What are PMADs?Understanding Perinatal Mood and Anxiety Disorders

This guest blog post was written by Dr. Liz Apkin, a licensed psychologist in Brookline, Massachusetts, who specializes in perinatal mental health.

“I think she has postpartum.” This is a familiar phrase we’ve all heard well-intentioned people say to express concern about a mother or birthing person’s mental health or wellbeing after having a baby. Oftentimes, people will use the phrase “postpartum” to refer to depression, anxiety, or seemingly any type of challenge after giving birth. But being postpartum simply refers to the period of time following a pregnancy and it encompasses all of the physical, emotional and life changes that occur during that time. All birthing people will experience emotional changes postpartum, some of which are completely normal (hello baby blues!).

“Baby blues” refers to the period of time following delivery where there is significant hormonal fluctuations, lasting 2-14 days, peaking at days 3-5 postpartum. It is common during this time to experience increased tearfulness, quick mood changes, and emotional sensitivity. However, during this time, one still feels a general sense of contentment, despite these occurrences. The baby blues are totally expected and resolve on their own once hormones begin to stabilize around two weeks postpartum. More frequently than you may realize, new parents experience changes to their mental health that have an ongoing negative impact on their wellbeing, and these conditions are known as Perinatal Mood and Anxiety Disorders or PMADs.  

So what does this jargony sounding phrase actually mean? “Peri” means around/about, and “natal” means birth. So, perinatal simply means before or after giving birth. We say “mood and anxiety disorder,” because it’s not just depression that can happen. Yes, depression can occur, but so can other mood concerns such as anxiety in different forms, mania, or rarely even psychosis – this one is uncommon. Lastly, “disorder” means these symptoms are getting in the way of one’s daily functioning.

This makes sense, right? It’s not just after delivering a baby that bodies change and new stressors arise. Given the changes that the body goes through during pregnancy, this is also considered a vulnerable period in which a birthing person is at risk for a PMAD. During pregnancy, and up to a year postpartum, 1 in 4 women/birthing people and 1 in 10 fathers/non-gestating parents will experience a PMAD. Of those, only half of the women, and even fewer men, get the treatment they need. Having a history of mental health concerns, as well as complications in pregnancy, birth, or with feeding, can also increase the risk for a PMAD. 

If this is so common, why aren’t more people getting treatment? Unfortunately PMADs are underdiagnosed and undertreated in clinical settings. Healthcare providers can only see what’s being reported, and symptoms or concerns might not be reported to providers due to shame, thinking this experience is “to be expected,” or maybe even timing of the appointment. For this reason, it’s important that birthing people, as well as their family and friends, remain attuned to changes in how they’re feeling and behaving and talk about symptoms they are concerned about with their healthcare provider. Everyone deserves to feel well.

So, what are some things you can look out for in yourself or someone you care about? Let’s revisit the definition of “disorder:” when a behavior or experience keeps you from doing the things you want or need to do, or when things seem markedly different from what once was. Here are a few examples of things to look out for:

• Trouble laughing and seeing humor in things you typically would

• A super short fuse, little things that might normally seem small are really frustrating or overwhelming

• Avoiding appointments or care for yourself or your baby

• Feeling disconnected from your baby

• Having a hard time leaving the house due to worry, fear, or being overwhelmed

• Difficulty falling asleep, when given the opportunity

• Fear of accidentally harming your baby

• Often fantasizing about a life without your baby

• Simply not feeling like yourself

• Inability to let people you trust help care for your baby

• Thoughts of harming yourself or your baby (if you are experiencing this symptom, please do not wait, reach out for help today) 

This list is not exhaustive, of course. These are just a few examples of common ways in which someone may be impacted by a PMAD. You might find that you identify with one or even several of these examples. Having a brief moment where you experience one of these things does not necessarily mean you have a perinatal mood or anxiety disorder, but you also don’t need to wait until you’re truly suffering to get help. You deserve to feel well and like yourself! 

The good news is, perinatal mood and anxiety disorders are treatable! If you see yourself in any of the examples identified above, or have a history of mental health concerns, therapy can be an incredibly effective tool to manage and improve symptoms. Therapists trained in perinatal mental health have expertise in treating and supporting folks experiencing the unique challenges of pregnancy and postpartum. In addition, there are well studied and effective medication options that are safe to use in pregnancy, during postpartum, and while breastfeeding. Psychotherapy and/or medication can be a life-changing or even life-saving resource. In addition to therapy and medication, there are many amazing supports within your community and online to increase connectedness and wellbeing during the perinatal period. 

Working with a trusted advocate, such as the nurses at Birth Savvy or a doula trained in perinatal mental health, can help you understand and recognize symptoms of PMADs and provide you a safe space to talk about them. Birth Savvy nurses even provide screening for perinatal mood and anxiety disorders and can help you navigate the healthcare system to access care. Local pregnancy support groups, new parent support groups, local playgroups, public libraries, prenatal or mommy and me yoga classes, new parent social media groups, and spiritual communities, are all great ways to connect with people going through similar life changes who may be experiencing many of the same challenges. Postpartum Support International (www.postpartum.net) is a wonderful organization that offers an array of online support groups, a searchable database of perinatal mental health trained providers, and a free helpline for immediate support (Call: 1-800-944-4773 or Text: “Help” to 800-944-4773).

Take Away: If you or someone you love are pregnant or postpartum and do not feel like yourself, please do not “wait it out.” You deserve to feel well and help is available. Seek out support from a perinatal mental health provider today.

Dr. Apkin provides outpatient psychotherapy out of her office in Brookline and via telehealth to folks in Massachusetts. She has years of experience providing therapy focused on pregnancy, postpartum, perinatal mood or anxiety disorders, new to parenthood, high risk pregnancies, pregnancy loss or termination for medical reasons, and other related concerns. www.elizabethapkinpsyd.com