Perinatal Mood and Anxiety Disorders
Did you know that PMADs affect at least 1 in 5 birthing people during pregnancy and/or during the first year after childbirth? These illnesses – also known as perinatal mood and anxiety disorders, or PMADs — are the #1 complication of pregnancy and childbirth.
PMADs are a spectrum of emotional complications that can affect expectant or new parents at any point during pregnancy or the first year after birth. PMADs most commonly impact the birthing person, but fathers, partners, adoptive parents can also experience anxiety, depression and other mood disorders after baby comes.
Women of every culture, age, income level, and race can develop PMADs. Onset of symptoms may be gradual or sudden, but should never be ignored. There are many reasons why PMADs occur, and often are caused by a “perfect storm” of changes in biology, physiology, lack of sleep, transition in identity (from pregnancy to parenthood) and one’s own expectations of parenthood versus the reality of a new baby.
The good news is that PMADs are temporary and are treated with some combination of self-care, social support, talk therapy, and, if necessary, medication.
Symptoms of PMADs
Birthing people suffering from anxiety, depression and other PMADs can experience a wide range of symptoms, from sadness to anger and everything in between. Symptoms can vary from person to person and even from pregnancy to pregnancy for the same woman.
Birthing people experiencing PMADs may:
- feel sad, hopeless, or overwhelmed
- feel anxious or panicky
- regret having a baby
- have trouble sleeping, even when baby sleeps
- think her family would be better off without her
- fear leaving the house or being alone
- isolate herself from friends and family
- have unexplained anger or irritability
- fear she might harm herself or her baby
- have trouble coping with daily tasks
- have difficulty concentrating or making simple decisions
- feel “out of control”
- feel guilty for feeling this way
- feel relentless worry
- feel tremendous self-doubt
Birthing people experiencing PMADs may feel physical symptoms:
- dizziness or lightheadedness
- persistent headaches
- racing heart
- chest pain
- shortness of breath
- numbness in hands or feet
Birthing people experiencing PMADs say:
- This is supposed to be the happiest time in my life… why am I so sad?
- Everything would be better if I got a good night’s sleep.
- I feel like the worst mother in the world.
- I’m having thoughts that are scaring me.
- Why am I such a failure?
- I worry all the time.
- Why can’t I snap out of it?
- I want to run away.
Experiencing any of these symptoms, especially if they last for more than two weeks, could be a sign of depression or anxiety. Reach out for help–there is no reason to suffer.
Predictors & Risk Factors for PMADs
Many factors can contribute to perinatal mood and anxiety disorders including changes in hormones, biology, psychology, and environment. These factors can vary from individual to individual and even from pregnancy to pregnancy for the same woman.
Risk Factors that can contribute to PMADs are biological, social/environmental and psychological:
- the dramatic change in hormone levels occurring during pregnancy and postpartum
- previous postpartum or clinical depression
- family history of depression
- personal history of mood/anxiety disorder
- severe premenstrual syndrome
- fertility treatments
- thyroid changes
- lack of sleep
- life changes (new home, new job, changes in work status)
- loss of a loved one
- isolation or lack of social support
- history of trauma
- domestic violence
- systemic racism
- substance use
- financial stress
- barriers to communication
- perfectionist tendencies
- difficulty with transitions
- unrealistic expectations
- relationship issues
- low self esteem
- anxious or highly sensitive personality
- feeding baby
Understanding the Many Types of PMADs
PMADs are disorders that last more than a few days and are not likely to resolve with time and without intervention. They are more severe and lasting than what we call "baby blues." If symptoms persist after the first two weeks postpartum, they are most likely a PMAD.
Most birthing people — up to 80% — experience a wide range of emotions, including sadness and irritability, during the first few weeks after baby is born. Often referred to as the “baby blues,” this is not a mood disorder but rather a normal adjustment as pregnancy and postpartum hormones calibrate. Symptoms usually last no more than 2 weeks and resolve without medical intervention. If it lasts longer than 14 days, it is more than the blues. Learn more about the Baby Blues.
A person experiencing perinatal depression during pregnancy or the first year postpartum might have social withdrawal and feelings of anger, sadness, irritability, guilt, lack of interest in the baby, changes in eating and sleeping habits, trouble concentrating, and feelings of hopelessness and sometimes even thoughts of harming the baby or themselves. Early assessment and treatment is crucial to prevent it from becoming a chronic condition. Learn more about depression including risk factors, symptoms and treatment options.
A person with anxiety may have extreme worries and fears, often over the health and safety of the baby and experience insomnia as a result. Some birthing people have panic attacks and might feel shortness of breath, chest pain, dizziness, a feeling of losing control, and numbness and tingling. Learn more about anxiety, including risk factors, symptoms and treatment options.
Perinatal Obsessive-Compulsive Disorder (OCD)
People with OCD can have repetitive, upsetting and unwanted thoughts or mental images (obsessions), and sometimes they need to do certain things over and over (compulsions) to reduce the anxiety caused by those thoughts. These moms find these thoughts very scary and unusual and are very unlikely to ever act on them. Learn more about OCD, including risk factors, symptoms and treatment options.
Perinatal Panic Disorder
This is a form of anxiety in which the sufferer feels very nervous and has recurring panic attacks or feels unsettling physical symptoms such as trembling, numbness, restlessness and agitation. During a panic attack, she may experience shortness of breath, chest pain, claustrophobia, dizziness, heart palpitations, and numbness and tingling in the extremities. Panic attacks seem to go in waves, but they are temporary and resolve without assistance.
Postpartum Post-Traumatic Stress Disorder (PPTSD)
PPTSD is often caused by a traumatic or frightening childbirth, and symptoms may include flashbacks of the trauma with feelings of anxiety and the need to avoid things related to that event. Learn more about PPTSD, including risk factors, symptoms and treatment options.
Psychosis– A TRUE MEDICAL EMERGENCY
Individuals experiencing psychosis sometimes see and hear voices or images that others can’t, called hallucinations. They may believe things that aren’t true and distrust those around them. They may have persistent thoughts of harming self or baby that are spurring them to act or to make a plan to act. They may also have periods of confusion and memory loss, and seem manic. They often have profound agitation and extreme sleep deprivation. This severe condition is dangerous so it is important to seek help immediately.
Perinatal postpartum psychosis is a very serious emergency and requires immediate medical help.
If you or someone you know may be experiencing postpartum psychosis, call a doctor or go to the nearest hospital emergency room. People with severe perinatal postpartum psychosis may require hospitalization and medication. Learn more about psychosis, including risk factors, symptoms and treatment options
Treatment for PMADs
Each person’s treatment plan and path to wellness will differ slightly, but the most successful plans include:
- A complete medical examination (some medical conditions, such as a thyroid imbalance and anemia, are fairly common in the postpartum period and can contribute to feelings of depression and lethargy)
- A psychiatric evaluation
- Self-help techniques
- Participation in a support group
- Talk therapy with a psychologist or counselor
- Medication and/or hospitalization when necessary
Read more about the Path to Wellness.
About Medications for PMADs
Several medications are available to treat the symptoms of anxiety, depression, and other perinatal mood and anxiety disorders that are considered safe for both pregnant and breastfeeding people. Decisions about medication are very individualized and should be made in consultation with a medical professional–particularly one who is familiar with the treatment of PMADs. Find a list of providers here.
Several websites provide information about medications taken during pregnancy or while breastfeeding, including: