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In many countries, up to 1 in 5 new mothers experience a mood or anxiety disorder. Unfortunately, these conditions often go undiagnosed and untreated due to lack of awareness and stigma, and everyone pays the price.
Today is World Maternal Mental Health Day and it’s time to recognize the importance of maternal mental health. How can you tell that you or a loved one needs help? What types of treatments are available? What can those who are pregnant or postpartum do and how can the community around them help?
To find out more, I spoke with Dr. CNN wellness expert Leana Wen. Wen, a mother of two young children, is an emergency physician and adjunct associate professor at George Washington University. She previously served as Baltimore’s health commissioner and as president of Behavioral Health Systems Baltimore, a regional nonprofit that promotes mental health and substance use disorder treatment.
CNN:Why is it so important to address maternal mental health?
Dr.Leana Wen:Mental health is an essential part of overall health. By itself, mental health influences well-being and has a significant impact on the physical health of both the woman and her baby.
Pregnant women with untreated mental health problems have a higher rate of lack of prenatal care. They are more likely to suffer from depression, anxiety, psychosis and other mental illnesses after childbirth. Untreated mental health conditions are also associated with premature birth, low birth weight babies, sleep and feeding problems, as well as developmental and cognitive problems.
Unfortunately, in the United States, mental health disorders are an underlying cause of mortality in many deaths that occur during and after pregnancy. According to the US Centers for Disease Control and Prevention, 22.7% of pregnancy-related deaths were associated with mental illness, even more than bleeding (13.7%) or infection (9.2%). This is a crisis and much more needs to be done to address it.
CNN: How common are maternal mental health conditions?
Wen:According to the World Health Organization, ten percent of pregnant women and 13% of women in the postpartum period suffer from a mental illness, the most common of which is depression. In developed countries, including the United States, the numbers rise to more than 15% during pregnancy and 19.8% after delivery.
These numbers are astonishing. Equally troubling are the numbers related to lack of treatment. Some studies indicate that less than 15% of people with these conditions receive any treatment.
Imagine if I were discussing any other serious illness. Imagine if less than 15% of people with diabetes got care for it, or if less than 15% of people with heart problems got treatment. We would not find these numbers acceptable, nor should we with the treatment of mental health conditions.
CNN: Many postpartum women have the baby blues. How do you distinguish between this and postpartum depression?
Wen:The baby blues are symptoms that most women experience after giving birth. They include experiencing mood swings, feeling overwhelmed, irritable and having trouble sleeping. Baby blues usually occur shortly after delivery and last for days. The person has some symptoms of low mood, but generally feels well.
The baby blues is quite different from postpartum depression. The symptoms of postpartum depression may initially resemble those of the baby blues, but they are more intense and last longer for at least two weeks and even months. Specific symptoms include continuous depressed mood, crying, overwhelming fatigue, and intense irritability and anger.
The woman may withdraw from family and friends, have less interest in activities she used to enjoy, and may even have difficulty bonding with or caring for the baby. The person may feel hopeless, worthless, and ashamed of not being a good mother. This could progress until the mother has severe anxiety and panic attacks and thoughts of harming themselves, their babies or others around them.
CNN: Are there other postpartum mental health issues?
Wen:Yes. Postpartum depression is the most common of the mental health conditions, but there are others.
Another condition that can occur on its own or alongside postpartum depression is postpartum anxiety. It’s normal to feel anxious after becoming a new parent, but it becomes a problem when feelings of anxiety are out of control and take over your thoughts. People with this condition have an all-consuming worry, including irrational fears about events that are unlikely to happen.
Other mental health conditions, such as obsessive-compulsive disorder, also known as OCD, can manifest in the postpartum period. In addition, substance use is often associated with mental health diagnoses.
One more condition I want to mention is postpartum psychosis. This is the most severe form of postpartum psychiatric conditions. It is rare, occurring in approximately 1 to 2 per 1,000 women in the postpartum period. Women may become erratic and switch between depression and euphoria, and may have hallucinations and delusions. This is a psychiatric emergency that requires immediate attention to prevent the woman from harming herself, her baby, and others.
CNN: What types of treatments are available?
Wen:Here’s the good news. A variety of effective treatments are available to treat postpartum depression and other mental health disorders.
The two types of treatments are talk therapy and medications. Psychotherapy involves talking about concerns with a mental health professional. There are different types of psychotherapy, such as cognitive-behavioral therapy. They generally help patients better recognize and cope with their feelings.
Health professionals may also prescribe antidepressant medications. Sometimes a doctor will add an additional medication based on symptoms. For example, people with anxiety may also benefit from an anti-anxiety medication.
The US Food and Drug Administration has approved two medications that specifically treat postpartum depression. These medications are used for shorter periods than antidepressants and could be a good option for some women, although insurance coverage and cost could be a barrier.
Like any other medical condition, some women may respond better to one form of treatment than others. Some may need a combination of treatments. The length of treatment will also depend on individual circumstances.
CNN:What can pregnant and postpartum women do? And how can those around them help improve their mental health and emotional well-being?
Wen:Good health during and after pregnancy begins long before pregnancy and birth. It is crucial for women and everyone to seek help for mental health issues. People with pre-existing mental health conditions such as depression and bipolar disorder have a much higher rate of experiencing mental health problems in the postpartum period. It is important to diagnose and treat these conditions before pregnancy.
That said, it’s also very important to recognize that postpartum depression and other mental health diagnoses during pregnancy and postpartum can occur in people who have no history of mental health problems. They can occur in anyone. Just as it is no one’s fault if they are diagnosed with diabetes or cancer, it is also no one’s fault if they have a mental illness. There should be no stigma attached to the diagnosis.
People around the individual can help if they look for signs of postpartum depression. They can offer support, including encouraging treatment and providing childcare and other help the person may need. Everyone should keep in mind that prompt treatment is effective and crucial to the well-being of the woman and her family.
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