What is Postpartum Depression?

Postpartum depression (PPD) is a mental illness affecting a new parent’s mood that may start during pregnancy or at any time up to one year after birth. Generally, it includes severe mood swings (specifically, a low mood), exhaustion and a sense of hopelessness. PPD affects a mother’s ability to go about her day. See below for a list of other common symptoms.

PPD affects up to 20% of new Canadian mothers, and in 50% of the cases, depressive episodes actually begin prior to delivery. If depressive symptoms are felt prior to delivery, it’s important to get help and learn ways to manage them in order to decrease the risk of depression after birth. It is thought that rates of PPD is similar in trans and non-binary new parents.

Symptoms: Postpartum Depression

You may have PPD if you are experiencing sadness (low mood) and/or loss of interest in activities that you previously enjoyed. In addition, if you have at least five of the following symptoms for two weeks or longer you should contact a health professional.

• losing or gaining of a lot of weight due to changes in hunger
• sleeping too much or too little, often
• being unable to sit still or, conversely, sitting quietly and feeling that moving takes great effort
• feeling tired all the time
• feeling unworthy (worrying that people don’t like you) or guilty for no good reason
• finding it hard to focus, remember things, or make decisions
• having thoughts of death or suicide
• feeling generally distressed in social or work situations

Symptoms may also cause significant impairment or distress in social or work life, or in other daily tasks.

Emotional changes are common during pregnancy and early after delivery, usually peaking around the fourth day and then easing up within the next two weeks. Typically known as the “baby blues,” these changes are not the same as, or necessarily signs of, postpartum depression.

Fast Fact

About 80% of women experience the baby blues after birth. The rate of the baby blues in trans and non-binary new parents is not known, but is thought to be similar.

The baby blues usually goes away without treatment. However, if symptoms last longer than two weeks or get worse, including having suicidal thoughts, it may be a sign of postpartum depression.

Symptoms: Baby Blues

• trouble sleeping
• mood swings
• tearfulness
• worry
• sadness
• hopelessness
• irritability
• poor concentration

Perinatal anxiety disorders are a group of disorders characterized by too much fear or worry leading to changes in behaviour. Fear is an emotional response or reaction to a real or perceived threat and anxiety is an example of worrying about a future threat.

Symptoms: Perinatal Anxiety Disorders

• constant worry
• feeling that something bad is going to happen
• racing thoughts
• trouble sleeping
• changes in hunger
• inability to sit still
• physical symptoms like dizziness, hot flashes, and nausea

Generalized anxiety disorder is persistent and excessive anxiety about any number of events or activities (e.g. health, children, money, etc.) that cause you to feel significant distress. Often there is no one specific reason for worry but it does tend to disrupt how you function day-to-day.

Fast Fact

About 2% of women experience generalized anxiety disorder during the perinatal period. The rate of generalized anxiety disorder in trans and non-binary new parents is not known, but is thought to be similar.

Agoraphobia is the anxiety about, and avoidance of, being in places or situations from which escape might be difficult or impossible (e.g. physical, sexual and/ or psychological abuse, natural disaster, accident). For example, you may not want to drive anywhere with the baby out of fear of a possible car accident.

Fast Fact

About 2% of women experience agoraphobia during the perinatal period. The rate of agoraphobia in trans and non-binary new parents is not known, but is thought to be similar.

Panic disorder is an unreasonable level of fear brought on by the presence or anticipation of a specific situation, which leads to unexpected and repeated panic attacks. Panic disorders are often accompanied by agoraphobia.

What is a Panic Attack?
A panic attack is a sudden feeling of intense fear or intense discomfort that reaches a peak within minutes. It’s accompanied by physical and/or emotional symptoms, which include pounding or fast heartbeat, sweating, trembling/shaking, chest pain, dizziness, and/or fear of dying.

Fast Fact

About 2% of women experience panic disorder during the perinatal period. The rate of panic disorder in trans and non-binary new parents is not known, but is thought to be similar.

Obsessive-compulsive disorder is the presence of obsessions and/or compulsions. Although many parents experience anxious thoughts often related to the baby’s health and happiness, these thoughts can transform into other thoughts or images of harming the baby that are frightening and shameful to the mother. With proper treatment and support, symptoms of obsessive-compulsive disorder can be well managed.

Obsessions: unwanted thoughts that are persistent, repetitive thoughts or mental images related to the baby. These can be very upsetting. For example, you may find yourself intensely worrying that your baby will be harmed due to contamination by germs/dirt.

Important Note: Obsessive Thoughts

People who experience obsessive thoughts typically know they are bizarre, and they are very unlikely to act on them.

Compulsions: repetitive behaviour or mental acts that you feel the need to perform to reduce fears/obsessions. For example, you may be washing/cleaning repeatedly and excessively preventing you from doing other things.

Fast Fact

About 2% of women experience obsessive-compulsive disorders during the perinatal period. The rate of obsessive-compulsive disorder in trans and non-binary new parents is not known, but is thought to be similar.

Other possible symptoms of obsessive-compulsive disorder:

• sense of horror about the obsessions
• fear of being left alone with the baby
• hypervigilance in protecting the baby
• inability to fulfill tasks related to everyday life due to obsessions/compulsions

Post-traumatic stress disorder is caused by a real or perceived trauma during delivery or the postpartum period. These traumas could include unexpected medical interventions or emergencies, triggering of past trauma during pregnancy or delivery, severe complications of the mother or child and feelings of powerlessness due to poor communication and/or lack of support and reassurance during the delivery.

Fast Fact

About 1% of women experience post-traumatic stress disorder during the perinatal period. The rate of post-traumatic stress in trans and non-binary new parents is not known, but is thought to be similar.

Symptoms: Post-traumatic Stress Disorder

• having repeated distressing memories of the traumatic event
• reliving the traumatic event as if it were happening again (flashbacks or nightmares)
• avoiding thoughts, places, activities, or people that remind you of the traumatic event
• being easily irritable
• having difficulty sleeping
• having anxiety and/or panic attacks
• feeling that you’re briefly losing touch with reality (or a blurred sense of reality)

Social anxiety disorder is an intense fear of being criticized, embarrassed, or humiliated, even in everyday situations like making small talk. For example, you may not want to attend prenatal classes, especially those in large groups, because you fear being judged by others.

Fast Fact

About 5% of women experience social anxiety disorder during the perinatal period. The rate of social anxiety disorder in trans and non-binary new parents is not known, but is thought to be similar.

Some common phobias include fear about a particular object or situation, such as going near an animal, flying on a plane, or getting an injection.

Fast Fact

About 2% of women experience a specific phobia during the perinatal period. The rate of specific phobias in trans and non-binary new parents is not known, but is thought to be similar.

Having anxiety increases a mother’s chance of developing depression, even if she didn’t have depression prior to pregnancy. Life stressors (e.g. lack of support, health concerns, etc.) around pregnancy can risk transition from anxiety disorders to postpartum depression.

Fast Fact

About 8% of mothers in Canada experience both PPD and anxiety. The rate of both PPD and anxiety in trans and non-binary new parents is not known, but is thought to be similar.

Postpartum psychosis is experiencing a break from reality where the delusions and beliefs make sense to the person but are not real. Most people don’t harm themselves or others, but there is always a risk of delusional thinking and irrational judgement.

Postpartum psychosis tends to come on suddenly, most often within the first two weeks postpartum. It’s usually temporary and treatable with professional help.

Symptoms: Postpartum Psychosis

• delusions or strange beliefs
• hallucinations (seeing or hearing things that aren’t there)
• feeling very irritated
• hyperactivity, such as being constantly active, distracted, and/or impulsive
• decreased need for, or difficulty sleeping
• paranoia or being suspicious of others
• rapid mood swings
• difficulty communicating at times

Bipolar has two phases: the lows and the highs. The low is clinically called depression, and the high is called mania or hypomania. This cycle is more than the natural moodiness of pregnancy or postpartum period and can look like severe depression or anxiety.

Your healthcare provider will ask you about these phases or “episodes.” They will ask how long these symptoms last during each episode and to what extent you feel in control. For diagnosis, symptoms must last longer than four days and interfere with daily functioning and relationships.

Symptoms: Bipolar Mood Disorders

• periods of severely depressed mood and irritability
• periods of mood being much better than normal
• rapid speech
• little need for sleep
• racing thoughts
• trouble concentrating
  continuous high energy
• overconfidence
• delusions and/or hallucinations (in severe cases)