What are Perinatal Mood & Anxiety Disorders (PMADs)?

Most people have heard of postpartum depression (PPD), but there are actually a number of mental health issues that can arise during the perinatal period, which is anytime during pregnancy all the way through the first year after birth.


Postpartum Depression (PPD)

Because it is the PMAD that most people are already familiar with let's start with PPD. PPD, occurs in 1 out of every 7, or about 15%, of women and 1 out of 10 men (yes, men can experience PPD too, which is sometimes referred to a paternal postnatal depression or PPND). Naturally, those who have a history of depression are more at risk as are those who have more complicated pregnancies or deliveries.


Those with PPD may experience sadness, feelings of emptiness, hopelessness, anger, irritability or agitation, sleep disturbance, appetite changes, thoughts of suicide, etc. Many people mistakenly believe that PPD is a strictly hormonal occurrence. While biology or physiological factors play a role, it is more accurate to say that PPD occurs for biological, social, and psychological factors, just like any other mental health issue. For example, a mother might have a genetic predisposition to depression or sensitivity to hormonal changes, but may also have a lack of support postpartum, or have unrealistic expectations about being a mother.


PPD is distinct from the baby blues, which occurs in 60%-80% of new mothers, and about 10% of new fathers, usually 3-5 days after birth. The baby blues is characterized by heightened emotionality and tearfulness. The baby blues often resolves on its own as hormones stabilize. PPD on the other hand is not something that goes away on its own. So, if you have been experiencing symptoms longer than two weeks or symptoms that are impacting your ability to function or bond with your baby it is important to reach out for help.


If you are experiencing PPD, please know that it is not your fault and absolutely does NOT mean you don't love your baby. And please don't wait to get help. Like most things, the earlier you seek support, the better. You do not have to do this alone. Find a therapist at postpartum.net or call the postpartum international support line at 1-800-944-4773.


Suicide is one of the three leading causes of maternal death. If you are experiencing thoughts of suicide or think that your baby would be better off without you, call the toll-free National Suicide Prevention Lifeline at 1-800-273-TALK (8255), or chat online, available 24 hours a day, 7 days a week. You can also call 911 or go to the nearest ER.


Postpartum Anxiety & Panic Disorder

While it is "normal" for new parents to worry, when anxiety escalates to the point of dread or physical symptoms like rapid heartbeat, nausea, dizziness, or shaking, you may have postpartum anxiety or panic disorder. Postpartum anxiety affects about 10% of new moms with about half of those who have PPD also experiencing postpartum anxiety. Just like with PPD, postpartum anxiety can be helped with therapy and medication.


Sometimes thyroid issues, which can arise postpartum, can contribute to mood issues so it may be important to rule out an underlying medical condition.


Postpartum OCD (PPOCD)

About 30% of women suffering from PPD also experience postpartum obsessive-compulsive disorder (PPOCD). Although, PPOCD can occur alone as well. Symptoms of PPOCD can include obsessions and compulsive behaviors such as checking to see if the baby is breathing every 15 minutes. PPOCD can also include intrusive thoughts or fears about losing control and doing something impulsive, even violent. It is important to distinguish these types of thoughts from thoughts about wanting to harm a baby, which can occur in the context of postpartum psychosis. When someone has PPOCD and experiences intrusive thoughts, they can feel horrified by them or a tremendous sense of guilt and shame whereas people who have postpartum psychosis are not disturbed by such thoughts. So, if you are experiencing intrusive thoughts and find yourself alarmed, please know that these kinds of thoughts do not reflect wanting these things to happen. In fact, when researchers look at the brains of people who experience intrusive thoughts they see activity in the parts of the brain associated with protection. Your brain is just alerting you to things that could harm the baby in an effort to keep the baby safe. PPOCD can be helped with therapeutic interventions such as exposure and response prevention and mindfulness, as well as medications like anti-depressants.


Postpartum PTSD (P-PTSD)

While pregnancy and birth are common experiences, they can be traumatic. An estimated 9% of new moms suffer from postpartum PTSD (P-PTSD) as triggered by a traumatic event during labor and delivery such as experiencing fetal distress and having to undergo an emergency c-section. Someone with P-PTSD might have flashbacks or nightmares. Women with a history of depression, anxiety, or prior trauma are at a higher risk of developing P-PTSD. P-PTSD can be helped with therapy for trauma and sometimes medication.


Postpartum Bipolar Disorder

The postpartum period can also bring about the onset of bipolar disorder, which is characterized by periods of depression and periods of mania. Mania is basically the opposite of depression. So, whereas depression involves feeling down, mania is characterized by an elevated, heightened, or expansive mood, in addition to things such as irritability, hyperactivity, impulsivity, decreased need for sleep, reckless behaviors, poor judgment, and in severe cases delusions and/or hallucinations. About 50% of women with bipolar disorder are first diagnosed postpartum. Postpartum bipolar disorder can be helped with mood stabilizers.


Postpartum Psychosis

Postpartum psychosis is very rare, occurring in 1-2% of mothers, but is also very serious. So serious that it should be considered a psychological emergency and warrants a call to 911 or a trip to the nearest ER. Postpartum psychosis is characterized by a loss of touch with reality, such as delusions (e.g., the baby is possessed by a demon), and/or hallucinations (e.g., seeing someone else's face instead of a baby's face). It is in the context of postpartum psychosis that mothers will sometimes kill their infants, which is why it is considered emergent, and requires immediate attention. Anti-psychotic medication is likely necessary.


Resources

Postpartum Support International is an amazing resource for all things postpartum. They have online support groups as well as a provider directory to find an individual therapist in your area who has specialized training in PMADs. They also have a 24/7 support hotline available at 1-800-944-4773.


If you are interested in learning more or in working with me please go to my homepage to contact me or schedule your free 15-minute phone call.


Please note that the information in this blog is intended for informational purposes only. It should not be used as a substitute for psychological or medical care. If you are looking for professional help, visit my resources page for guidance on how to find a therapist. If you are experiencing a mental health emergency, call 911 or go to the nearest ER.