Anna Glezer, MD, reproductive psychiatrist

Sydney McCall Patel, LMFT, postpartum depression and anxiety specialist

Perinatal mood disorders are extraordinarily common - up to 80% of new mothers experience baby blues, and up to 20% experience postpartum depression and anxiety. Yet for women who are struggling during any phase from preconception through pregnancy to postpartum and loss, there can be stigma and shame attached with sharing our struggles. It can also be challenging to take that first step toward getting professional help. 

We sat down with reproductive psychiatrist Anna Glezer, MD, and postpartum depression and anxiety specialist Sydney McCall Patel, MFTA, to help elucidate issues around perinatal mental health - especially around when to get help. What we’ve learned is that continuing to have conversations helps to demystify therapy and remove the shame. 

Can you talk about the interplay of hormones, neurobiology, and psychology on mental health in the fourth trimester?

The biology and physiology of motherhood is complex and we are working to understand all the factors that interplay - from the molecular level of neurotransmitters, hormonal influences, genetic and epigenetic components to larger lifestyle factors such as stress, sleep, and the environment. 

What is matrescence and how can therapy support a pregnant mother during this transformation? 

Matrescence is an important way of understanding motherhood. Just as in puberty, having a new child also changes a woman's hormonal and chemical makeup, which affects emotions, interests, thoughts, and energy. Armed with this knowledge, a mother can be more gentle with herself, let others know what she’s going through, and ask for more space and understanding. 

Physiologically, there are many changes that occur during pregnancy at the levels of hormones, blood flow, molecular signaling, and more. The flood of estrogen and progesterone during pregnancy can lead to mood swings and those hormones interact with many others. The changes in sleep can be particularly profound and impact both biology and psychology. Apart from that, it's natural to have emotions concerned with security and finances during pregnancy and thoughts about the shift in identity both for mom and the entire family unit. After pregnancy, the rapid loss of the pregnancy hormones can contribute to the very common baby blues (75 to 80% of women report experiencing them) and the highly prevalent postpartum depression and anxiety (15 to 20% of women report experiencing them). 

Therapy can provide stillness in order to see our reflection in these waters. It teaches us to cultivate a kinder relationship with ourselves as we uncover who we are and what we need. When we discover how to listen to what we deeply require, then from that place of being cared for we learn to care for our children. It can also provide concrete skills (such as cognitive reframing, mindfulness, and more) to help us during this period of transition. 

What is the spectrum of perinatal mood disorders? What is normal, not normal, and how can you recognize when you should get help? 

Up to 80 percent of women experience baby blues. This seems to be a very natural response to the loss of the surge of pregnancy hormones and leads to weepiness, irritability, and anxiety. These symptoms begin within the first few days postpartum, peak by the end of the first week, and dissipate toward the end of the second week. 

If they persist and become more intense, this may be a sign of postpartum depression (PPD) and women should seek help through therapy and possibly medication. PPD can include the inability to bond with the baby and thoughts of suicide and anxiety is often a prominent symptom. 

Another perinatal mood disorder to be aware of is postpartum anxiety. This includes panic disorder, obsessive compulsive disorder, and generalized anxiety disorder. It can manifest as panic attacks, sleeplessness, worry thoughts and compulsions, thoughts of harming one’s baby and incessant anxious thoughts.

Post-traumatic stress can also be triggered during the perinatal period. 

Lastly, and far less common (about 1 to 2 of every 1,000 women), is postpartum psychosis which requires immediate intervention as it includes delusions, hallucinations, and disorganized thinking.

If you are contemplating getting help, then getting some help is probably a good idea. If symptoms are extreme and you feel alarmed, then getting support right away can be critical.

What are some examples of topics a mental health professional help with in the months following birth?

Processing your birth (traumatic delivery, not what you expected, etc.)

Breastfeeding

Questions about medication safety if you are breastfeeding

Difficulty with the transition to parenthood

Identity changes

How do I know if I should continue with my therapist or see someone new? Is individual or group therapy more appropriate? What are the benefits of each?  

In general, it might be best to stick with a therapist with whom you already have an established strong relationship. If that therapist needs more support about how to specifically address postpartum symptoms they can consult with a specialist. However, if your symptoms are not subsiding and you feel you are not getting better then it’s important to speak with your therapist about this issue and get the help you need to get better. This may include seeing a PPD specialist.

Going to individual therapy versus group therapy is a very personal decision. One thing to keep in mind is that group therapy is different from general group support (like a mama’s circle or baby and me class). Group therapy is led by a professional and has therapeutic benefits and goals. Group support can also be useful, but it is not always led by a certified professional and the main purpose is to provide community and support. For some, the group experience is exactly what they are looking for as they need to puncture the suffering caused by isolation and they recognize they can achieve this by hearing their struggles echoed by others. This sharing of experience can be incredibly healing.

If I have struggled with mental health issues in the past, how can I best prepare for the postpartum months?

This is such an important question. Try focusing on that which has ensured you feel well in the past. This could mean medication, psychotherapy, and a focus on self-care. If you’re not already connected with either individual, couples, or group counseling, that’s often a great place to start to ensure healthy support during this vulnerable time. We also encourage you to focus on compassion for yourself and on ensuring that you feel repleted and nourished. That means focusing on sleep and good sleep hygiene, a healthy diet, physical activity, and time in nature. It also means ensuring a well-rounded system of support and becoming comfortable asking for help. If you’re on medication, have a conversation with your doctor about the right dosing and your options for pregnancy and postpartum.