Lifting the Mask on Maternal Mental Health
By Jeanette Quiroga, MD
I admired the ultrasound picture with a grin from ear to ear. My heart pounded as happy tears rolled down my face. It was the first time in 9 years that the positive pregnancy test had turned into an ultrasound I could frame. By that time, we were deep into the complex world of In-Vitro Fertilization, on transfer number 4, getting close to the last of our 13 precious embryos. But we were finally pregnant. And, although the 37 weeks that followed were complicated by daily hormone injections, Chief Resident duties, and late nights on call protecting my bump from the chaos of the emergency room, we were on cloud nine in anticipation of the arrival of our baby girl.
The surge of emotions when they handed her to me and we locked eyes is something I will never forget. She was a part of me, and she was perfect. But after that moment, I just wasn’t the same. Days went by, and I thought to myself- this is exhaustion; it’s the hormones, the “baby blues,” surely this will get better. But it did not get better. The more time that went on, the more I cried, the more I felt like a failure as a mother, and the more disconnected I felt from this precious child I had wanted with all my being.
I had filled out the depression questionnaires slipped between piles of intake paperwork. Did I miss something? Why is this happening to me? Did I do something wrong? But It was not my fault. I was a highly educated woman, a physician, and a psychiatrist with postpartum depression.
Perinatal depression, formerly known as postpartum depression, is different than “baby blues” as it is characterized by depression symptoms that are more severe and persistent and can result in significant impairment in functioning. The term postpartum depression was recently broadened to include the perinatal period of pregnancy because it was found that up to 30% of postpartum depression actually begins during pregnancy. Symptoms of perinatal depression can include extreme sadness, loss of interest, poor concentration or indecisiveness and low energy. But the symptoms can become even more severe, to include extreme anxiety, feelings of guilt, self-blame or worthlessness, agitation, thoughts of death, as well as paranoia and psychosis. The symptoms may emerge during pregnancy or within a few weeks after giving birth and, when left untreated, may last for weeks or even months.
The exact cause of perinatal depression remains unclear, with a multitude of factors that are thought to play a part. Those factors include hormone fluctuations, especially the rapid shift in progesterone, estrogen, oxytocin, and prolactin after childbirth. As with other psychiatric diagnoses, a family history of mental health disorders can play a role, and environmental factors such as limited support coupled with sleep deprivation and the physical stress of childbirth and caring for a newborn may also be contributing factors.
The prevalence of perinatal depression is staggering. Studies show that around 15% of women experience perinatal depression. But the numbers may be even higher, as many cases go undisclosed and undiagnosed due to the stigma associated with mental health treatment.
Recognizing and treating perinatal depression is crucial to the well-being of both mother and baby. Screening tools have recently become a routine part of perinatal care; there are many antidepressant medications that have been found to be safe and effective in pregnancy and lactation, and novel treatments have shown promise for more rapid recovery. Emerging programs are also guiding primary care physicians, psychiatrists, and therapists through the complexities of perinatal issues, so doctors and their teams can work together to identify and address maternal mental health issues.
Although there are hurdles left to overcome, women are lifting the mask on maternal mental health. We are listening, sharing our experiences, and learning more about something that was once held secret, with the hope of guiding the next generation of women through healthier pregnancies and motherhood.
Dr. Jeanette Quiroga is the Medical Director of ECT and Neurostimulation at Laurel Ridge Treatment Center. She is also the founder of Ascend Psychiatric Specialty Services, where she specializes in the treatment of mood disorders, depression, and ADHD with a focus on women’s mental health.
This article is provided for educational and informational purposes only and does not constitute providing professional services or medical advice. Those seeking medical advice should consult with a licensed physician or medical provider.
