What is Prenatal and Postpartum Depression (PPD)?

Pregnancy is a profound experience of physiological and psychological change. Motherhood becomes a new identity and attachment with the unborn child forms. This time can bring about many changing feelings and cognitions. For some, pregnancy is a very positive experience, despite the physical demands; however, for many, this time can be distressing and activating. Women who have been traumatized in the past may find pregnancy to be especially troubling. Conflicting feelings and self-doubts may arise, contributing to post-traumatic stress disorder (PTSD), depression, anxiety, substance abuse, and other mental health issues.

Symptoms of Prenatal and Postpartum Depression

Prenatal depression refers to depression that occurs while pregnant, and perinatal, or postpartum, depression (PPD) refers to depression that happens after pregnancy. Some mothers may feel depressed before and after her child’s birth. Additionally, women often experience anxiety and PTSD symptoms along with depression. Typically, psychological symptoms vary in presentation and intensity and include:

  • Panic attacks
  • Oversleeping
  • Insomnia
  • Lack of appetite
  • Loss of interest in once appealing things
  • Fear of hurting one’s child
  • Intense sadness
  • Anxiousness
  • Anticipatory anxiety
  • Constant worry
  • Guilt and shame
  • Relationship conflict
  • Feeling overwhelmed
  • Fluctuating self-identity
  • Suicidal thoughts

How Many Women Have Postpartum Depression?

Many mothers experience the “baby blues”, or feeling periods of worry, sadness, and frustration. In fact, the American Pregnancy Association found that 70% to 80% of moms feel mood swings. These feelings are common and typically reside after a time of adjustment. However, according to the Centers for Disease Control and Prevention, approximately 1 of 8 of new mothers are affected by PPD. Unfortunately, many mothers are not formally diagnosed with PPD and may suffer without treatment. Without support, these moms are a higher risk of suicide. Suicide is a leading cause of death among mothers during the postpartum period.

When a mother is consumed with depression and anxiety symptoms, she may have difficulty bonding with her child. The needs of an infant are hard to manage when a mom is feeling overwhelmed and withdrawn. Attachment with a child requires an intense focus on the relationship and attunement to a child’s needs. This attunement can be hampered when a mother is unable to devote emotional resources to her child.

What Causes Depression During and After Pregnancy?

A biopsychosocial model explains the development of depression and anxiety during the prenatal and perinatal periods. Biological, psychological, and social factors contribute to how well a new mother adapts psychologically to motherhood.

Hormonal fluctuations have a major influence on a mother’s psychological well-being. Levels of reproductive hormones, including progesterone and estrogen are constantly in flux, which can influence a mother’s mood and energy levels. Additionally, alterations in thyroid function, HPA axis function, and lactogenic hormones influence a mother’s psychological well-being.

Mothers who underwent fertility treatments may have been exposed to additional hormones and procedures. Even when a mother became pregnant, the worry about miscarriage and the baby’s health continue to be stressors throughout pregnancy.

Mothers who struggled with psychiatric disorders before becoming pregnant are more likely to exhibit symptoms of PPD. Having a depression, bipolar, or anxiety disorder prior to pregnancy can lead to an exacerbation of related symptoms during pregnancy and after birth. Additionally, individuals who deal with chronic medical problems are at higher risk of developing mood-related disorders both during and after pregnancy.

Mothers who are not supported by their friends, family, and community are much more likely to feel symptoms of depression and anxiety. Raising a child is extremely demanding and when there is a lack of support, a mother’s social isolation contributes to psychological issues. Mothers who have a history of trauma may find motherhood triggering. PTSD symptoms can appear and interfere with daily activities and infant bonding.

Therapy for Prenatal and Postpartum Depression

New mothers should not suffer alone. Treatment for prenatal and PPD should include the mother’s psychologist, physician (i.e. OBY/GYN), doula, nurse mid-wife, and any other maternal healthcare providers. Additionally, the child’s father and other family members may be involved in therapy.

Research has shown that psychological treatment for prenatal and PPD is effective and can significantly alleviate symptoms. Treatment may include:

Cognitive-Behavioral Therapy (CBT): CBT for postpartum depression is a comprehensive psychotherapy approach aimed to positively change a mother’s emotions, thoughts, and behaviors. Using CBT, a mom will learn new and effective ways of dealing with disturbing feelings and thoughts. She will develop an array of helpful coping skills to help overcome her problems and to live a more fulfilling life with her family.

Prenatal and Perinatal EMDR: Mothers who are struggling with traumatic pasts may benefit from traumatic processing and resourcing using EMDR therapy. This therapy is focused on processing stored memories of traumatic events. Bilateral stimulation is utilized to facilitate memory processing, leading to a resolution of negatively stored memories. An important part of EMDR therapy for PPD is a focus on resourcing, which are techniques used to maintain stabilization, calmness, and relaxation.

Hypnosis: Hypnotherapy is a therapy focused on making internal and behavioral changes using direct and indirect suggestions given by a hypnotherapist. Hypnosis can lead to a positive change in one’s mindset, leading to improved daily functioning.

Marriage Counseling: Fathers can experience symptoms of depression and anxiety with the demands of fatherhood and marriage. The stressors of parenthood can cause relationship conflicts. Marriage counseling provides a therapeutic space to work on these conflicts and to develop healthier communication styles.

Lifestyle Guidance: Ensuring that moms are getting adequate sleep, exercise, nutrition, and self-care are all essential for her psychological and physical well-being.

How to Start Counseling

Dr. Mazzei is a Health Psychologist who has helped many moms overcome their emotional struggles. Based on your needs, she integrates evidence-based psychological therapies into treatment. She aims to foster a compassionate space while instilling hope, facilitating insight, and encouraging positive change.

Within a compassionate and supportive space, Dr. Mazzei will help facilitate the necessary changes so that you can better enjoy motherhood. She will coordinate with other healthcare providers to ensure that you are being fully supported during pregnancy and after childbirth. If you or someone you know could use PPD therapy, please reach out to schedule an initial consultation or to ask any questions. Dr. Mazzei offers online postpartum depression therapy, as well as therapy at her office in Chandler, AZ. To start therapy, please text 480-448-6755 or schedule an initial consultation.


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