Becoming a parent is a transformative experience—and an overwhelming one. While bringing new life into the world is certainly a time for joy, it can also bring forth a complex and confusing array of emotions during this unique experience. Perinatal mental health disorders, which encompass various conditions developed both during pregnancy and in the postpartum (or post-birth) period, are far more common than many people realize.
The journey to parenthood—as seen through the lens of physical changes, hormonal fluctuations, and the weight of newfound responsibilities—can trigger profound psychological challenges that imperil a new parent’s (and the child’s) overall well-being. Expectant parents often experience a whirlwind of emotions, ranging from excitement and anticipation to fear and self-doubt. Amidst this emotional turbulence, perinatal mental health conditions can manifest in various forms, with such conditions impacting everything from your overall functioning to the dynamics within the larger family unit.
Today, Clear Behavioral Health is beginning a new series of articles to address several aspects of perinatal mental health problems, beginning with many of the common perinatal disorders and their causes. We will also explore the different modalities and environments in which treatment can occur, working to de-stigmatize perinatal challenges and give you a better understanding of these concerns.
What Causes Perinatal Disorders?
Perinatal mental health disorders, like other mental health conditions, are caused by a combination of genetic, biological, environmental, and psychological factors. These conditions are thought to arise due to the interplay of all these various elements, sometimes referred to as bi-directionality.
Some common factors that can contribute to perinatal disorders include:
- Hormonal Changes: Fluctuations in hormones, particularly estrogen and progesterone, during pregnancy and the postpartum period can affect brain chemistry and mood regulation.
- Genetic Predisposition: Individuals with a family history of mental health disorders, including perinatal disorders in particular, may be at a higher risk.
- Biochemical Factors: Imbalances in neurotransmitters (the chemical messengers in the brain) such as serotonin, dopamine, and norepinephrine are believed to play a role in the development of perinatal disorders.
- Psychological Factors: Stressful life events, a history of trauma, or difficult life circumstances can contribute to the onset of perinatal mental health concerns, particularly if someone lacks adequate coping mechanisms or feels overwhelmed by their circumstances.
- A Lack of Social Support: Limited support from partners, family, or friends can increase the risk of developing perinatal disorders. Social isolation and lack of emotional assistance can exacerbate previous or already present feelings of depression and anxiety.
- Medical Complications: Any complications experienced during pregnancy, childbirth, or in the health of the baby can lead to increased stress and anxiety.
- Personality Traits: Certain personality traits, such as perfectionism or a tendency to worry excessively, might increase the vulnerability to perinatal disorders.
- Sleep Deprivation: Disrupted sleep patterns, common during pregnancy and after childbirth, can contribute to mood disturbances and exacerbate existing mental health conditions.
- Societal Messaging: Having a child is frequently discussed as a life-changing and fulfilling event—but many new parents can also feel deprived, let down, or stressed out by the level of care now required of them. As a result, many new parents can experience shame and guilt when their feelings around the perinatal experience do not align with the messaging so often propped up around parenthood being a wholly fulfilling experience.
What may trigger a perinatal mental health disorder in one person may not affect someone else in the same way, as these factors often interact in complex ways. Early recognition, support, and appropriate treatment are nevertheless essential in managing perinatal mental health disorders effectively.
What Kinds of Perinatal Mental Health Conditions Exist?
There are several different kinds of perinatal-based disorders. They include:
Perinatal Mood and Anxiety Disorders (PMADs)
Perinatal mood and anxiety disorders, or PMADs, is an umbrella term encompassing a range of mental health conditions experienced by individuals both during pregnancy and after childbirth. These conditions can impact a parent’s ability to care for themselves and their newborns.
- Perinatal Depression: Prenatal and postpartum depression are forms of clinically significant depression that occur either during pregnancy or within the first year after childbirth (postpartum). Symptoms may include persistent sadness, changes in appetite or sleep patterns, and a loss of interest in activities.
- Perinatal Anxiety: This condition involves experiencing anxiety symptoms such as excessive worry, fear, and apprehension. Women with postpartum anxiety often experience racing thoughts, restlessness, and physical symptoms like dizziness and nausea.
- Perinatal Bipolar Disorder: Up to 20% of women who screen positive for depression in the perinatal period may in fact have bipolar disorder, as experiencing clinical depression may also belie periods of manic or hypomanic activity, which are distinct periods of abnormally elevated, expansive, or irritable mood, often accompanied by increased energy, decreased need for sleep, impulsivity, and heightened self-esteem.
Postpartum Psychosis
Postpartum psychosis is a relatively rare but severe mental health condition that can lead to hallucinations, delusions, and extreme mood swings after giving birth. It requires immediate medical attention and often involves inpatient treatment to ensure the safety of both the parent and the child.
Postpartum Obsessive-Compulsive Disorder (OCD)
Postpartum OCD is characterized by intrusive and unwanted thoughts or mental images, often involving harm to the newborn baby. Such thoughts can be distressing and frightening, along with causing the person to feel shame around their experience.
PTSD
Post-traumatic stress disorder, or PTSD, related to birth trauma or complications can arise from distressing childbirth experiences. As with PTSD not associated with childbirth, flashbacks, nightmares, and potentially debilitating anxiety are all some of the common symptoms. Timely recognition and suitable intervention are vital for individuals to process these traumatic events effectively.
The ‘Baby Blues’
The ‘baby blues’ are a very common experience for new parents, characterized by mild mood swings, bouts of crying, and feelings of sadness or being overwhelmed. Unlike many of the other perinatal conditions, this temporary and common sadness typically resolves on its own within a couple of weeks after childbirth.
Grief and Loss
The loss of a child during pregnancy or after birth is a profound and heartbreaking experience. Grieving parents require compassionate support from their families and from professionals to navigate their emotions and seek ways to heal.
How Common Are Perinatal Disorders?
According to a systematic review of the literature conducted in 2012, perinatal disorders were experienced by 15.6% of women before their babies were born and by 19.8% of women postpartum across the world. Furthermore, a landmark British study published in 2018 found that women were around 22 times more likely to have a psychiatric admission in the month following birth than in the pre‐pregnancy period—an increased risk for women both with and without prior psychiatric illness, but more so among women who had experienced a pre‐existing mood disorder, such as depression.
Can Men Experience Perinatal Disorders?
While these conditions are often associated with women due to the hormonal and physiological changes that occur during pregnancy and childbirth, expectant and new fathers can also experience mental health problems and face significant emotional challenges as well. Research has shown that the risk of depression in men increases during the perinatal period, with new fathers experiencing similar symptoms to those seen in postpartum depression in women, which can include mental health symptoms such as sadness, anxiety, irritability, and a sense of inadequacy.
What Are My Treatment Options?
Perinatal mental health disorders are treatable, and various approaches can be employed to help individuals affected by these conditions. The choice of treatment depends on the severity of the disorder, the individual’s preferences, and the recommendations of mental health professionals. For example, inpatient care may be required for episodes of psychosis or depression which has become debilitating, whereas milder cases of depression or anxiety may be more suitable for telehealth services and outpatient applications. Intensive outpatient care may be considered for more severe instances of depression, anxiety, OCD, and PTSD.
Help and Support
If you or a loved one is struggling with perinatal mental health, reaching out to mental health providers is a great step to take. Clear Behavioral Health is in-network with most major insurance providers and offers several levels of care to ensure that your mental health treatment is tailored to your unique needs. From virtual iop to inpatient and outpatient mental health programs, we’re dedicated to delivering the very best evidence-based practices to help you heal and reach your fullest potential.
Stay tuned for more in our series on perinatal mental health coming soon!
References
- Baby blues and postpartum depression: mood disorders and pregnancy. (2023, October 24). Johns Hopkins Medicine. https://www.hopkinsmedicine.org/health/wellness-and-prevention/postpartum-mood-disorders-what-new-moms-need-to-know
- Chhabra, J., Li, W., & McDermott, B. (2022). Predictive factors for depression and anxiety in men during the perinatal Period: A Mixed Methods study. American Journal of Men’s Health, 16(1), 155798832210794. https://doi.org/10.1177/15579883221079489
- Doyle, M., Carballedo, A., & O’Keane, V. (2015). Perinatal depression and psychosis: an update. BJPsych Advances, 21(1), 5–14. https://doi.org/10.1192/apt.bp.112.010900
- Kendell, R. E., Chalmers, J., & Platz, C. (1987a). Epidemiology of Puerperal Psychoses. British Journal of Psychiatry, 150(5), 662–673. https://doi.org/10.1192/bjp.150.5.662
- O’Hara, M. W., & Wisner, K. L. (2014). Perinatal mental illness: Definition, description and aetiology. Best Practice & Research in Clinical Obstetrics & Gynaecology, 28(1), 3–12. https://doi.org/10.1016/j.bpobgyn.2013.09.002
- Perinatal mental health. (n.d.). ACOG. https://www.acog.org/programs/perinatal-mental-health
- Bhat, A., Cerimele, J. M., & Byatt, N. (2018, December 1). Pregnant and postpartum women with bipolar disorder: Taking the care to where they are. Psychiatric services (Washington, D.C.). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6382604/
- Fisher, J., Cabral de Mello, M., Patel, V., Rahman, A., Tran, T., Holton, S., & Holmes, W. (2012, February 1). Prevalence and determinants of common perinatal mental disorders in women in low- and lower-middle-income countries: A systematic review. Bulletin of the World Health Organization. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3302553/
