Perinatal Mood and Anxiety Disorders (PMADs)

Around 20% of new mothers will develop a perinatal mood or anxiety disorder (PMAD) — a mental health condition that occurs during pregnancy or the first year after giving birth. PMADs include depression, anxiety, OCD, PTSD, and postpartum psychosis. With the right support, full recovery is possible.

Key Takeaways

• A large portion of new mothers experience the baby blues, which involves mild sadness, anxiety, and irritability that resolve within the first few weeks of giving birth.
• Around 20% of new mothers will develop a perinatal mood or anxiety disorder (PMAD), which are mental health conditions that occur during pregnancy or during the first year after giving birth.
• Depending on the type of PMAD and severity, treatment may include therapy, medication, or hospitalization.

Understanding Perinatal Mental Health

Perinatal mental health is a broad term that refers to the mental health concerns of pregnant and postpartum women.

Pregnancy and postpartum bring about significant physical, hormonal, and emotional changes. If a woman experiences persistent emotional symptoms that impact her functioning, she may have a perinatal mood and anxiety disorder (PMAD). A PMAD is a mental health condition that affects women who are pregnant or up to one year postpartum.

The different types of PMADs are:

• Depression
• Anxiety
• Obsessive-compulsive disorder
• Post-traumatic stress disorder
• Postpartum psychosis

The Baby Blues

Between 50% and 85% of postpartum women experience the 'baby blues' within the first few weeks of giving birth. During this time a woman may feel sad, anxious, irritable, and tearful. This experience can be confusing for both her and her partner since we tend to associate new motherhood with joy and excitement, not tears and anxiety.

The baby blues are completely normal and typically subside within the first month. They are not considered a perinatal mental health disorder. In some cases, though, symptoms may continue beyond this time frame or briefly go away and then return later on. If a woman's symptoms are moderate to severe, impact her functioning, or persist beyond one month, then she may be experiencing a PMAD.

Depression

Perinatal depression is also referred to as peripartum, prenatal, or postpartum depression, depending on when it develops. Depression during pregnancy affects around 10% of mothers and postpartum depression affects approximately 12 percent. It's important to note that actual numbers may be higher, since women may not report depression for a number of reasons, including a fear of being judged.

Symptoms of perinatal or peripartum depression include:

• Feeling sad and tearful
• Loss of interest in previously pleasurable activities
• Feelings of guilt or worthlessness
• Feeling anxious or on edge
• Excessive worry about the baby's health
• Difficulty concentrating
• Changes in appetite
• Fatigue
• Feeling overwhelmed or unable to cope with having a new baby
• Suicidal thoughts

Some of the symptoms above may occur in mild form during the baby blues. To qualify for a diagnosis of perinatal depression, symptoms must occur most days for at least two weeks.

Anxiety

Anxiety can present at any point during pregnancy or the postpartum period. By definition, anxiety involves a sense of worry that feels beyond a person's control. Sometimes a mother may be aware of why she's feeling anxious. Other times she may feel uncomfortable or distressed but have trouble pinpointing why.

Anxiety is the most common mental health concern experienced by pregnant and postpartum women. Rates of anxiety are approximately 35% among pregnant women and 20% among postpartum mothers.

Women with postpartum anxiety often experience postpartum depression too.

Anxiety symptoms can include:

• Uncontrollable worry
• Irritability
• Difficulty sleeping
• Feeling restless or on edge
• Difficulty concentrating
• Muscle tension
• Low energy

Some women with anxiety may also experience panic attacks — sudden episodes of severe anxiety. Symptoms include:

• Heart palpitations
• Chest pain
• Difficulty breathing
• Choking sensation
• Shaking
• Sweating
• Numbness or tingling
• Chills or hot flashes
• Feeling lightheaded or dizzy
• Nausea or other abdominal discomfort
• Fear of losing control or going crazy
• Fear of death
• Feeling disconnected from reality or one's self

Obsessive-Compulsive Disorder

Perinatal obsessive-compulsive disorder (OCD) affects around 1 to 2% of new mothers. It is a type of anxiety disorder that involves obsessions and compulsions. Obsessions are persistent thoughts or images that are distressing. Compulsions are repetitive behaviors that are performed to help cope with obsessions.

Women who are pregnant or postpartum are at an increased risk of developing OCD. Other risk factors include a personal or family history of anxiety or OCD, history of depression, certain personality disorders and traits, and experiencing a traumatic birth.

Symptoms of perinatal OCD include:

• Obsessions involving fear that something bad will happen to the baby or that the mother will accidentally harm the baby
• Compulsions intended to stop the obsessive thoughts, such as constantly checking the baby's breathing or excessively washing
• Avoiding certain activities, like putting the baby in their car seat
• Feeling anxious and overwhelmed by the obsessions and compulsions
• Fear that other people will think you are "crazy" if you share what you are experiencing
• Difficulty caring for yourself and/or the baby because of your symptoms

Many women with perinatal OCD who have obsessions about hurting their babies worry that they will act on these thoughts. Experts say that people with OCD are at very low risk of acting on their obsessions. The fact that you are disturbed by these thoughts distinguishes perinatal OCD from postpartum psychosis.

Post-Traumatic Stress Disorder

Post-traumatic stress disorder (PTSD) can develop after a traumatic birth experience — one where a mother or baby's life is threatened, or where a mother feels powerless or unsupported. Trauma is said to be "in the eye of the beholder," so an experience that is traumatic to one person may not be to another. Examples of traumatic birth experiences include unplanned C-section, NICU stay, and severe complications for mother and baby.

Symptoms of PTSD include:

• Re-experiencing the birth through thoughts, memories, or flashbacks
• Avoidance of reminders of the event
• Changes in the way that you think and feel
• Changes in your arousal or reactivity (e.g., being easily startled, difficulty concentrating, trouble sleeping)

Perinatal Psychosis

Perinatal psychosis, also referred to as postpartum psychosis, is a serious mental health condition where a woman experiences a break from reality. She may hear or see things that are not there, function on little to no sleep, and have unusual beliefs that may feel real to her. It is a rare condition that affects approximately 1 out of every 1,000 postpartum women.

Symptoms of postpartum psychosis include:

• Hallucinations — seeing or hearing things that are not there
• Delusions — strong beliefs that are false
• Elevated mood
• Hyperactivity
• Extreme irritability
• Severe mood swings
• Depressed mood
• Extreme confusion
• Paranoia
• Running on little to no sleep

Women with a history of bipolar disorder are at greatest risk of developing postpartum psychosis. Postpartum psychosis is a serious condition that requires emergency intervention. There is a greater risk of suicide and infanticide in women experiencing a postpartum psychotic episode. If you suspect that a person is experiencing this condition, seek help right away — contact their healthcare provider, call 911, or take them to the nearest emergency room.

Additional Resources

For more information and support:

• 988 Suicide & Crisis Lifeline — Call or text 988
• Postpartum Support International (PSI) HelpLine — 1-800-944-4773
• National Alliance on Mental Illness (NAMI)