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.
18 comments on “Should Perinatal Mental Illnesses Be Treated Individually?”
Really interesting post. I suffered terribly from Post Natal OCD, and my Doctor thought it was pyschosis so I ended up having the trauma team visit my home 3 days before Christmas. They recognised what I was going through thank God. I really think that there needs to be more awareness around OCD especially, many GP’s don’t seem to understand this condition and it gets misdiagnosed which can often lead to more trauma and anxiety. #bestandworst
Absolutely. One of my greatest OCD fears was “am I psychotic?” so I can imagine how traumatic that must have been for you. More education needed for HCPs but hopefully this is moving in the right direction. Thanks for reading and commenting, Hun x
Very interesting and I too can see both sides. You don’t want to over complicate but specialist care for the separate aspects of PND may help further as more specific. It is good more research and work is going into this area too. Thanks for sharing with #bestandworst x
Still a long way to go with research but slow progress is being made. Thanks for reading and commenting x
I agree with you certain aspects should definitely be kept separate, because symptoms vary so dramatically. Yet as you said others overlap, so it’s definitely worth putting them in an umbrella category but focusing on what symptoms someone may be having. I think mental illness as a whole can sometimes have overlaps, and people don’t recognise it, more definitely needs to be shared so this stops becoming a stigma. xxx #BloggerClubUK
There are definitely lots of overlaps with mental health issues. The medical field still has such a long way to go but hopefully progress is being made. Thanks for commenting x
Thank you so much for sharing. I suffer from PTSD and Anxiety and Panic attacks, but they don’t stem from my pregnancies. I absolutely feel that there needs to be more attention. The stigma is terrible for mental illness and new moms are under so much pressure an worry so much about how they are doing and what others will think of them or judge them. With more research, more information out there for the public, maybe women will come forward for help when they need it most.
Completely agree. I also think that anxiety isn’t taken as seriously as it should be – I personally find anxiety more challenging than depression even. Thanks for reading and commenting, and I’m sorry for your struggles x
What a great post, so informative! I have suffered with PND for twelve years now but also antenatal depression and the worst I think for me, postnatal anxiety. I have been lucky to be treated for all three, through counselling and CBT and I have a supportive GP in that respect. I agree that more needs to be done for the other types of pregnancy related mental illness, it’s great that everyone is aware of PND and treatment plans are in place but the others should be getting the same kind of treatment also. Fab post. #bestandworst
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Totally agree, thanks for reading. I too find anxiety more debilitating than depression X
Great post! In Australia they categorise everything as PND. Really not helpful for patients or workers. I think although there may be overlap that essentially the treatment is unique for each. Anti depressants can be for both anxiety and depression but time, symptoms etc differ. As someone who had psychosis and am recently diagnosed with bipolar but as we don’t differentiate in Australia it is difficult for me to know where I sit on the diagnosis spectrum. And that makes it hard as a patient and I can understand why my condition was not picked up earlier by workers. Confusion abounds.
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I can’t believe they don’t even separate psychosis, terrible. Thanks for reading and commenting, lovely x
Crikey, I never realised PND was so complex. What a minefield.
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I know, it’s so complex and sadly many medical professionals don’t even know what to do *sigh Thanks for reading X
This is a really good point & I don’t know which side is right – to separate or not. As you said, you don’t want any added pressure of knowing which you fall into at the time. I guess knowing how to help is more important than the label. Thanks so much for joining us at #bloggerclubuk x
This is really true. The labels are good for HCPs but all us mums’ need is access to treatment and support. Thanks x
Well, I have had post partum anxiety and then in another pregnancy I developed OCD. I think psychosis should definitely be in a category all its own. The others I am not sure. I think what would have been most helpful to me is to have known ahead of time that post partum anxiety and OCD were even possible. Depression is the only think I had ever heard of. I have never been depressed or down after birth ever. Not in any way out of the norm. But having intrusive thoughts in my head and checking to make sure my baby wasn’t dying of SIDS every 5 minutes was not on my “List of Things to Expect or Watch Out For”. A heads up from my doctor would have been nice.
I don’t think it really matters at that point whether you call it OCD or anxiety or whatever, but just to have been given a list of “abnormal” behaviors or developments that would be considered quite “normal” for a “post partum” woman to experience, would have been quite helpful to me and I think I may have not over reacted to them the way that I did, thus prolonging them.
I couldn’t agree more. I didn’t know much about anxiety either and I think the shock was one of the hardest things about it. Thanks so much for reading and for your thoughtful comment x