What is it?
Perinatal Mood and Anxiety Disorders often called PMAD is a blanket term for a range of mood and anxiety disorders affecting parents in the pregnancy and postpartum period. During this time many parents experience very intense hormonal changes that can affect the way they are feeling both mentally and physically. These changes along with other factors can cause a series of disorders ranging from mild to serious.
What is it not? - The baby blues:
Baby Blues is NOT considered a mood or anxiety disorder, although it is directly related to the intense hormone fluctuations that occur immediately after birth. Baby blues is heavily influenced by changing sleep patterns for the parent during this time, as well as other common newborn stressors. Baby Blues can start 2-3 days after delivery, but should only last up to 2 weeks postpartum. Think of this as a natural postpartum transition that all birthing parents may experience.
Baby Blues may look like:
- Tearfulness
- Reactivity
- Exhaustion
- Mood changes
- No loss in self esteem
- Parent is typically happy
Symptoms of PMAD are often more serious and have a much larger range.
What are Symptoms of PMADs?
- Sadness
- Guilt
- Hopelessness
- Anger
- Rage
- Irritability
- Scary, unwanted thoughts
- Difficulty bonding
- Lack of interest
- Lack of joy or pleasure
- Changes in sleep
- Changes in appetite
- Constant worry
- Racing thoughts
- Unexplainable crying
- Dizziness
- Hot flashes
- Nausea
- Possible thoughts of harming yourself or baby
Why do PMADs Happen?
Clinically, there is still a lot to learn about PMADs and why they affect new parents. What we do know is there are a number of factors that can feed into increased risk. We also know that PMADs can affect anyone regardless of income level, ethnicity and culture.
Throughout pregnancy and postpartum, our bodies are going through different levels of hormones that are specific to certain parts of the journey, post-delivery, one month postpartum, etc. Due to these constant fluctuations, parents may feel significant highs and lows both mentally and physically. Our bodies start working overtime to help support those shifts and changes, like a scale constantly trying to stay at even. Sometimes, though, despite our best efforts, things fall out of balance.
Other factors like our experiences and genetics also affect how our bodies and brains develop and process interactions and events. Previous mental health disorders increase someone’s risk as well as a family history of mental illness.
What are the Risk Factors for PMADs?
- History of mental health disorders
- Thyroid imbalance
- Diabetes
- Endocrine disorders
- Premenstrual syndrome (PMS)
- Financial stress
- Unplanned pregnancy
- History of abuse
- Lack of support
- Pregnancy or delivery complications
- Infertility
- History of sexual trauma or abuse
- Single parent
- Miscarriage
- Infant loss
- Challenges with breastfeeding or abrupt stop in breastfeeding
What are the Different PMADs?
Perinatal Depression: A serious mental health illness occurring in the pregnancy and/or postpartum periods.
Symptoms include: Feeling overwhelmed, unable to cope, lack of connection, inability to provide caring support to self or family, self isolating, withdrawal, agitation, irritability, not feeling like one’s self. Physical symptoms include increased headaches, body pain and GI issues.
Perinatal Anxiety: An anxiety disorder during pregnancy or postpartum period.
Symptoms include: Excessive, persistent worry (often about health of parent or baby), agitation, irritability, escalating to rage, restlessness, hard time concentrating, difficulty sleeping, Physical symptoms include increased headaches, body pain and GI issues., GI issues).
Panic Disorder: A type of anxiety disorder that occurs in the perinatal period.
Symptoms include: Panic attacks- episodes of extreme anxiety or frantic fear. Typically experienced with shortness of breath, feeling like choking, inability to take deep breaths, and/or dizziness. As well as, hot/cold flashes, shaking, rapid heartbeat, numbness or tingling sensations, restlessness, agitation, irritability, excessive worry and fear, fear of losing control.
Obsessive Compulsive Disorder: Mental illness presenting as intrusive thoughts or compulsions.
Intrusive: thoughts are unwanted thoughts that reoccur and cause anxiety or distress and cannot be ignored.
Compulsions: are repetitive, recurring actions or behaviors that are unable to be ignored or stopped in order to prevent anxiety or distress.
Postpartum Post Traumatic Stress Disorder: Serious mental health disorder that is associated with trauma (perceived or experienced). In the perinatal journey. It can be associated with pregnancy complications, unplanned cesarean sections, birth interventions, NICU stay, lack of support, physical complications in labor and delivery.
Symptoms include: Flashbacks, nightmares, distressing memories, social withdrawal, denial, apathy, avoidance, emotionally numb, guilt, depression, irritability, hopelessness, self blame, lack of interest, sleep disturbance, unable to concentrate, aggression, hypervigilance. Physical symptoms include increased headaches, body pain and GI issues.
Bipolar Disorders: Spectrum disorder ranging from elevated mood to excessive depressive moods. Often misdiagnosed as depression. About half of the women with bipolar depression are diagnosed in the postpartum period. Likely to be resistant to SSRI medications.
Symptoms include: Depression, mania, hypomania, and mixed mania
Perinatal Psychosis: An extreme PMAD that affects 1 in 1,000 women- typically in the first 2 weeks postpartum.
Symptoms include: Disorientation, agitation, hyperactivity, elation, dysphoria and hallucinations. Often described as your thought process is not equating to reality.
How can PMADs be treated?
There are various ways to treat PMADs. However, it is important to remember that treatment looks differently for everyone. Working with a health care professional to find the right treatment plan is key.
Treatment may look like:
- Counseling / talk therapy
- Medication
- Support
- Exercise
- Adequate sleep
- Healthy diet
- Bright light therapy
- Yoga
- Relaxation / comfort techniques
It is ok to not be ok. It is ok to ask for help. Receiving treatment helps promote overall wellness and avoid long lasting effects for you and baby.
