See Assessment Tools for Your Practice at the PPSC for complete details and links.
Postpartum depression is one of several mood disorders that new or expectant mothers may experience. There are a range of disorders that screening can help identify, including:
• Postpartum Stress Syndrome (Kleinman & Raskin, 1996) — A term coined by Karen Kleinman, LCSW, and Dr. Valerie Raskin, to describe the difficulty some mothers experience with daily, persistent distress. These symptoms do not meet the DSM criteria for a major depressive episode or anxiety disorder, but present as an adjustment disorder that does not readily resolve on its own.
• Postpartum Depression Disorder (PPD) — The onset of depression symptoms usually within three months and up to one year after childbirth.
• Postpartum Anxiety or Perinatal Anxiety — Anxiety that occurs after or during pregnancy, which can take many forms, such as intense nausea, disturbed sleep patterns and acute, persistent worry or scary thoughts. While diagnostic criteria are not yet established, it is beginning to receive more recognition and study.
• Perinatal Obsessive-Compulsive or Postpartum Obsessive-Compulsive Disorder (PPOCD) is the most misunderstood and misdiagnosed condition, says Postpartum Support International. About 3-5% of new mothers experience intrusive, scary thoughts that may lead to hyper vigilance and a persistent sense of horror, and may occur whether or not a person has been diagnosed with OCD before.
• Postpartum Psychosis — A rare illness, usually with sudden onset within the first two weeks after childbirth. Symptoms can include delusions, paranoia, insomnia and paranoid suspicions. The presence of symptoms is a medical emergency and it is critical to act promptly and get immediate help. Call a doctor or emergency crisis line such as the National Suicide Prevention Hotline at 1-800-273-8255.
• Postpartum Bipolar Mood Disorder — Many women who are diagnosed with bipolar disorder receive support for the first time during pregnancy or postpartum. A person experiences intense moods that cycle in phases (lows and highs), or which may both occur together. It is very important to find a professional informed in assessing and treating bipolar symptoms during pregnancy and after childbirth.
When a Postpartum Mother Needs Treatment: What to Do
Having a good referral network of qualified therapists can help more mothers get access to mental health care. Many prenatal care providers maintain a list of therapists, psychologists and other providers to call on for mental health referrals.
Some therapists (myself included) have a special interest in treating postpartum depression and mood disorders and supporting better mental health for mothers and parents. We have taken postgraduate training to understand the needs of new mothers who are struggling.
The Postpartum Stress Center maintains a nationwide directory list of therapists who have successfully completed postgraduate training at the PPSC. Postpartum Support International (PSI) and its local affiliates also have a directory of therapists and psychiatrists nationwide. PSI has a great local directory of support services. These resources are just some ways the medical community can find therapists who are prepared to treat perinatal mood disorders.
Finding a Therapist for Postpartum Treatment
It may not be possible to get access to a provider who specializes in postpartum disorders in your area. However, it is important to know that PPD is treatable. You may be able to find a good therapist who is skilled in treating women and depression.
I find that a trauma-informed approach is a particular strength in addressing mental health issues for everyone, including new mothers. This approach helps therapists create a safe space where it is absolutely “okay to tell another person that you’re not okay.”
As medical and mental health clinicians, greater awareness of PPD, perinatal mood disorders, and treatment options can save more lives and help more families access the help they need. We can be our most proactive and effective by learning more and talking more about PPD assessment and treatment.
2020 Mom Project
DC-MD-VA (DMV) Perinatal Mental Health (PMN) Resource Guide
Depression among Women of Reproductive Age, CDC
Jane Honickman, MS
Mother to Baby
Postpartum Stress Center
Assessment Tools for Your Practice
PPSC Clinician Referral List
Postpartum Support International (PSI):
Overview of Pregnancy and Postpartum Mental Health Disorders
Postpartum Support Virginia (local PSI chapter)
“Anxiety in Childbearing Women: Diagnosis and Treatment,” by Amy Wenzel
“Beyond the Blues, Understanding and Treating Prenatal and Postpartum Depression & Anxiety,” by Shoshana Bennett and Pec Indman
“Dropping the Baby and Other Scary Thoughts: Breaking the Cycle of Unwanted Thoughts in Motherhood,” by Karen Kleiman, MSW and Amy Wenzel, PhD
“When Survivors Give Birth: Understanding and Healing the Effects of Early Sexual Abuse on Childbearing Women, “by Penny Simkin and Phyllis Klaus
‘Facing Postpartum Depression: The Honesty, Courage and Support It Takes to Seek Help for PPD,” by Robyn Brickel, MA, LMFT
“How do I find a PPD Therapist?” by Karen Kleinman, LCSW
“Northwestern study finds new moms at far more risk for OCD,” by Patrick Svitek, Chicago Tribune reporter
“The Mood Disorder Questionnaire: A Simple Patient-Rated Screening Instrument for Bipolar Disorder,” by Robert M.A. Hirschfield, M.D.
“Onset Timing, Thoughts of Self-harm, and Diagnoses in Postpartum Women with Screen-Positive Depression Findings” by Katherine L. Wisner, MD et al.
“Risk of Recurrence in Women with Bipolar Disorders in Pregnancy,” Am. J. Psychiatry 2007, by Viguera. A, et al.
“Self-Recognition of and Provider Response to Maternal Depressive Symptoms in Low-Income Hispanic Women,” by Linda Chaudron et al.
“Surprising Rate of Women Have Depression After Childbirth,” by Maria Paul
Postpartum Depression photo from Shutterstock.