Recognizing and treating postpartum mood or anxiety disorders
Becoming a mother can be the most magical of times in a woman’s life. It can also be among the most trying of times, especially for moms who struggle with mental health matters as they adapt to their new roles. That’s why mental health care for new moms is critical.
Here, Sharon Fisher, a psychiatric mental health nurse practitioner, answers some questions about perinatal or postpartum mood or anxiety disorder (PMAD). Fisher is the owner of Nurtured Well, a women’s mental health clinic in Maryland.
How common are perinatal and postpartum depression?
Nationally, 15-20 percent of women will experience a PMAD. In over half of these women it will start during pregnancy. In Maryland, latest data indicate 14 percent of women experience postpartum depression and 20 percent experience postpartum anxiety.
Who is most at risk for wrestling with these mental health conditions?
Women who have had a past episode of depression, whether during pregnancy or not; women with lower educational levels; minorities; women who have had medical complications in pregnancy or delivery, or whose babies have had issues; and women with overall less social or financial support are more at risk for a PMAD.
What sort of signs or symptoms should people be aware of?
Mental health issues can be insidious. Often the woman is well into it before anyone, including herself, really can see a problem. Depression may present as sadness, but many times it presents itself as a lack of pleasure. The woman will not say she is feeling down, but she is not feeling any interest or joy either. The woman feels “meh” towards everything, even things that once brought her happiness, and even towards her baby. She may feel empty.
Is it something that the mom will effectively recognize in herself?
In my practice, I request that the woman bring in her partner, or a trusted support person if she is single, to review signs and symptoms of PMADs versus “baby blues.” I also give explicit instructions on what to do if they think there is a problem. If it takes a village to raise a child, it takes a community to support a new mom. Often, the mom is so focused on the baby that she neglects her own needs. She may also be confused by what her new normal is as her role shifts to mom. It’s hard to see a storm if you’re standing in the eye of it.
How well do all providers screen for signs of trouble?
This is improving. In a 2009 study, less than 44 percent of obstetricians reported screening new moms for PMADs. Today, all major groups representing obstetricians, pediatricians and physicians in general recommend screening. The American College of Obstetricians and Gynecologists, American Academy of Pediatrics and The American Medical Association all have screening guidelines, and Medicaid offers financial incentives to pediatricians who screen mothers. It’s significantly more prevalent now.
The big obstacle is timing and followup. For example, screening in the hospital after delivery and at the 6-week postpartum appointment is great; however, PMADs can develop in the first year, so ongoing assessment is necessary.
What does treatment generally involve?
A combination of cognitive behavioral therapy and medication coupled with practical advice and support work amazingly well. Many antidepressants are considered safe during breast feeding as well. I find that my patients are usually feeling much better after six to eight sessions of therapy.
Finding ways to help the mother get more sleep is imperative. Having the partner or a family member take a night shift can make a huge difference, even if it only gives the mother a four-to-six-hour block of sleep. Couples need to be creative and problem-solve how they can work together to get the mom some sleep. It’s important to understand that she may be too overwhelmed to figure this out on her own. For families with financial means, hiring a postpartum doula can be a lifesaver.
If a new mom finds herself struggling with depression or anxiety, is it something that is likely to be a passing phase of motherhood?
Many people confuse baby blues with PMADs. The basic difference is length and severity. Baby blues will not last longer than two weeks, and the symptoms will be a lot less severe. PMADs do not go away on their own. Treatment is imperative. Not treating PMADs can have long lasting effects on the entire family, including older children as well as the baby and mom’s partner.
In what ways do you suggest women prepare themselves to be in good mental health during maternity and motherhood?
Developing a good mindfulness practice through yoga, meditation or another method is essential. Mindfulness is nonjudgmental awareness that allows you to respond to things versus react to them. With mindfulness you can really hone in on what’s important to you and why. You can also better adjust to changes in your plan if necessary (i.e. an unplanned C-section or being unable to breast feed). It can allow you to attend to your needs and your baby’s cues instead of getting lost in the minefield of parenting information and advice. Most importantly, it will clue you in quicker if you are experiencing symptoms of a PMAD.
Written by Courtney McGee
This article originally appeared in the February 2020 issue of Baltimore’s Child.