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    Mental Health During and After Pregnancy: What Women Should Know

    October 28, 2020
    sad pregnant woman with head in hands

    If there’s one sure thing about pregnancy, it’s that it brings about a whirlwind of changes. But even the most prepared mother-to-be may be surprised by what could lie ahead.

    Sure, all the books told you that your body would change, but did anyone warn you that almost every part of it could be affected?

    Similarly, yes, you braced yourself for mood swings—but what if changes in your mood are actually a sign of something more serious?

    “Having a baby is supposed to be such a happy, joyful time,” says Samantha Meltzer-Brody, MD, director of the University of North Carolina Center for Women’s Mood Disorders. “But more than one in eight new moms will experience postpartum depression,” or depression that occurs after having a baby.

    In fact, a woman may experience one of many perinatal mood and anxiety disorders (PMADs) during pregnancy and the year after giving birth.

    Here’s what pregnant women, new mothers, and their loved ones should know about maternal mental health.

    More Than Baby Blues

    Postpartum depression and other PMADs, including depression during pregnancy, anxiety, obsessive-compulsive disorder (OCD), and bipolar disorder, are more than baby blues. They are mental health conditions that can interfere with daily life and require treatment.

    Postpartum Depression

    It’s common for new mothers to experience a mild case of baby blues—characterized by worry, unhappiness, or fatigue—in the days after giving birth, according to the Centers for Disease Control and Prevention (CDC). Usually, these cases improve naturally within two weeks.

    Postpartum depression, however, is more severe and can last longer. Symptoms typically start one to three weeks after birth. They vary from person to person but may include:

    • Intense sadness or hopelessness
    • Loss of interest in activities
    • Withdrawal from loved ones
    • Feeling disconnected from your baby
    • Thoughts of hurting yourself or your baby

    “Depression is one of the most common complications of childbirth—and suicide associated with postpartum depression is one of the greatest causes of maternal deaths following childbirth,” Dr. Meltzer-Brody says.

    New moms aren’t the only ones who may have postpartum depression. Up to 10 percent of fathers experience postpartum depression in the first year after a baby’s birth, according to a review in Innovations in Clinical Neuroscience.

    Prenatal Depression

    Though we most often hear about postpartum depression, women may also experience prenatal depression, or depression that occurs during pregnancy. In fact, 7 to 20 percent of pregnant women may have depression, according to Mental Health America.

    Symptoms are similar to postpartum depression. They vary from person to person but may include:

    • Intense sadness or hopelessness
    • Loss of interest in activities
    • Withdrawal from loved ones
    • Thoughts of hurting yourself or your baby
    • Restless sleep or insomnia

    Anxiety

    Up to 10 percent of women may experience anxiety during or after pregnancy, according to a study in the Journal of Women’s Health.

    Symptoms vary from person to person but may include:

    • Excessive and uncontrollable worry, especially about the health of your baby, your partner, or yourself
    • Hyperventilation
    • Restless sleep or insomnia

    Obsessive-Compulsive Disorder

    New or worsening symptoms of OCD can occur during pregnancy and the postpartum period, according to the International OCD Foundation.

    Generally, people with OCD may have symptoms of:

    • Obsessions: Intrusive thoughts, urges, or mental images that cause anxiety
    • Compulsions: Repetitive behaviors that a person with OCD feels the urge to complete in response to an obsessive thought

    For a new mother, an obsession may be, for example, worrying that you might hurt your baby. A compulsion may be checking on your baby excessively.

    Bipolar Disorder

    Women with bipolar disorder may experience a worsening of symptoms during pregnancy. They may also have a postpartum relapse risk of 37 percent, according to a study in the American Journal of Psychiatry.

    There are different types of bipolar disorder, but symptoms generally reflect a:

    • Manic episode: Extremely high energy levels and feelings of restlessness
    • Depressive episode: Extremely low energy levels and feelings of intense sadness or hopelessness

    Help and Treatment Are Available

    Although lots of mothers-to-be and new mothers experience mental health changes, many of them don’t get the help they need. About 20 percent of women are not asked about depression during their prenatal visits, according to the CDC. Worse, more than 50 percent of pregnant women with depression don’t get treatment.

    But treatment can be lifesaving—for both mother and baby. “Moms with perinatal depression have a higher risk of kids with adverse neurodevelopmental outcomes,” Dr. Meltzer-Brody says.

    “There can be long-lasting consequences for the child that may be partly related to disrupted attachment,” she continues. “Moms who are depressed or highly anxious may have more trouble bonding with their babies.”

    If you’re pregnant or a new mom, and this sounds like you, seek help. “No one should suffer in silence,” Dr. Meltzer-Brody says. “There are effective treatments available, and the cost of not getting treatment can be high.”

    Take these steps to get the care you need.

    1. Make a Plan with Your Clinician

    If you’ve previously been diagnosed with a mental health condition, you may be at higher risk of worsening symptoms or a recurrence of the condition during or after pregnancy. Don’t wait until after the birth of your child to take care of your mental health—take action as soon as possible.

    “Women with histories of mood and anxiety disorders will want to work with their healthcare providers to map out a plan for careful follow-up during pregnancy and postpartum,” Dr. Meltzer-Brody says.

    2. Don’t Keep Your Feelings to Yourself

    Ideally, your ob-gyn or maternal health provider will screen you during the perinatal period for symptoms of depression and anxiety, as recommended by the American College of Obstetricians and Gynecologists. But if this doesn’t happen and you’ve been experiencing changes in your mood or having difficulty functioning, bring the issue up yourself.

    It can help to write down any symptoms before your appointments. Bring this list with you, and then start the conversation by saying, “I’m not feeling like myself” or “I’m having a hard time.”

    Remember, you are not alone, and help is available. If you don’t feel heard by one provider, consider reaching out to other providers. This can be:

    • Your primary care doctor
    • Someone else on your maternal care team, such as a lactation consultant
    • A mental health clinician

    If you’re experiencing an emergency, call 911 for immediate help. You can also find urgent support from the National Suicide Prevention Lifeline at 1-800-273-TALK (8255) or Lifeline Chat.

    3. Set Up Counseling Appointments

    In some cases, your mental health clinician may recommend counseling, such as cognitive behavioral therapy (CBT) or interpersonal therapy (IPT), which can both be very effective, Dr. Meltzer-Brody says. CBT can help you learn different ways of thinking and reacting to situations, and IPT can help you manage relationships.

    If you can’t get to regular counseling appointments in person, telemedicine visits can be convenient and effective.

    4. Consider Medication

    In some cases, your clinician may recommend starting a new mental health medication or adjusting a current one.

    Perinatal depression, for example, is commonly treated with antidepressants, according to the National Institute of Mental Health.  “The evidence shows that medication can be very effective,” Dr. Meltzer-Brody says. “So, depending on the severity of symptoms, it’s a good idea to look at the risks and benefits and have a thoughtful, informed discussion with your doctor.”

    If you have bipolar disorder, ask your clinician how to manage your symptoms, including whether to continue taking medication. For women with bipolar disorder, taking medication during pregnancy may help maintain mood stability in the postpartum period, according to a study in the American Journal of Psychiatry.

    When discussing mental health medication, be sure to let your clinician know:

    • All of the prescription medications, over-the-counter drugs, and supplements or vitamins you take
    • If you are pregnant or breastfeeding

    5. Ask About Pharmacogenetic Testing

    Though mental health medication can be effective, finding one that improves symptoms with minimal side effects usually involves trial and error. That’s because not all mental health medications work for all people in the same way, and part of this is due to your unique genetic makeup.

    If your clinician recommends medication, ask if pharmacogenetic (PGx) testing can help. Genomind® Professional PGx Express™, for example, looks at 24 genes related to mental health treatment. It provides guidance across 10+ mental health conditions and 130+ medications to help clinicians determine:

    • Which medications will likely be the most effective
    • Which medications may have side effects
    • How you metabolize medications for personalized dosing guidance

    The Genomind test requires a prescription. Wondering if it can help you? Learn more about Genomind here.

    6. Take Care of Yourself

    Even with counseling and medication, it’s possible to experience new or changing mental health symptoms. Looking after yourself can make a difference.

    “All women should engage in self-care that promotes mental health and should reach out if any worrisome symptoms emerge,” Dr. Meltzer-Brody says. This can include leaning on your loved ones for support and relieving stress in healthy ways, such as participating in mindfulness classes.

    Does Your Medication Work for You?

    Get a lifetime of smarter mental health treatment guidance. Genomind’s leading pharmacogenetic test was designed to help your clinician personalize your treatment plan based on your genetic profile.

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    Topics: anxiety, bipolar disease, depression, depression treatment, OCD, postpartum depression

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