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Women more vulnerable to depression, anxiety during reproductive years

By Dr. Elizabeth LaRusso

May is widely associated with flowers, warm weather (sort of) and Mother’s Day. Fewer people know that May also is Maternal Mental Health Awareness Month.

For me, a perinatal and reproductive psychiatrist specializing in pregnant and postpartum women, May is no different than any other month: Women with mood and anxiety disorders come to my clinic, suffering, feeling isolated and unsupported, wondering where things went wrong and if they will ever again be able to feel “normal.”

Our cultural celebration of motherhood brings with it many widely held assumptions, leaving many women to expect that pregnancy will be a time of emotional well-being, and that caring for infants and young children will be overwhelmingly positive and fulfilling. The reality is that the reproductive years are a time when women are particularly vulnerable to the onset of psychiatric conditions like depression and anxiety. For example, the “baby blues,” a condition that occurs for up to two weeks postpartum and is characterized by tearfulness, mood lability and insomnia, affects up to 80 percent of postpartum women; as many as 1 in 5 women will experience postpartum depression. As joyful as it is to have a new baby, the combination of the physical experience of childbirth, the dramatic hormonal shifts, sleep disruption and the social and emotional role changes associated with becoming a mother are massively stressful. Some women navigate these transitions with relative ease, but many women, particularly those with risk factors for postpartum depression (ex: personal or family history of depression, untreated depression during pregnancy, poor social support), have more difficulty.

As with any new role or responsibility, it takes time to develop competence. In the first couple of weeks postpartum, it is common for women to lack confidence caring for their baby, to struggle to feel connected to the baby, to have difficulty sleeping and check frequently on their baby, and to feel overly emotional, worried, and reluctant to be alone. Many women experience intrusive thoughts or images of harm coming to their baby, like dropping their baby or coming to the crib and finding the baby not breathing. In general all of these symptoms should be improving over time, not getting worse.

Women who experience significant sadness, frequent tearfulness, feelings of guilt, inability to sleep even when given the chance, significant disruption in appetite, concentration, energy or difficulty functioning may be experiencing postpartum depression. In severe cases, postpartum mood disorders are associated with thoughts of harming oneself or the baby, and any woman experiencing these thoughts should be brought to her physician or the nearest emergency room for immediate evaluation. Anxiety, although less well studied in perinatal populations, frequently goes hand in hand with depression. Mothers who experience severe anxiety, worry or panic that it interferes with their ability to sleep, care for their infant or be alone may be experiencing a postpartum anxiety disorder.

The most important thing that any woman struggling during pregnancy or the postpartum period can do is speak up and reach out to the people she trusts. Letting family or friends know about mood and anxiety symptoms is the first step in increasing support and getting a plan in place to obtain further evaluation and treatment. Contacting one’s obstetrician, midwife or primary care physician to schedule a visit is the next step in seeking care. At Allina Health and Children’s Hospitals and Clinics of Minnesota, we are developing care processes that will increase the ability of women to obtain prompt evaluation and treatment for perinatal mental health issues. Other organizations such as Postpartum Support International offer information and resources to help connect women to appropriate care.

Dr. Elizabeth LaRusso is a perinatal and reproductive health psychiatrist at The Mother Baby Center.