What are Perinatal Mood and Anxiety Disorders or PMADs?
For over a century, the only recognized mental health challenge of the perinatal period was postpartum depression. While this is a common and sometimes debilitating condition, we now know that there is a much larger spectrum of symptoms and disorders linked to this time of great physical, psychological and social change. We also know that these disorders can begin at any time from conception through the first year after birth. We call the disorders in this spectrum “perinatal mood and anxiety disorders” or PMADs.
PMADs are distressing psychological conditions that affect about 20% of pregnant and postpartum people overall. For perinatal people of color, adolescents, and immigrants, this rate more than doubles. PMADs include the following:
Perinatal Mood Disorders
Depression
Perinatal depression includes the more commonly known postpartum depression, but also depression during pregnancy. Someone who is more than a year postpartum can still struggle with postpartum depression, especially if it has gone untreated. Perinatal depression can look like:
frequent crying or weepiness
a lack of interest in previously pleasurable experiences
difficulty sleeping or too much sleep
low mood
irritability and/or rage
negative self-talk
suicidal thoughts
Perinatal depression often occurs alongside perinatal anxiety, but they can also occur separately. Perinatal depression is often treated with either one or both of evidence-based therapeutic approaches and medication.
Mania & Bipolar disorder
At times, depression can begin to cycle with mania, which is called “bipolar disorder.” People sometimes have their very first episode of mania in the perinatal period, often in the first few weeks after birth. When someone is in a manic state, they may experience
decreased need for sleep
racing thoughts, rapid speech, and trouble concentrating
high energy and a lower need for sleep
irritability
elevated mood and overconfidence or grandiose ideas
It is important that someone in a state of mania is evaluated by an experienced mental health practitioner. Perinatal bipolar mood disorders typically call for medication support alongside therapy. If someone knows that they have Bipolar I or II or have a family history of it, they should meet regularly with a mental health provider throughout their pregnancy and into the postpartum period.
Psychosis (detachment from reality)
Perinatal psychosis is a rare but very serious form of perinatal mood disorder which requires immediate care. Signs of psychosis include
delusions: thoughts that are not based in reality
hallucinations: hearing or seeing things that are not there
disorganized thinking
Often a loved one close to the birthing parent will notice these symptoms and need to seek help, as delusions and/or hallucinations will seem real and sensical to the person experiencing the symptoms. If you are concerned at all that someone is experiencing psychosis, get help immediately as it can be life-threatening. In the Triangle, you can call UNC Crisis Psychiatry for further assistance: (984)974-5217 option 4
With proper evaluation and treatment, typically in a hospital setting and then stepping down to an intensive outpatient program or a close therapeutic relationship with on-going medication management as well, perinatal psychosis is treatable.
Perinatal Anxiety Disorders
Anxiety
Perinatal anxiety involves
excessive worry
racing thoughts
hyperventilating
panic attacks
repeating thoughts of potential harm coming to you or your baby
It is important to realize these thoughts are not actions, they do not make you a bad parent or caregiver and talking about them can help.
Perinatal anxiety can feel paralyzing and distressing, but there are helpful effective treatments for perinatal anxiety such as medications and cognitive and mindfulness-based therapies.
Obsessive thoughts and behaviors (Obsessive Compulsive Disorder)
Sometimes perinatal anxiety can become repeated on a loop and/or appear alongside compulsive behaviors. These behaviors are often centered around protecting baby from the intrusive thoughts becoming reality. When this happens, it’s called perinatal obsessive compulsive disorder. The repeated thoughts are obsessions and the protective behaviors are compulsions.
Perinatal OCD can be distressing when the intrusive thoughts alarm the person having them or when the protective behaviors are extreme or not based in a reasonable protective measure (e.g. refusing to leave the house or being afraid to hold your baby)
Having perinatal OCD does not always mean that a person will go on to have typical OCD forever. And there are effective treatments for these thought and behavior patterns such as Dialectical Behavior Therapy, other cognitive behavioral based therapies, and/or medications.
Reproductive trauma
The process from conception through birth can come with unexpected pain, grief, or trauma. Whether the trauma was intentional or not, and whether everyone came out “healthy” in the end does not negate the difficult experience someone had in the birth process. Medical interventions, pain, mistreatment during birth, NICU stays, medical complications, feeding challenges, and grief over unmet hopes or desires can all impact how we process, remember, and feel about our birth experience.
Birth trauma can show up as flashbacks, anxiety, insomnia or nightmares, weepiness, inability to think about the birth or reminders of birth without feeling intense distress, dissociation, physical pain, tension, shakiness, and/or sweating.
If you are struggling with your perinatal experience either soon after or years down the road, it is worth speaking with a trauma-informed perinatal specialist to to help your brain and body process the experience and file it into a past memory rather than a present terror.
