the baby develop to help her prevent harm to herself and her child.Between 3 percent and 5 percent of women will develop obsessive-compulsive disorder (OCD) after the birth of their child. Some will develop this struggle during pregnancy.
• Bipolar disorder: This involves episodes of depression and mania cycling at different rates and extremes, depending on what type of bipolar disorder the individual is experiencing. It is unlikely that bipolar disorder develops because of pregnancy, loss, or childbirth, but the condition symptoms may be triggered or worsen due to intense physiological changes associated with these maternal experiences.Manic episodes are periods of intense high energy and mood. Hypomania involves elevated mood and energy that is less intense but still contrasts with later depressive episodes. Bipolar disorder may be rapid-cycling or occur over several months or years. New parents with any bipolar disorder are typically diagnosed in the postpartum period regardless of when symptoms begin. Most people with bipolar disorder, especially bipolar I, are misdiagnosed with depression at first. Untreated bipolar disorders increase the mother’s risk of suicide.
• Post-traumatic stress disorder (PTSD): About 18 percent of women experience a traumatic birth, and 5-9 percent of these women will develop PTSD as a result of this trauma. Additionally, losing a pregnancy may lead a woman to develop PTSD.After she develops PTSD, a woman may perceive that she is not cared for or does not have provider respect. She feels abandoned and often feels like she has lost her dignity. There is poor communication. She feels invisible, powerless, or out of control. Her trust has been betrayed, and she feels unsafe.

Are Men Affected by Perinatal Mood Disorders?

While men are statistically less affected than women by perinatal mood disorders, they are still at risk of developing any of these conditions. Men’s hormones fluctuate during their female partner’s pregnancy and after childbirth. If they are involved in the child’s life, they will experience drastic lifestyle changes, sleep deprivation, and social pressure just like women. Men, like women, with family histories, genetic risks, and previous diagnoses of mood disorders are more likely to develop a perinatal mood disorder.

This condition is stigmatized enough in new mothers, but research on men’s experience with these mental health challenges is only beginning. It is important to know that men can display any of the above symptoms for the first year or two of their child’s life, and men need care for these conditions just like women do. About one in 10 new fathers will develop a perinatal mood disorder.

Get Help Overcoming Mood Disorders to Avoid Addiction

It is important to treat any mood disorder, including perinatal mood disorders. For new parents, it is important to work with a therapist and/or psychiatrist and follow a few basic steps:

• Prioritize sleep and rest.
• Start mild or moderate exercise as soon as possible.
• Call on social support, like friends and family, for help.
• Avoid intoxicating substances like alcohol or drugs
• Take prescription medicines only as a doctor prescribes.

The signs and symptoms are not always clear, so if there is any concern about a new parent’s behavior or emotional state, they should seek help from a physician or therapist. There is a risk for pregnant women and new parents who develop a perinatal mood disorder to also develop an addiction or substance abuse problem as a method of self-medication. One study of individuals with any mood disorder found that 32 percent of the study subjects also struggled with addiction. Among those with depression, about 16.5 percent had an alcohol use disorder and 18 percent had a drug abuse disorder. About 56 percent of people with bipolar disorder struggled with addiction.

Abusing drugs and alcohol while pregnant can harm fetal development, leading to chronic behavioral or physical disorders in the child. Men and women who develop a postpartum mood disorder and abuse drugs or alcohol also put themselves and their children at risk of physical, emotional, financial, and social harm.

It is important to get help to treat any perinatal mood disorder when symptoms begin. Therapists, physicians, and addiction specialists are all available to help.