What You Need to Know About Perinatal Mood and Anxiety Disorders (PMADs)

Becoming a mother is a transformative and vulnerable time. We experience shifts in our relationship, an evolving identity, and changes to our physical bodies while surviving on limited sleep. While new motherhood is beautiful in so many ways, parents can often experience a range of mental health challenges in postpartum that can impact the new mom, child, and the family. 

What are PMADs?

Perinatal Mood and Anxiety Disorders (PMADs) are a group of mental health conditions that occur in the perinatal time frame (pregnancy and within the first year after pregnancy). PMADs affect up to 20-25% of all perinatal women and their families. Unfortunately, PMADs are the most common complication after childbirth, but they are often undiagnosed, untreated, and highly stigmatized. 

Perinatal Mood and Anxiety Disorders include:

• Perinatal Depression

• Perinatal Anxiety

• Perinatal Obsessive-Compulsive Disorder

• Perinatal Post Traumatic Stress Disorder

• Postpartum Psychosis

While postpartum depression and postpartum anxiety are the most commonly known terms when describing emotional struggles in new parents, the reality is that mental health concerns in moms do not only present in the postpartum time. Emotional struggles often present in pregnancy as well, so it is most accurate to use terms like “perinatal depression” to accurately describe the time period for these challenges. 

An important note on postpartum psychosis: This condition is rare, and it may present when thoughts and feelings are paired with hallucinations, delusions, bizarre behavior, confusion, or disorganized thinking that seems disconnected from reality. Postpartum psychosis is an emergency and requires rapid intervention. 

Risk Factors for PMADs

PMADs do not discriminate and affect people from all cultures and backgrounds. It is important to consider that a personal or family history of depression, anxiety, or other mental health concern may increase your risk for developing PMADs. Other risk factors include: complications during pregnancy, traumatic birth, infertility, problems with breastfeeding, financial stress, relationship stress, recent major life changes, military families, and lack of support/geographical isolation, to name a few. 

Additionally, non-birthing partners can also experience changes in mood after welcoming a new baby. It is estimated that 1 in 10 non-birthing partners develop depression or anxiety in the postpartum period, with that rate increasing when the birthing partner is also diagnosed with a PMAD.

One of the reasons that PMADs are not diagnosed and treated is that new moms are often dismissed when they report not feeling okay. In most cases, the standard of care for postpartum mothers is just one visit 6 weeks after the birth. This leaves the mother feeling like an afterthought as they focus their attention on all things baby. If they do manage to recognize some concerning symptoms, often their symptoms are brushed off as “just the baby blues.” However, it is important to note that baby blues and PMADs are very different things. 

Baby Blues 

So what are baby blues anyway? The baby blues refers to the biological, hormonal and emotional adjustment that most mothers experience after giving birth. This is a normal response to becoming a parent, with up to 80% of new moms reporting symptoms like:

• Crying  or tearfulness

• Feeling overwhelmed or uncertain

• Acute sleep deprivation or fatigue

• Mood instability or reactivity

• Irritability 

Many mothers report feeling confused by these symptoms, as they are generally feeling happy and optimistic about their new role in motherhood. They may even report that they don’t know why they are crying because they cannot pinpoint any specific reason. About 4-5 days after childbirth there is a drop in hormones that can impact a mother’s experience of baby blues. 

Is it Baby Blues or a PMAD?

In order to determine whether someone is experiencing baby blues or a PMAD, it is important to look at the timing, duration and severity of the new mom’s symptoms. 

Baby blues is not a psychiatric diagnosis, but rather a time-limited phenomenon that typically resolves in a few weeks. While this experience can be dysregulating, most women find that they are still able to take care of themselves and their baby without much disruption in the day-to-day activities. 

PMADs, on the other hand, can present at any time during pregnancy or the first year of postpartum. The symptoms can overlap with what is seen in baby blues, but they will last longer, occur almost daily, and last throughout the day. The intensity of the symptoms can also be more severe, making it difficult for the mother to care for herself or her baby as she typically would.

Signs and Symptoms of PMADs

• Feelings of guilt, shame or helplessness

• Feelings of worthlessness or incompetence

• Feelings of anger, rage or irritability

• Scary or unwanted thoughts, often intrusive in nature

• Lack of interest in your baby or difficulty bonding with your baby

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

• Disturbed sleep (not due to the baby waking)

• Disturbed appetite (more or less hungry)

• Changes in weight, not otherwise accounted for normal postpartum shifts

• Crying and sadness 

• Constant worrying or racing thoughts

• Dizziness, hot flashes, nausea or unexplained physical symptoms

• Thoughts of harming yourself or your baby

If you are having thoughts of harming yourself or someone else, call 911 or go to the nearest emergency room right away. 

This is not an exhaustive list of symptoms, and we recommend that you reach out to a qualified perinatal mental health provider or doctor should you have concerns about your unique experience. 

Support for New Moms

Dealing with any of these symptoms at any stage of pregnancy or postpartum can be really daunting. Fortunately, you can feel better and get better with support! You are not alone and there is help available to you. 

Here are some ways take care for yourself:

• Ask for help from others (and actually accept it)

• Get outside for sun exposure and move your body a few times a week

• Eat nutritious foods

• Prioritize sleep and rest

Here are some ideas on how to help a friend or partner in the postpartum period:

• Ask questions about how the mother is *really* feeling, without using blame or shame. Respond with validation and empathy as they share their struggles without rushing to fix it. 

• Check in with the mom on a consistent basis, not just during the “fourth trimester” (the three months following birth).

• Look for tangible ways to lighten mom’s mental load, and show up with physical relief (cooking a meal, offering to watch baby so mom can nap/shower/etc., sending a gift card for grocery delivery or take out)

• Educate yourself on PMADs. Know the symptoms so you can be of support should the mother develop PMADs. Help her find the resources if she needs extra support. 

Getting help for PMADs

If you have been struggling with distressing thoughts and feelings for longer than two weeks, I recommend you reach out to a therapist that specializes in perinatal mood and anxiety disorders, as well as your doctor. PMADs are very treatable.

A perinatal mental health provider has advanced understanding and training in many areas of emotional health during the pregnancy and postpartum period. This specialist will assure you are appropriately screened and treated using evidence-based treatments, and they understand the unique needs of women experiencing a perinatal mood or anxiety disorder. 

Even if it has been less than two weeks but you feel something may not be right, listen to your intuition and reach out for help. Ultimately whether it’s baby blues or PMADs, you deserve to feel supported and cared for. In my practice in San Diego, CA where I specialize in perinatal mental health, I offer free consultations to find out if I am the right therapist for you.

Postpartum Health Alliance is a non-profit resource in San Diego that provides education and resources to local parents.

Postpartum Support International (PSI) is a national organization that maintains a warmline and a list of trained providers that specialize in perinatal mental health, as well as many virtual support groups.

If you or a loved one need immediate support, please call the San Diego Access and Crisis Line at 1-888-724-7240. They are available 24 hours a day, 7 days a week. 

About Jennifer Mendoza, LCSW

Jennifer Mendoza LCSW is a licensed therapist specializing in perinatal mental health. Her practice is located in San Diego, CA and she also provides virtual therapy throughout California and Oregon. Jen helps women, mothers, and couples strive for wellness as they build their young families. 

What sets Jen apart is that sessions are collaborative & connected, rather than cold and overly clinical. Whether you have been in therapy before or if this is your first time opening up to someone, she will take things at your own pace, with your trust and safety being her top focus. “Becoming a parent is amazing, but it can also be really hard! Whether you are going through fertility challenges, stress in pregnancy, or overwhelmed by parenthood, I would love to support you.”

How to contact Jen:

Email: hi@jennifermendozatherapy.com

Phone number: 760-304-1401

Website: www.jennifermendozatherapy.com

References:

Fairbrother, N., Young, A., Antony, M., Tucker, E. (2015). Depression and anxiety during the perinatal period. BMC Psychiatry, 15:206. 

Postpartum Health Alliance (2023) PMADS 101: A Crash Course in Understanding and Responding to Perinatal Mood and Anxiety Disorders.

Postpartum Support International (2021) Perinatal Mood and Anxiety Disorders Components of Care Training.