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What Is Perinatal Depression And Anxiety?

CLINICAL DEFINITION OF PERINATAL DEPRESSION

Pregnancy and the first year of parenthood (the perinatal period) is a unique time and involves major changes in a person’s life. The challenges of this adjustment to parenthood are often underestimated within our society and cultures. All expectant and new parents, including both mums and dads or partners, will have some good days and bad days. Ups and downs are expected and common. But when bad days become the norm, a parent may be experiencing perinatal depression or anxiety.

Perinatal depression and anxiety affect almost 100,000 expectant and new parents in Australia each year. Often, estimates for anxiety and depression are combined because many new parents experience symptoms of both. Sometimes, one may present more strongly than the other.

Depression alone affects up to one in ten women during pregnancy. In the first year after birth, it affects up to one in five women. Perinatal depression in dads or partners is not as well-researched. Evidence to date estimates about one in ten new dads are affected at some point from pregnancy through to the first year after birth. This rises to I in 5 if the mother is depressed. Dads’ roles have evolved in recent decades and men can find this transition to parenthood tricky.

Mood disturbances, such as depression, tend to fluctuate more frequently and deteriorate more rapidly if they occur in the perinatal period than at other times. It is a vulnerable time. Perinatal depression is a recognisable and diagnosable medical condition. Genetic and prior life experiences are important. Triggers can include biological factors (for example, interrupted sleep; hormonal changes), psychological factors (for example, personal or family history of depression or anxiety), and social factors (for example, lack of family support). It is treatable, and it is important to remember that recovery is possible with the right supports in place.

An episode of perinatal depression and anxiety can be mild, moderate, or severe. It is diagnosed when several of the following symptoms occur for more than two weeks, causing significant distress or impairment:

–  Depressed mood, including feeling “sad, empty or hopeless”

–  Loss of interest or pleasure in life

–  Physical symptoms: (changes in appetite, headaches, sweaty palms, heart racing)

–  Insomnia or hypersomnia (sleeping issues)

–  Moving more slowly than usual or finding it harder to slow down than usual

–  Loss of energy or fatigue

–  Not feeling attached or bonded with your baby

–  Feelings of worthlessness, guilt, feeling trapped

–  Impaired concentration or indecisiveness

–  Thoughts of death, self-harm or a suicide attempt

CLINICAL DEFINITION OF PERINATAL ANXIETY

Pregnancy and the first year after birth (the perinatal period) involve uncertainty, upheaval, and change.

In an environment where people try to retain as much control as possible over their lives, these new challenges are often anxiety-inducing.

It is expected and common for new parents to experience some worries and concerns. But if worries and fears start to feel overwhelming, or if they interfere significantly with daily life, a parent may develop some perinatal anxiety symptoms.

Specific statistics are not readily available as perinatal anxiety and perinatal depression are often diagnosed together. Some studies have found up to one in five women are affected by perinatal anxiety. Although perinatal anxiety in dads or partners is not as well-researched, similar rates are estimated for men.

Anxiety tends to fluctuate more frequently and deteriorate more rapidly in the perinatal period compared with other times. There are many reasons for this.

Triggers for perinatal anxiety can include biological factors (for example, hormonal changes); psychological factors (for example, the desire to be a “perfect” parent); and social factors (for example, loss of financial independence for a stay-at-home parent; no family support). Although it is common, perinatal anxiety is treatable – early intervention helps and recovery is possible.

Perinatal anxiety is commonly diagnosed by medical professionals using criteria applied to other anxiety disorders. If a parent experiences several of the following symptoms at once within a specific time period, and they cause distress or impairment, an anxiety diagnosis may be given:

–  Difficulty concentrating or focussing

–  Feeling unusually restless

–  Fear that something awful might happen

–  Excessive worry and difficulty controlling the worry

–  Irritability

–  Muscle tension

–  Sleep disturbance

–  Appetite disturbance

–  Other physical symptoms such as heart palpitations, sweaty hands, stomach complaints

In addition, many parents have repetitive, intrusive thoughts or images about a baby’s health or safety. These may be unwanted thoughts of harming their baby, or of someone else doing so.

These include sudden thoughts (for example, “what if I drop the baby on the stairs?”) or sudden images (for example, picturing the baby falling off the changing table). These thoughts and images are very distressing.

They can be associated with Obsessive-compulsive Disorder (OCD), which is a specific diagnosis. However, if these intrusive thoughts or images are not linked to repetitive, behavioural urges or compulsions, they may be diagnosed as an Anxiety Disorder.

These thoughts and images are common and do not indicate a parent is doing a bad job or is unable to care for their baby. Parents are encouraged to disclose these thoughts and fears to their health practitioners so they can receive supportive care and treatment.

Depression, anxiety, OCD, stressor and trauma-related disorders frequently occur together.

CLINICAL DEFINITION OF PERINATAL OCD

Obsessive-compulsive Disorder (OCD) is related to but no longer classified with the anxiety disorders. It is disturbing and distressing for the person experiencing it and can significantly affect their capacity to cope during early parenthood. It is a treatable condition and benefits from an experienced GP and/or psychiatrist/psychologist or other health professional who can help with strategies and treatments to manage the distress.

OCD is defined as repetitive, disturbing thoughts or images (obsessions) that cause anxiety and stress. These are commonly followed by thoughts or actions (compulsions) a person keeps repeating to try and reduce the anxiety. In the perinatal period, these often revolve around the baby’s safety but may also show up in other ways. The cycles can become overwhelming and dominate a person’s day, stopping them from being able to do other things. The cycles may be accompanied by feelings of frustration, guilt, and shame.

Many people are familiar with stereotypical compulsive behaviours such as repetitive hand-washing, which may temporarily relieve fears about germs and illness. However, OCD can emerge in many different ways.

Parents who have previously experienced OCD or extreme anxiety may be more susceptible to a recurrence in the perinatal period. However, some parents experience OCD for the first time during pregnancy or after birth.

OCD in the perinatal period has not been extensively researched. Research on OCD during pregnancy or among men is even more limited. Some studies estimate that, after birth, OCD rates among new mums are very high.

Some of the following are common, but not exclusive, ways that OCD may show up during the perinatal period.

–  Fear around a baby being harmed by germs or dirt

–  Worries about something a parent did or didn’t do to keep their baby safe

–  An image (a picture that flashes into a person’s mind) or a thought of harming a baby, either accidentally or deliberately. These can include sexual or violent thoughts, which can be very distressing for a parent.

Some of the behaviours that may follow to alleviate anxiety:

–  Rituals such as washing, cleaning or sterilising repetitively and excessively

–  Checking a baby’s breathing repeatedly when he/she is sleeping, to the point where it interferes with the parent’s own sleep

–  Seeking repeated reassurance from others that everything is OK

–  Correcting obsessional thoughts by counting, praying or repeating a special word

–  Avoiding feared situations or activities, for example avoiding nappy changing or taking a baby out in public because of germs.

Although perinatal OCD can be scary to experience, medical professionals understand that it does not involve any intention to harm a baby, that it is a mental health issue, and does not define the parent as bad or unable to care for their baby. Actual harm to the baby is very rare. It is important to seek professional help in order to recover from perinatal OCD.

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