Before I had Caterpillar the words Perinatal Mental Illness or Perinatal Mood & Anxiety Disorders had never entered my vocabulary. I had heard of one – Postnatal Depression – but as with most who’ve never experienced it my knowledge was limited and – shamefully – stigmatised.
When Caterpillar was born and I first realised I wasn’t at all well I didn’t display what I knew as “classic” depression symptoms: i.e. feeling unable to get out of bed, unmotivated to leave the house, not wanting to be around others, lethargic, tearful etc. In fact, I felt quite the opposite. I couldn’t stand to be alone, I couldn’t bear having no plans or nothing to do. Hiding under the duvet was my worst nightmare as that would firstly, leave me alone with my loud and frightening thoughts and secondly, remind me that I had been unable to sleep for the last five nights in a row.
Instead, I felt only one overriding emotion – terror. It came in all forms, brought all manner of thoughts with it and affected my physical health and yet it all boiled down to fear. Or, for clinical purposes, anxiety. I knew I felt anxious, I suspected I was experiencing extremely frequent panic attacks and I knew I’d recently had a baby so I assumed it was some form of Postnatal Depression and yet the lack of “depression” threw me a little.
When I was diagnosed by a psychiatric nurse it was as having PND and yet it was anxiety they talked about and anxiety we began treating. When I discuss my experience now, via blogging or in real life, I tell people I had PND – because that is the familiar term that requires less explanation and the condition recognised by medical professionals. But in reality, if I had to pigeonhole myself I would say I had Postnatal Anxiety with a large side dish of Postnatal OCD.
The first time I saw mental illness in the perinatal period being discussed using these separate terms, among others, was on the fantastic US site Postpartum Progress. According to them, and other leading experts in the field over there and – progressively – in the UK too, there are, in fact, eight types of Perinatal Mental Illness:
- Postnatal Depression
- Antenatal Depression
- Postnatal Anxiety
- Postnatal OCD
- Postnatal Panic Disorder
- Postnatal Post Traumatic Stress Disorder (PTSD)
- Postpartum Psychosis
- Bipolar, Perinatal Onset
Postpartum Progress have provided definitions for all these illnesses here.
The trend is the U.S. is to separate these illnesses and recognise them as separate conditions requiring separate treatment and I very much appreciate the need for this. When it comes to Postpartum Psychosis and Bipolar, Perinatal Onset these are very different illnesses and absolutely need to be recognised as such and treated accordingly. But what about the others? Is the difference between the remaining conditions so cut and dried or do almost all sufferers experience elements of several at once?
I certainly experienced many elements over the course of my illness. It began with intense Postnatal Anxiety, with a lot of intrusive thoughts and some compulsions symptomatic of Postnatal OCD. This sometimes lead to panic attacks, characterised by Postnatal Panic Disorder. And eventually the Postnatal Depression set it – sadness, anger and isolation. I would go so far as to say I experienced a small amount of PTSD and some mild anxiety during pregnancy too. So I ticked all six boxes.
I’ve met many others who also experienced a great deal of overlap between conditions so is it actually helpful to separate them or not? As with most things in life, there are pros and cons:
- Recognising separate conditions makes it easier for healthcare providers to make sure you’re receiving the most appropriate treatment
- The very fact that these illnesses are recognised separately may encourage more research and more funding into all elements of the illnesses as opposed to just stereotypical symptoms
- Specific categories brings with it specific symptom lists and more detail (as demonstrated by the brilliant Postpartum Progress’s Symptoms in Plain Mama English list) which will help sufferers to feel they are not alone and their feelings are understood
- Many people, like myself, experience a lot of overlap and may feel pressure to pick the most severe/frequent area of concern
- Depression and anxiety are almost always comorbid, one can lead to the other and back again, so by clinical definition almost impossible to separate
- Suffers may feel pigeonholed into one category and symptoms from other categories may go untreated and given less priority
- Could make it difficult to find the appropriate treatment path
I have no idea what the right answer is at this point, and I’d be really interested to hear response/opinions from the British experts in the field. My gut feeling at present is that Postpartum Psychosis, Biopolar Perinatal Onset and Postnatal PTSD should definitely be kept separate as there are very clear-cut differences between those illnesses and the rest. Regarding the remainder, a certain amount of overlap dictates that perhaps our medical professionals should still be treating these under one umbrella – but perhaps that umbrella should be Perinatal Mental Illness as opposed to simply Postnatal Depression.
The most important thing, of course, is that all of these illnesses receive the research and funding necessary – but that’s another post entirely.