All About Perinatal Mood and Anxiety Disorders (PMADs)

What are Perinatal Mood and Anxiety Disorders (PMADs)?

Perinatal mood and anxiety disorders, also known as PMADs for short, are the most common complication of childbearing. It’s estimated that up to 1 in 5 to 7 women will experience a perinatal mood and anxiety disorder and 1 in 10 fathers will experience postpartum depression.

The term “perinatal” refers to the period from pre-conception (for example, fertility challenges) through the first year after giving birth or after the loss of a pregnancy or infant. In the past, the term “postpartum depression” (PPD) has been used more broadly to refer to mental health issues that come up around the life transition of having a child. While PPD is an important mental health condition to recognize and treat, the term only refers to one mental health condition, and only refers to the period after childbirth. The term “perinatal”, which is now being used more commonly, captures the longer span of time that we can see mental health conditions related to childbearing arise.

Similarly, the term PMADs is meant to encompass a wider range of mental health conditions that can happen during this period, rather than just depression. Under the umbrella of PMADs are three anxiety disorders and four mood disorders, and each has their own distinct criteria that must be met to meet a diagnosis. However, even if you do not meet full criteria for a diagnosis, you are still worthy of receiving support for your symptoms and can benefit from treatment.

Types perinatal mood and anxiety disorders:

• Major depressive disorder

• Generalized anxiety disorder

• Obsessive-compulsive disorder (OCD)

• Panic disorder

• Post-traumatic stress disorder (PTSD)

• Bipolar disorder

• Psychosis

Common signs and symptoms of perinatal mood and anxiety disorders can include:

• Excessive crying and sadness

• Excessive worry and racing thoughts

• Other intense emotions like anger, rage, irritability, guilt, shame, or hopelessness

• Intrusive thoughts and images

• Loss of interest or pleasure in things you used to enjoy

• Sleep disturbances not related to baby waking 

• Changes in appetite

• Thoughts of harming the baby or yourself

PMADs vs. Baby Blues

It’s important to note that PMADs are different from the baby blues. The baby blues are a common, temporary period of adjustment where mothers may experience exhaustion, overwhelm, tearfulness, and crying spells. Around this time, sleep deprivation is setting in, hormones are fluctuating drastically as pregnancy hormones drop and milk comes in, and parents are leaving the hospital and newly adjusting to life at home. The baby blues typically occur from two days up to two weeks postpartum and peak around days 3-5. If these symptoms continue beyond the first few weeks postpartum, they may be a sign of postpartum depression or another PMAD.

What Causes PMADs?

PMADs can impact anyone regardless of age, race, or income level. They are not a sign of personal weakness or a sign that someone is unfit to be a parent! There are a number of risk factors for PMADs, and the more of them you have, the more likely you may be to develop a perinatal mood or anxiety disorder. 

Risk factors for PMADs:

• Hormone changes

• Abruptly ending breastfeeding

• Sleep deprivation

• Unwanted pregnancy

• Infertility

• Pregnancy or infant loss

• Complications during pregnancy or delivery

• Health challenges for baby or baby staying in the NICU

• Traumatic birth experience

• Hyperemesis gravidarum

• History of mood or anxiety disorders - personally or within the family

• Lack of social support

• History of abuse 

• History of Adverse Childhood Experiences (ACEs)

• Systemic racism and prolonged discrimination

• Financial stress

• Barriers to adequate care

• Recent loss or life transition

• Relationship stress

Treatment Options

If you or a loved one is struggling with a perinatal mood or anxiety disorder, the good news is that there is hope. Treatment options including therapy, medications, and peer support groups have been shown to be effective!

Therapy

Working with a trusted mental health professional is a key part of the path to wellness for many people during the perinatal period. During this time, you may wish to seek help from a therapist who is certified in perinatal mental health (PMH-C) or who has experience working with perinatal mental health issues. Many therapists who do not specialize in this area are also capable of offering support and evidence-based interventions that can still be very effective during this time. So, if you already have an existing relationship with a therapist who you feel safe and comfortable with, resuming or continuing your work together may be a great option as well. 

If you’re looking for a new therapist who specializes in this population, I recommend looking at the directory of providers offered by Postpartum Support International (PSI), which can be found here. You can also ask your OBGYN or midwife for referrals, as they likely already have some providers in mind that they refer patients to for mental health concerns. You can also do an online search for therapists in your area, adding terms like “perinatal mental health” or “PMH-C” to narrow down your options. 

When you’re looking for a therapist, keep in mind that it’s okay to shop around. The relationship, trust, and connection you have with your provider is an important factor in the healing process - listen to, and trust, your gut reactions about whether or not someone feels like a good fit for you. Even if it looks like you may be a good fit with someone on paper, if you’re still not feeling like it’s a good fit after a few sessions, don’t be afraid to keep looking and meet with someone else.

Medications

There are a number of psychiatric medications that are considered safe to take while pregnant or breastfeeding for the treatment of PMADs, despite the misconception that psychiatric medications shouldn’t be used during pregnancy or the postpartum period. It can also be important to consider that, for some, there may be more risks associated with not taking medication or going off of it than there would be with taking medication during the perinatal period, depending on the nature of their mental health condition. If you’re interested in exploring medication options, discussing this with your OBGYN or nurse midwife can be a helpful starting point. 

Peer Support Groups

Peer support groups are often free, many are virtual, and centered around sharing experiences, giving and receiving support, and decreasing isolation. They can allow you to discuss your experiences with others who are in a similar phase of life and allow you to have a greater sense of community, which is especially important during major life transitions. To find peer support groups near you, you can talk to your providers for recommendations, search online for local ones available (especially if you’re looking for something more in person), or you can look through the list of support groups offered by PSI here.

Lifestyle Changes

In addition to exploring these treatment options, making some lifestyle adjustments can be beneficial as well, particularly related to sleep, nutrition, movement, and getting time to yourself. The good news is that making small, often free or low-cost changes in these areas can make a difference!

Sleep

It’s no secret that sleep is expected to be challenging due to the demands of having a new baby, however, increasing stretches of uninterrupted sleep, when possible, can make a big difference. One study found that can be both necessary and effective to protect a 4-5 stretch of uninterrupted sleep for the birthing parent, especially if they are having symptoms of postpartum depression or other mental health issues. When I took a childbirth class years ago, a doula also suggested to me that having a 4 hour stretch of uninterrupted sleep could be protective against postpartum depression. 

Increasing our access to sleep is going to depend on the resources and support we have available to us and will likely require some planning ahead. If the baby wakes, who will feed them when mom is resting? Do you want to pump to make milk available? If you’re concerned about what a 4-5 hour stretch will do to your milk supply, do you need to speak with a lactation consultant? If the option is available to you, you can also see if you can do shifts with your pattern and capitalize on the times when you are naturally the most tired and able to find a deeper sleep. Finally, don’t forget that it does get better. As babies get older, they will sleep better and longer, and you will too. If you’re really struggling to fall or stay asleep, even when the baby is sleeping during the night, it’s worth exploring with a healthcare provider.

Nutrition

Our nutrition often changes during the perinatal period due to nausea and vomiting during pregnancy, cravings, irregular eating patterns, appetite changes, and more. Making some adjustments to balance your blood sugar can help reduce stress, fatigue and irritability and be helpful for balancing your hormones and improving your mood and sleep! Eating snacks and meals regularly, ensuring you are getting protein and healthy fats in your diet, and limiting sugar and caffeine intake are all important parts of blood sugar balance.

Movement

When it comes to movement, think about what’s gentle (especially if you’re in the postpartum period) and doable, and talk to your OBGYN or midwife about what’s appropriate for you. Often, a brief walk around the block alone can bring a mood boost due to the added benefits of fresh air and change of scenery. Finding a form of movement that is safe for your body’s needs and is enjoyable to you can make a difference in how you feel relatively quickly!

Time to yourself

We are worthy of the rejuvenation that alone time can bring. While meeting this need gets more difficult during the perinatal period, it also becomes more important. You may decide to start with something small, such as running to get a coffee by yourself, taking a few minutes to journal or spend time in nature, or watching a bit of a show you enjoy. For many, a challenge of getting necessary alone time is finding help or feeling comfortable asking for it. If you do have the help available to you, remember that you deserve time to yourself and that this is an opportunity for you to get more comfortable with asking for and receiving help - something that you will surely need to do more of if you are welcoming a child. Also, try to not count chores or time in the bathroom as “me time”!

Social support

We know that boosting social support can play a major role in helping with the adjustment to parenthood, especially if you’re struggling with PMADs. Discussing both the joys and challenges of this season of life with non-judgmental listeners who can offer support is important. This can be a partner, parent, sibling, or a friend, for example. Mom groups, childbirth classes, and breastfeeding support groups can be other wonderful ways to find social support and connection.

If you or someone you love may be suffering from PMADs, remember that help is available and that there is hope. For additional support, you can check out postpartum.net. If you’re in the state of Michigan and would like to discuss how I may be able to support you in your journey, please feel free to reach out so we can connect!