Disorders Related to Pregnancy

• Depression During Pregnancy
• Postpartum Depression (PPD)
• Pregnancy Loss
• Infertility

Disorders Related to the Menstrual Cycle

• Premenstrual Syndrome (PMS)
• Premenstrual Dysphoric Disorder (PMDD)
• Perimenopausal Depression

 

Depression During Pregnancy

Depression that occurs during pregnancy or within a year after delivery is called perinatal depression. Researchers believe that depression is one of the most common complications during and after pregnancy. Factors that may increase the likelihood of depression during or after pregnancy can include; history of depression or substance abuse, family history of mental illness, inadequate support from family and friends, anxiety about the fetus, problems with previous pregnancy or birth, marital or financial problems, young age (of mother or newborn). Tiredness, problems sleeping, stronger emotional reactions, hormone changes, and changes in body weight normally occur during and after pregnancy, but these symptoms may also be signs of depression.

It is natural for women to experience changes in their feelings and mood during pregnancy, including feeling more tired, irritable or worried. However, while mild mood changes during pregnancy are common, mood symptoms can sometimes become severe enough to require treatment by a health provider. If feelings of depression or anxiety persist for a few weeks or interfere with daily activities it is time to ask for help. Depression and anxiety during pregnancy can worsen and continue into the postpartum period.

Symptoms of Depression During Pregnancy:

• Feeling sad, depressed, and/or crying a lot.

• Diminished interest in becoming a mother.

• Feeling worthless or guilty, especially about not being a good mother.

• Strong anxiety, tension, and/or fear either about your future child or other things.

• Sleep problems (not being able to sleep despite feeling very tired or sleeping more than usual but not feeling rested).

• Thoughts of wanting to be dead or wanting to kill yourself.

• Having low energy.

• Loss of or increase in appetite or weight.

• Trouble focusing, remembering things, or making decisions.

• Feeling restless or irritable.

• Having headaches, chest pains, heart palpitations, numbness, or hyperventilation.

Postpartum Depression (PPD)

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Many women have a variety of mood symptoms in the aftermath of delivery. 50%-85% of women feel Postpartum Blues or “Baby Blues” for a short time, usually 1-3 weeks after delivery. Common symptoms of “Baby Blues” can be mood instability, depressed mood, weepiness, sadness, irritability, anxiety, lack of concentration, feelings of dependency. Symptoms of “Baby Blues” usually subside 1-3 weeks after delivery. These symptoms are often self limited and are to be distinguished from a more severe condition often called Postpartum Depression (PPD) which has increased severity and duration of symptoms.

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Postpartum Depression occurs in up to 10% of births.  It typically emerges over the first 2-3 months after childbirth but may occur at any point after delivery. Symptoms of PPD last for more than 2 weeks. Depression after childbirth is a serious illness and can have significant and lasting impact on the patient, infant, and family.
 
Symptoms of Postpartum Depression:

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• Feeling sad, depressed, and/or crying a lot

• Intense anxiety; rumination, obsessions (See Postpartum Anxiety Disorders below)

• Loss of interest in usual activities

• Feelings of guilt, worthlessness or incompetence

• Fatigue, irritability, sleep disturbance

• Change in appetite

• Poor concentration

• Feeling inadequate to cope with new infant

• Excessive worry about baby’s health

• Suicidal thoughts

  
  

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Postpartum Psychosis

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Another form of Postpartum Depression is Postpartum Psychosis. Postpartum Psychosis is a serious illness that can be severe and life threatening. The psychotic symptoms include delusions (thoughts that are not based in reality), hallucinations (hearing or seeing things that aren’t there) or disorganized thinking. Often mothers who develop postpartum psychosis are having a severe episode of a mood disorder, usually bipolar (manic-depression) disorder with psychotic features. It is essential for women to get evaluation and treatment immediately. 

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Postpartum Anxiety Disorders

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Postpartum anxiety disorders such as panic disorder, obsessive compulsive disorder and generalized anxiety disorder appear to be as common as postpartum depression and even coincide with depression. Perinatal anxiety symptoms can include the following: panic attacks, hyperventilation, repeated thoughts or images of frightening things happening to the baby, excessive worry and restless sleep. 

Pregnancy Loss

Experiencing miscarriage at any point in pregnancy can be a shocking and devastating event.  Many women struggle with physical and emotional pain and grief that is powerful and overwhelming. Miscarriage can leave women feeling numb, helpless and isolated from others. Common reactions to miscarriage are sadness, anger, and guilt and depression.

Infertility

Infertility occurs in 10-15% of couples of reproductive age. Investigation of the causes of infertility and treatment can bring on a “life crisis” that can tax a couple’s existing problem-solving resources, threaten achievement of life goals, and awaken unresolved past difficulties.

 

Premenstrual Syndrome (PMS) and Premenstrual Dysphoric Disorder (PMDD)

Many women experience symptoms of Premenstrual Syndrome (PMS).  In most instances the mood symptoms and emotional components of PMS are the most troubling. To women in such cases, PMS is often referred to as Premenstrual Dysphoric Disorder (PMDD).

Premenstrual Dysphoric Disorder is a more severe form of PMS, affecting 5-10% of women in their reproductive years. In contrast to PMS, PMDD is characterized by more significant premenstrual mood disturbance that can seriously impact relationships and impair functioning. Many women with PMDD experience clinical levels of depression or anxiety during the week or two before each menstrual cycle. It is not uncommon that the emotional symptoms of depression anxiety and irritability can seriously interfere with normal functioning and relationships.

Common symptoms include: irritability, depressed mood, anxiety, or mood swings. Mood symptoms are only present for a specific period of time, during the luteal phase of the menstrual cycle. Symptoms emerge one to two weeks before menses and resolve completely with the onset of menses. Women with PMDD should experience a symptom-free interval between menses and ovulation. An estimated 40% of women who seek treatment for PMDD actually have a premenstrual exacerbation of an underlying mood disorder rather than PMDD. Therefore, it is important for patients to be carefully evaluated for the presence of an underlying mood disorder in order to develop the best treatment plan.

Perimenopausal Depression

Menopause is defined as the permanent cessation of the menses. Perimenopause is defined as the transitional period from normal menstrual periods to no periods at all. At this time menstrual periods gradually lighten and become less frequent. The transition to complete menopause may last anywhere from a few months to a few years.
During the perimenopausal transition you may experience a combination of PMS and menopausal symptoms or no symptoms at all. Some normal symptoms of the perimenopause period are hot flashes, insomnia, vaginal dryness, and mood problems. Symptoms of perimenopausal depression are emotional flatness, “inability to cope”, irritability, social isolation, tearfulness, decreased energy, and failure to enjoy normal activities and relationships.

Times of intense hormonal fluctuation can cause increased vulnerability to depression. Perimenopause may be a period of increased vulnerability to the onset of depression in women with no prior history of depression.  Since symptoms are gradual in onset, women will not recognize symptoms as part of a reversible disorder, but rather will interpret them as a permanent change in their life.