Perinatal and postpartum depression and anxiety are common.
Did you know? 1 in 10 women will experience depression during pregnancy while 1 in 8 during the postpartum period. Research has found that effective screening for associated symptoms is often complicated by limited access to struggling women, mothers’ presentations as “put together”, and difficulties disclosing symptoms as a result of feelings of embarrassment, guilt, resentment and worries that their concerns will be dismissed. Moreover, the symptoms of postpartum difficulties are often ambiguous as a result of the overlapping symptoms within the realm of normal postpartum adjustment.
What is depression?
Depression is characterized by symptoms that persist nearly all day every day for 2 weeks with difficulties taking care of one’s self, children, home and/or work. Symptoms include:
- Depressed mood or extreme sadness
- Crying spells for no apparent reason
- Guilty thoughts or feelings of worthlessness or hopelessness
- Restlessness, lack of control, or lack of energy
- Difficulty concentrating or disorganized thoughts
- Feelings of guilt or inadequacy
- Changes in sleep or appetite, e.g. sleeping or eating too little or too much
- Withdrawing from partner, family, friends, co-workers
- Thoughts of suicide or other frightening thoughts of hurting others
Mothers struggling with postpartum depression may experience:
- Feeling low, sad, irritable, restless, numb or empty
- A loss of interest and enjoyment in previously pleasurable activities
- Changes in desire for and enjoyment of food
- Difficulties sleeping or getting rest when the baby is sleeping or attended to
- Psychomotor changes often noticeable to others, such as moving slowly or being restless or on edge.
- Excessive low sense of worth or guilt
- Concentration difficulties, including slowed thinking or having trouble making simple decisions
- Recurrent thoughts of dying and no longer being able to go on.
Perinatal and postpartum difficulties often present themselves initially by specific thought patterns, which are often characterized as scary, worrisome, intrusive and unwanted and are hard to disclose. Examples of thoughts include:
- Ideas: What if I don’t feed my baby enough?
- Images: I keep picturing the baby drowning.
- Impulses: Every time the baby cries, I feel like I’m going to do something to the baby.
Or can be about:
- Yourself: I’m certain my baby would be better off without me.
- Others: My partner thinks I am a bad mother.
- The future: What if my baby grows up to be a bad person.
What is anxiety and excessive worry?
Worries, doubts, and fears are a normal part of being pregnant and a new parent. Excessive worrying differs from normal worry in that it is:
For example, after hearing about someone having a miscarriage while pregnant, the average person might feel a temporary sense of unease and worry. Excessive worriers, however, might be up all night, seek reassurance by researching symptoms, then continue to worry for days about how a lack of morning sickness indicates a miscarriage.
Normal Worry vs. Generalized Anxiety Disorder
|Normal Worry:||Excessive Worry:|
|Your worrying doesn’t get in the way of your daily activities and responsibilities.||Your worrying significantly disrupts your job, activities, or social life.|
|You’re able to control your worrying.||Your worrying is uncontrollable.|
|Your worries, while unpleasant without distress.||Your worries are extremely upsetting and stressful.|
|Your worries are limited to a specific, small number of realistic concerns.||You worry about all sorts of things, and tend to expect the worst.|
|Your bouts of worrying last for only a short time period.||You’ve been worrying almost every day for at least six months.|
- Emotional symptoms:
- Constant worrisome thoughts
- Feeling like your anxiety is uncontrollable
- Intrusive thoughts about things that make you anxious even though you try to avoid them, but you can’t
- An inability to tolerate uncertainty; you need to know what’s going to happen in the future
- A pervasive feeling of apprehension or dread
- Behavioural symptoms:
- Inability to relax, enjoy quiet time, or be by yourself
- Difficulty concentrating or focusing on things
- Putting things off because you feel overwhelmed
- Avoiding situations that make you anxious
- Physical symptoms.
- Feeling tense; having muscle tightness or body aches
- Having trouble falling asleep or staying asleep because your mind won’t quit
- Feeling edgy, restless, or jumpy
- Stomach problems, nausea, diarrhea
What are helpful screening questions?
- Do you feel extremely anxious, sad, down or depressed?
- Are you having any crying spells for no apparent reason?
- Do you feel bothered by little interest of pleasure in doing things?
- Do you have guilty thoughts or feelings of worthlessness or hopelessness?
- Are you having thoughts of ending your life or other frightening thoughts?
- Are you feeling inadequate or resenting being pregnant or having your baby?
- Have you noticed changes in your sleep or appetite (e.g., not being able to fall asleep at night or in the middle of the night despite being tired or your baby sleeping)?
- Do you feel restlessness, out of control, or have no energy?
- Are you having difficulty concentrating?
- Do you find yourself withdrawing from family, friends and social situations?
What are barriers to accessing treatment?
It is difficult for woman to talk about feeling irritable, weepy, anxious, down, agitated and angry because of the perceived deviation from the ‘ideal pregnancy’ and the ‘ideal image of a mother’. Feeling ashamed, alone, and different can result in a spiral into deeper feeling of depression and anxiety. The best approach is a supportive and empathic one where uncomfortable physical or emotion symptoms are normalized and hope is offered.
If you are concerned about how you, a partner, a friend, or a client is feeling during the postpartum period, please seek guidance, advice or reassurance. If left untreated, postpartum depression may increase in severity or lead to chronic episodes of depression.
At The Therapy Centre, our clinicians can assess the symptoms of postpartum depression, provide differential diagnosis, offer effective treatment options to help women recover and mothers enjoy their time with their child.