Understanding Perinatal Mood Disorders

Most people who have been around pregnancy and birth are familiar with the concept of perinatal mood and anxiety disorders but only know of them as something called “Postpartum” and conventionally only consider postpartum depression in that category. The word “postpartum” is a period of time and not a diagnosis and as awareness and understanding grows, it has become clear that depression is only one form that perinatal mood and anxiety disorders (PMADs) can take. Unfortunately, the lack of funding, education, and awareness of these disorders has resulted in misdiagnosis and lack of diagnosis in both women AND men and thus a lot of unnecessary suffering as well as injury and even death.

Creating a broader term to cover the prenatal period as well as a full year following delivery will hopefully eventually result in more women getting diagnosed and treated. These disorders can appear during pregnancy or within days or even months of birth (or pregnancy loss). There are certainly some known risk factors for PMADs including a history of depression or another mood disorder (amongst several others), but most people affected are not aware of any risk factor. In addition to postpartum depression, which affects roughly 1 in 5 pregnant women, the umbrella term PMAD includes postpartum psychosis, panic disorder, anxiety, obsessive-compulsive disorder (OCD), post-traumatic stress disorder, and bipolar disorder.

The impact of these disorders on the families affected by them can range from mild and short-lived to severe and life-altering, even life-threatening. PMAD’s are a notable cause of maternal death, as significant as hypertensive disorders of pregnancy which is screened for several times throughout pregnancy, during labour and delivery, and during the postpartum period. Though there are screening tools available for postpartum depression, they are not used regularly enough and they aren’t appropriate for diagnosing the full spectrum of PMADs.

So what can we do? Ideally, we work towards a health care system where awareness, screening/diagnosis, and support/treatment are well-integrated and accessible by every woman and their partners. There isn’t a perfect solution but here are some ideas to start:

    1) Awareness - Perhaps the first step is education and awareness. People aren’t aware of the prevalence and the breadth of PMADs, writing off behaviour as “typical new parent anxiety” and “baby blues” (a separate and typically self-limited diagnosis). Education should be widespread so every adult member of the family knows what to look for. Some types of PMADs allow those afflicted to have self-awareness and realize they need help but many do not and accurate diagnosis and treatment rely on those around them as well as routine and repeated screening for everyone.

    2) Screening/Diagnosis - Part of the process of spreading awareness is incorporating a routine screening tool that is utilized with everyone on multiple occasions in their pregnancy and during the postpartum period. This is easiest with a universal tool and continuity of care (seeing the same provider throughout). Screening everyone and on multiple occasions will be less likely to single out or alienate those that are most worrisome and will have the added benefit of making providers more comfortable asking the hard questions.

    3) Support/Treatment - Once someone is identified as being high risk or diagnosed with one of the PMADs, the next step is putting together a treatment plan (typically multifaceted) as well as a safety plan, particularly when dealing with severe postpartum depression and postpartum psychosis which can be very difficult to diagnose. Treatment varies based on the individual but usually will include counselling, possibly medication, developing support systems at home, a plan for sleep, and rarely but occasionally hospitalization. These disorders, once diagnosed, are highly treatable.

Perinatal mood and anxiety disorders do not discriminate. Everyone is susceptible, and it is important to remember that no one is to blame. No one is at fault. Treatment is available in many different forms and with treatment, things will get better. If you are worried about your mood or have questions about symptoms that you have been experiencing, speak to your care provider. If you need immediate assistance, in the Elk Valley call the Interior crisis line at 1-888-CARE or anywhere else, call 1-800-944-4PPD and access www.postpartum.net for more resources including providers in your area who have extra training in perinatal mental health.