What is Perinatal Mood and Anxiety Disorders (PMAD)/Pregnancy Related Depression and Anxiety?

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What is the common thing about these celebrities; Brooke Shields, Courtenay Cox, and Gwyneth Paltrow?  They came out that they suffered from Postpartum Depression.  They are part of 13% of new mothers who suffered Postpartum Depression.  Postpartum Depression affects 1 in 7 new mothers in the USA at any given time.  

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Also, it is researched now that 1 in 10 dads experience depression and /or anxiety during their partner's pregnancy and after the birth of the baby. 

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It is normal to experience some mood swings, a bit of sadness, a bit of being overwhelmed, and anxiety to care for a newborn baby during pregnancy or after the birth of the baby.   They are usually mild where you can shrug it off and short-lived such as a couple of minutes to a few days.

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However, when these feelings take over your life for more than a few days and are affecting daily tasks, your work, and care for you and your baby, it may be one of Perinatal Mood and Anxiety Disorders.  It can start during pregnancy, soon after the delivery, or several months after delivery.  It can be diagnosed as Perinatal Mood and Anxiety Disorder up till one year after the delivery.

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It is very important that you reach out to healthcare professionals, like your primary care doctor, Ob-Gyn, midwife, nurse, or therapist, and express what you are experiencing to get professional help right away. 

 

If you do not know whom to call or talk to about scary thoughts, self-defeating thoughts, sadness, and guilt, call Postpartum Support International Helpline at 1-800-944-4773 or text them at 503-894-9453.  Check out their website at https://www.postpartum.net/

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You might have heard "time will heal", "just snap out of it" or "it is just laziness" about what you are going through.  They are not helpful for real healing.  PMADs are serious mental health disorders and should not be taken lightly or pushed aside.   With appropriate help and support, PMADs are treatable.  Research shows that the majority of women experience no symptoms with proper treatment after one year.

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If they are untreated, they can affect the physical health and development of your baby in the long run.  Also if they are untreated, it can cost a mother's life.  Sadly, suicide is one of the top reasons for women's death within one year of a baby's delivery in the USA. 

 

They can affect any woman regardless of age, marital status, education level, or socioeconomic level. Having these diagnoses does not mean your personal weakness, laziness, or personality fraud.  It is quite the opposite.  Often it is found that women who have a stronger sense of motherhood tend to experience these.  Sometimes, it is called "maternal instinct in overdrive".

 

 

What are the signs and symptoms of PMADs?

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There are 6 types of Postpartum Psychiatric Disorders.   

 

When you are experiencing these symptoms, you need to call your doctor or therapist right away to seek professional treatment.

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Baby Blues

 

This is not mental health diagnosis.  It usually starts soon after the delivery of the baby and lasts shorter than three weeks.  It happens to 80% of mothers.

Symptoms are mild mood swings, some sadness, crying spill, worries, lack of concentration, forgetfulness, and feeling overwhelmed.

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Prenatal Depression and Anxiety

 

During the pregnancy, mood swings, persistent sadness, irritability, guilt, lack of joy or pleasure, constant worry, excessive fear, scary thoughts, panic, or OCD symptoms happen. These symptoms make it difficult to carry on daily tasks and activities for a long period of time, more than a couple of weeks.  It does not go away on its own.

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Postpartum Depression

 

It happens after giving birth and one year after birth.  Some women experience depression after weaning. Symptoms are sadness, irritability, short temper, overwhelmed feeling, guilt, hopelessness, difficulty making choices, difficulty to remember, lack of joy or pleasure, or lack of feeling for your baby.  You have difficulty falling asleep when you can or staying asleep when you can.  You do not feel refreshed after rest.  You do not have any appetite.    You think that things will be better off without you.  You feel like you want to disappear, leave everything behind, hurt yourself physically, or kill yourself.

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Postpartum Anxiety

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It often occurs hand in hand with depressive symptoms.  These symptoms can happen all of a sudden or gradually emerges over a period of time.

Symptoms are excessive worry, excessive fear which is unreasonable for the situation, feelings of numbness, nausea, knot in the stomach, easily tiredness, feeling restless, agitated, irritated, feeling keyed up, difficulty relaxing when you can, or difficulty sleeping.

Postpartum Panic Disorder: It also can happen alongside depression and anxiety.  Often it feels like a heart attack.  The episode of panic starts with or without a particular triggering experience.  Usually, the panic attack ends within 20 to 30 minutes.

Symptoms are periods of extreme anxiety, fear, or worry, shortness of breath, hyperventilate, chest pain, feeling dizzy, feeling suffocating or choking, shaking, rapid heartbeat, a feeling of numbness, restlessness, irritation, or feeling like you are going to die or you are going crazy.

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Postpartum Obsessive and Compulsive Disorder

 

Fewer new mothers report OCD symptoms, and often it comes with depression or anxiety symptoms.  Women who had OCD tendencies or had OCD with previous birth tend to have recurrent OCD symptoms.

Symptoms are intrusive, repetitive, and persistent thoughts, visions, or rituals, repetitive behaviors, loss of appetite or fear of eating, or avoiding certain activities or behaviors.  Some women report frightening thoughts or visions, such as hurting their baby, some horrible things happening to their baby, hurting themselves, or thinking they are going to die.   They feel guilty, fearful, and disgusted by having these thoughts or pictures in their head.

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Postpartum Psychosis

 

This is the most severe form of PPD.  It happens approximately 1 or 2 in 1000 women after birth.  Symptoms emerge soon after childbirth, as soon as two or three days after birth, or within a few weeks. Symptoms can come and go.

It feels and looks very different from Postpartum Depression or Postpartum Anxiety.  The biggest difference is that people with psychosis usually cannot tell that their own thinking or belief is odd and bizarre and does not match reality.  They think it is normal.  On the other hand, people suffering from depression or anxiety feel like they are going crazy, but can tell that they are not acting like themselves and some thoughts are not normal and scary to have.

This disorder has an increased risk of women's suicide and infanticide.   

Common symptoms are delusional/bizarre thinking, hallucination, not being in touch with reality, confusion, suspicion, and paranoia.

 

 

Why is this happening to me?

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There are many identified risk factors for these PPD symptoms, such as hormonal changes, sleep deprivation, marital and family stressors, lack of social support, stressful life event before or during pregnancy, traumatic birth, family history of mental health disorder, or previous psychiatric history.   

 

However, there is no study that pinpointed one clear-cut cause for these disorders.  PPD also does not happen because of specific methods that you used for birth.  It happens to women with home birth, hospital birth, natural birth, or cesarean birth.

 

The most important point here is that it is not your fault.  You did not contribute to it or you did not create it.  It is an illness and it is treatable.    

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What are treatment options?

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There are few well-researched and well-established treatment options for PMADs.  You may choose to pick one or combine a few.  It is very important to keep doing what works for you to feel better and healthier, not because of solicitation or testimonials of others.  Just because you read or heard really good testaments of certain treatments, if it does not work, it is more than okay to say no to that treatment. Some treatment options may not work for you as well as others experienced.

The list below is not a comprehensive list of all the treatments for PMADs out there.  You may find alternative treatments that are not listed here that work for you, and that is great news.  More option is better.  

          

           Talk-Therapy/Counseling

           Psychiatric medications

           Electro-convulsive therapy (ECT)

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Other support and self-care treatment that other mothers found helpful.

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           Postpartum Women Support groups

           Mom and me groups

           Yoga           

           Meditation

           Acupuncture

           Chiropractic

           Ayurveda

 

 

Where can I get more information on PMADs and support?

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Massachusetts General Hospital; Center for Women's Mental Health

​National Coalition for Maternal Mental Health

​Postpartum Support International

​Postpartum Progress

 

 

References

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Massachusetts General Hospital; Center for Women's Mental Health

Beyond the Blues; Understanding and Treating Prenatal and Postpartum Depression & Anxiety, Shoshana Bennett & Pec Indman

Therapy and the Postpartum Women; Notes on Healing Postpartum Depression for Clinicians and the Women Who Seek Their Help, Karen Kleiman

Perinatal and Postpartum Mood Disorders; Perspectives and Treatment Guide for the Health Care Practitioner, Susan D. Stone & Alexi E. Menken

Diagnostic and Statistical Manual of Mental Disorders Fifth Edition, American Psychiatric Association

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Update on May 26, 2023

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