Almost one in five women will experience a mood or an anxiety disorder during pregnancy or in the postpartum period. From a mental health standpoint, it’s the most vulnerable time in a woman’s life. So, if it happens to you, remember that it’s not your fault and there are many other women who have survived and recovered from this illness. I’m a psychiatrist who specializes in women’s mental health and perinatal psychiatry. In 2018, through a grant from Mary’s Center for Maternal Health in Washington DC, I developed and implemented maternal mental health trainings for health care providers and psychoeducation groups for patients. I’d like to share 10 tips with you about these common conditions.
1) It’s not just post-partum and it’s not just depression.
Postpartum depression is the buzzword that gets the most media attention, but it’s important to know that these symptoms can also begin during pregnancy. Perinatal mental health issues are not limited to depressed mood. Many women don’t realize that overwhelming fears and obsessive ruminative thoughts are also a sign that something is not right. If you start to develop high levels of anxiety, even without feeling sad or down, this could be a sign that you would benefit from help.
2) Not everyone with post-partum depression feels sad.
Depression and anxiety can take many different forms. In my clinical practice, I commonly see women who complain of anger and rage that seemingly comes out of nowhere. Emotional lability, or rapid and exaggerated changes in mood, can be an outward manifestation of depression or anxiety. Everyone experiences depression in a different way. For some women, it can look like not being able to get out of bed and isolating themselves from family or friends. For other women, it can be quite the opposite – going into overdrive to get everything done and becoming irritable and upset with partners and children in the process.
3) It’s common to have scary thoughts.
These most often come up in the form of “what if?” As in, “What if this terrible thing happened to my baby?” You may picture scary images of an accident happening to your baby, or, you may fear being the one to cause the accident. I see this from women all the time. These thoughts are typically driven by anxiety. Having these intrusive anxious thoughts is very different from wanting to act on them.
4) Sleep is your best friend.
I know this sounds obvious and impractical with a newborn. But, sleep deprivation impairs cognition and can worsen or mimic the symptoms of post-partum depression or anxiety. For women who have a history of depression or anxiety prior to pregnancy, sleep is even more essential in the post-partum period. I recognize that it’s easier said than done, but, it’s hard to overstate the importance of getting several hours of consecutive sleep every night. Sleep deprivation itself can mimic the symptoms of depression and anxiety, and, so removing it as a variable can help us more accurately understand the full clinical picture.
5) Say “Yes” to help.
We also know that social support can be protective, and lack of support can make symptoms worse (It takes a village, people!). For many of my patients, pregnancy and motherhood is the first time in their lives they truly cannot control the outcomes. Taking care of an infant requires a skill set that is not taught in graduate school. Even if you are someone who takes pride in taking care of yourself, now is not the time for independence. If you have access to help, say yes!
6) Taking medication is OK.
There is no one-size-fits-all treatment. In the case of perinatal depression and anxiety, we must balance the risks of untreated depression and anxiety during pregnancy and post-partum with the risks that come with exposing the baby to medication in pregnancy or during breastfeeding. This equation is going to be very different for each woman, as we take into consideration the severity of your symptoms, your level of functioning, and the risk profile of the medication in question. As a perinatal psychiatrist, my job is to help guide you in making this very important decision. Social support, moms’ groups, psychotherapy and other healing modalities like acupuncture are also important parts of the recovery process. It’s important to remember that healing from perinatal mood and anxiety disorders often takes a program of several different treatment modalities, and in some cases, medications can be one part of that program.
7) Medications do work, but they take time.
It can take antidepressants anywhere from two to six weeks to start working, with most people seeing some effects by four weeks. And, it can take up to three months to see the full therapeutic benefits of these medications. That period of waiting is usually the hardest time for my patients. Sometimes you get side effects even before the medication starts working. In some cases, the side effects are severe enough that we need to switch to a different medicine. In other cases, the side effects fade within a few days, and we can keep going. It’s frustrating that we don’t have something that works instantaneously for post-partum depression and anxiety. There is a great deal of research going into finding new and safe medications, specifically for perinatal mood and anxiety disorders.
8) Medications won’t change who you are.
Many of my patients tell me they are worried that taking medication for depression or anxiety will change their personality. It’s true these medicines do re-wire the brain. What I commonly find is that people say medication helps them be more of who they are — or who they want to be — as opposed to changing them into someone different. I know my patients are getting better when they tell me, “I feel like myself again!”
9) Treatment is an ongoing process and it should change over time.
My patients are often worried that if they take antidepressants now, they will be stuck on them for the rest of their life. This is not the case. Treatment should be a collaborative effort between you and your doctor, with guideposts along the way. Some good questions to discuss with your psychiatrist include: How do you measure your anxiety? What is your limit to when you might consider medication? Are there people in your life who know you well, and can serve as mirrors to help you see where you are on your own map? How will you know when you are better? If you are someone with a history of anxiety or depression, and you were previously taking antidepressants, stopping your medication cold turkey puts you at higher risk for developing a perinatal mood or anxiety disorder. These decisions should be made under the care of your doctor. If, together, you make the decision to taper your medication, consider adding in additional sources of support like psychotherapy or a moms’ group.
10) We’re on the same team.
There’s a lot of stigma out there about depression and anxiety during pregnancy and post-partum — and about taking medications as treatment. It seems everyone has an opinion. Plus, if you’re a mom who is on the fence, the internet can be a dangerous place. Find a psychiatrist who you trust and who works collaboratively with you. Ask questions and take notes.
The contents of this article are for informational and educational purposes only. Nothing found here is intended to be a substitute for professional medical, psychiatric or psychological advice, diagnosis or treatment. Always seek the advice of your physician or other qualified mental health professional with any questions you may have regarding a medical condition or mental disorder.
If you’d like more information about psychiatric treatment during pregnancy and post-partum, please visit www.womensmentalhealth.org or www.postpartum.net (Postpartum support international Helpline 1-800-944-4773)
A version of this piece was previously published in Dr. Emma’s Basch’s “Maternity Matters” PsychCentral Blog.
Image by Natalia Deriabina / gettyimages.
Pooja Lakshmin MD is a board-certified psychiatrist and Assistant Professor of Psychiatry & Behavioral Sciences at the George Washington University School of Medicine. She is passionate about women's mental health. You can find her on twitter @PoojaLakshmin. She is a 2018-2019 Doximity Author.
