Written by Psychologist, Nikolina Miljus
Some mental health disorders can be amplified during pregnancy, while others show first symptoms as the pregnancy unfolds.
In this article, we discuss how this happens and which mental disorders are affected or caused by pregnancy.
Pregnancy often is the period of significant transformation and challenges in a woman’s life, but even though we tend to associate pregnancy with joyful birth of a new baby, the reality is not always so bright.
Mental health issues in pregnancy are common, and 1 out of 10 women worldwide will experience them in some form during her pregnancy.
Women with a history of mental health disorders or on a psychotropic medication treatment face a particular challenge when they decide to try for a baby or discover they’re pregnant.
The current evidence suggests that the likelihood of symptoms worsening during pregnancy is high while not all current psychiatric medication is safe for the baby.
Pregnancy, for many women, is also a time of uncertainty and fear, and these two emotions tend to relate closely with anxiety and stress.
Hormone-fuelled intense feelings can negatively influence the overall mood, which in extreme cases results in antenatal or postnatal depression.
Finally, pregnancy is sometimes linked with the most profound break in one’s sense of reality and results in postpartum psychosis.
Anxiety Disorder During Pregnancy
Worrying about your pregnancy is normal. Fearing you might miscarry or how your labor will go is also normal.
There is no way around some degree of anxiety, even for moms who went through pregnancy before.
However, when you try different ways to cope with worrying thoughts and you still find yourself overwhelmed with anxiety, it may be a different story.
If you have extremely worrisome thoughts, tension, jitters, and you feel like your world is going to end, then you might be experiencing generalized anxiety disorder triggered by your pregnancy.
The common symptoms of anxiety disorders include persistent worry about the future, changes in appetite and sleep patterns, muscle tension, feeling “on edge,” and stressed.
Sometimes anxiety disorders come with panic attacks that involve brief periods of excessive and intense fear triggered by everyday situations.
Panic attacks can be daunting because of their physical symptoms that include rapid heartbeat and hyperventilation which bring on the physical sensation as if you’re about to die.
Again, feeling worried or tense in pregnancy is normal, but you should not be feeling on edge every day and go through sleepless nights tormented by catastrophic thoughts each evening.
Strong anxiety affects your ability to concentrate and function in day-to-day life, and dramatically increases your stress levels, which can reflect on your baby’s development.
Panic attacks are particularly physically stressful and increase the levels of the stress hormone cortisol, which also enters into the baby’s bloodstream.
This is why you should share how you feel with your midwife and ob-gyn.
Talk therapy choices for managing anxiety are available and backed by evidence, and anti-anxiety medication that is relatively safe in pregnancy are too.
Obsessive-Compulsive Disorder in Pregnancy
Similar to how pregnancy-triggered worry and anxiety can lead to generalized anxiety disorder, great changes brought on by pregnancy can also trigger the full-fledged obsessive-compulsive disorder (OCD).
Women who have dealt with OCD before pregnancy usually notice their symptoms worsening, but a small percentage of women develop first time OCD in pregnancy.
Before you start worrying you are developing OCD, it’s important to note that what we think is OCD in everyday life, is not necessarily a disorder.
For example, when you say a person who prefers their things neatly organized or plans each day in great detail is “OCD”, you are just describing a person who has neatness or attention to detail as personality traits.
OCD diagnosis involves intrusive, obsessive thoughts, and compulsive behaviors that are out of your control.
An obsessive thought springs into mind randomly and brings on the anxiety.
A compulsive behavior, some action or a ritual serves as a ”tool” to relieve the negative emotion caused by obsessive thoughts.
Obsessive thoughts in pregnancy are frequently related to miscarriage, especially in women who lost their pregnancy before.
The disorder can make them interpret every normal bodily signal as a sign of the miscarriage.
And they can get into a cycle of compulsively checking the underwear for signs of blood, or searching symptoms online to “confirm” how their pregnancy is going.
Sometimes the obsessive thoughts can be very violent or sexual, or constantly torment you with ideas about how you are going to be a terrible mother.
The treatment for OCD involves both psychotherapy and medication and is usually a long-term process.
Antenatal and postnatal depression
Pregnancy hormones can make you feel sadness and loneliness more intensely.
There likely isn’t a pregnant woman who hasn’t found herself crying her tears out at the sight of a cute puppy or after hearing a heart-warming story.
Mood shifts from your regular self to intense fury at the smallest cue are also frequent.
There are also times in pregnancy when you might feel hopeless, fatigued and exhausted from the lack of sleep or physical symptoms of pregnancy.
These symptoms happen to as much as 75% of all pregnant women, and you know them as “baby blues.”
Even though all these are also symptoms of depression, your overall life situation, hormonal shifts or a complicated pregnancy are most likely their sources.
However, when a pregnant woman experiences symptoms like intense sadness, sense of hopelessness, loss of appetite, insomnia or excessive feeling or guilt on a daily basis for two weeks or more, she might be encountering antenatal depression.
Suicidal ideas, self-harming or suicide attempts are also evident marks of antenatal depression.
Antenatal depression affects one in eight pregnant women and needs to be treated professionally.
The usual choice of treatment involves talk therapy and counselling, but pregnancy-safe anti-depressants might be a necessary treatment option, too.
Postnatal or postpartum depression usually begins after the delivery (even though some women had antenatal depression and were undiagnosed.)
Aside from symptoms typical for antenatal depression, women who experience postnatal depression also encounter a lack of emotional attachment to the baby and usually feel guilty for that, as they perceive themselves as bad mothers.
Suicidal ideas are not uncommon in either antenatal or postnatal depression, this is why seeking support, and medical help is critical.
Childbirth-related post-traumatic stress disorder (PTSD)
Childbirth-related PTSD is not an uncommon condition. Some estimates suggest it affects up to 6% women in the first weeks after the delivery.
The symptoms of this mental health disorder often are mixed with the symptoms of postnatal depression, and even though there are some similarities between the two the symptoms of childbirth-related PTSD are distinctly different.
The core of childbirth-related PTSD lies in how the woman experiences the labor.
Even under the ideal conditions, the labor is an intenseexperience and one in which a woman can feel entirely powerless and out of control.
When there are unforeseen complications and additional medical procedures, a woman may feel like her body is violated and labor becomes a traumatic event.
The symptoms of PTSD and childbirth-related PTSD include intrusive memories of the trauma.
These memories often come in the form of compulsive images that force the woman to re-experience the traumatic event all over again, sometimes through vivid dreams but also in the form of “flashbacks.”
Additionally, there may be difficulties in bonding with the baby, mood swings, anxiety and avoidant behaviour.
The treatment for post-labor PTSD involves reintegrating the traumatic memories with the help of the trained professional, and it is very effective, once the condition is diagnosed correctly.
Postpartum Psychosis
Postnatal or postpartum psychosis is far less common than the above mental health disorders linked with pregnancy.
It affects two in every 1000 women after childbirth, but it is also far more dangerous regarding symptoms and the threat it poses to both mother and the baby.
Postpartum psychosis begins in the first days after the baby is born and is characterized by a dramatic shift in one’s personality and behaviour.
A woman’s mood might become excessively agitated, manic, or excessively catatonic (motionless and inactive).
Her speech might start sounding like rambling, and she might be experiencing auditory or visual hallucinations, with severely distorted thinking.
The content of the delusionsis often filled with ideas that can result in harming the baby or herself.
Paranoid ideas about someone changing the baby in the hospital or ideas of persecution are also characteristic for postpartum psychosis.
Postpartum psychosis can rarely affect women with no prior history of mental health issues.
However, women who were diagnosed with bipolar disorder or schizophrenia before pregnancy are at a substantially higher risk of a psychotic episode after the labor.
Even though the symptoms of postpartum psychosis are severe and frightening, the condition is actually entirely treatable with antipsychotic medication.
It rarely leaves long-term consequences in mothers who did not have a prior history of mental disorders.
What can you do if you notice symptoms?
Pregnancy is a time of tremendous changes, and it can be difficult to distinguish between those caused by hormonal shifts, difficult life situation or symptoms of a mental health disorder.
To complicate things further, there still is a significant social stigma associated with speaking about mental health in pregnancy.
Since it is no longer only your wellbeing on the line, you should always seek professional help and share your worries with someone if you think you might be experiencing a mental health disorder in pregnancy.
Source: