What are Perinatal Mood and Anxiety Disorders?

Perinatal Mood and Anxiety Disorders (PMADs) are a group of illnesses that can affect expectant and new mothers anytime from pregnancy until up to twelve months after birth, however, untreated symptoms of PMAD can last for much longer. Postpartum Depression is one of the most commonly recognized perinatal mood disorders. Other PMADs include Antenatal Depression (depression during pregnancy), Postpartum Anxiety, Postpartum OCD and Postpartum Psychosis.

Read on for detailed explanations of Postpartum Depression, Postpartum Anxiety and other PMADs.

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How do I know?

Not sure if you have a PMAD? Many women, with our without the risk factors noted above, often have a difficult time identifying and expressing how they are feeling. Perhaps you are just not feeling like yourself but can't put your finger on it, or you are wishing you had never had a baby to begin with. Perhaps you are feeling like you just want to run away from it all and start fresh. You have done nothing wrong, you are not a weak person or a bad mother, and most importantly, you are NOT alone! THOUSANDS of women in our state experience a PMAD each year. You have a treatable mental health condition and there is an expansive network of professional and peer support in your local Southern Maine community.



Risk Factors

PMADs can happen to any mother after the birth of a child, regardless of how many other births she has experienced. According to MayoClinic.com, factors that can increase the risk of experiencing a PMAD include:

  • History of depression, either during pregnancy or at other times
  • History of bipolar disorder
  • Family history of depression or other mood stability problems
  • The experience of recent stress, such as pregnancy complications, illness or job loss
  • Health problems with your infant or other special needs
  • Difficulty breast-feeding
  • Relationship programs with your spouse or significant other
  • Lack of a solid support system
  • Financial problems
  • If the pregnancy was unplanned or unwanted


What is Postpartum Depression?

Depression is different from “baby blues”. A drop in estrogen after delivery may cause vulnerable feelings, emotional swings, mood changes, feeling occasionally down and crying.  This is normal as estrogen levels affect brain chemistry. “Baby blues” is transient and should subside after a few days.  Some may experience these symptoms in the first 2 weeks after the birth.

Depression symptoms are different from the blues and can be experienced slightly different for everyone but may include:

  • A loss of pleasure or interest in things you used to enjoy

  • Feeling down

  • Eating much more, or much less, than you usually do

  • Feeling guilty or worthless—blaming yourself

  • Sadness, crying uncontrollably for very long periods of time

  • Feeling hopeless, empty inside, numb emotionally

  • Inability to sleep, sleeping too much, difficulty falling or staying asleep

  • Disinterest in the baby, family, and friends

  • Excessive irritability, anger or agitation—mood swings

  • Difficulty concentrating, remembering details, or making decisions

  • Thoughts of hurting yourself or the baby

If these warning signs or symptoms last longer than 2 weeks, you may need to get help. Whether your symptoms are mild or severe, recovery is possible with proper treatment.

For half of women diagnosed with postpartum depression, this is their first episode of depression.  About half of women who are later diagnosed with PPD, many began experiencing symptoms during pregnancy–so it’s important to seek help early.

If a woman reports symptoms similar to those list above but the symptoms are milder or to a lesser degree than typical depression or anxiety symptoms, she may be suffering from Adjustment Disorder, which is a stress response reaction to a life event, stressor or significant life change. A person can
experience emotional or behavioral symptoms with a depressed mood or anxiety disturbance with maladaptive reactions affecting normal level of functioning. The symptoms arise within three months of the onset stressor and last no more than 6 months. It can also be called situational depression and or anxiety.



What is Postpartum Anxiety?

Anxiety Symptoms can include:

  • Worrying , anxiety, panic attacks

  • Racing thoughts, feeling restless and unable to relax

  • Fear of not being a good mother

  • Fear of being left alone with the baby

  • Fear of leaving the baby alone or something bad will happen to the baby

If these warning signs or symptoms last longer than 2 weeks, you may need to get help. Whether your symptoms are mild or severe, recovery is possible with proper treatment.



What is Antenatal Depression/Anxiety?

Depression during pregnancy can occur in up to 20% of women and is called antenatal or prenatal depression. This typically occurs with women who have prior history and diagnosis of major depressive disorder. It can be a precursor to postpartum depression. If women have symptoms present in pregnancy and these are not treated with medication and or therapy, they do not get better after the baby is born. They typically become worse. It is important to seek
treatment in pregnancy. Women with a history of past depressive episodes have as high as a 50% chance of relapse of depression and or anxiety symptoms postpartum. The symptoms and characteristics of antenatal depression are the same as listed above for postpartum depression.

Anxiety which occurs during pregnancy is called antenatal anxiety. It is estimated to occur in 6% of pregnant women and can co-occur with or without depression during pregnancy. Symptoms are the same as listed above for postpartum anxiety.



What is Perinatal OCD?

Perinatal Obsessive Compulsive Disorder (OCD) effects approximately 2-5 % of women during the perinatal time frame which can be any time during the pregnancy or within the first year after the baby is born. Fathers also can experience Perinatal OCD.

The obsessive part of OCD is comprised of obtrusive, unwanted thoughts. Most often these thoughts have to do with the safety and well-being of the baby:
● Constantly worried that something bad will happen to the baby
● Feeling the need to engage in specific behaviors in an attempt to get rid of the obsessive thoughts or fear
● Fear of getting into accident or fear of germs and behaviors to avoid the concerns.
● Intrusive thoughts which may be thinking about bad things happening to the baby
● Checking, seeking repeated reassurance, and or cleaning behaviors.
● Repeat actions a set number of times or feel the need to experience things in a certain order.
● Fear that they will accidentally or even intentionally do something that harms the baby.

Often times mothers do not want to let anyone know that they are having obsessive thoughts, particularly if they are associated with harming the baby, or if they are having inappropriate sexual thoughts. They fear they will be viewed as a danger to their baby.

An important distinction between obsessive thoughts and delusions is that with perinatal OCD women know that their thoughts and behaviors are irrational even though they have difficulty letting go of the thoughts. They have good judgment and insight. They are in touch with reality. They have a very low risk of acting in harmful ways toward themselves or infant and have strong desire to provide loving safe care to the baby.

Symptoms of perinatal OCD can be affected by coming to terms with the incredible amount of control we as parents have over our baby’s well-being as well as the overwhelming sense of vulnerability and not being able to cope if something bad happened and fearing being at fault or blamed.



What is Postpartum Psychosis? 

Postpartum Psychosis is a rare psychiatric illness which affects 1-2 women per 1000 after childbirth. It is a severe form of postpartum depression caused by a combination of factors mostly preempted by dramatic changes in brain chemistry after birth. The symptoms, listed below, cause a change to a women's normal level of functioning. Sometimes the symptoms are subtle and will get worse without immediate treatment. She should not be left alone with the baby.

● Cognitive impairment
● Disorganized thoughts and behaviors
● There is lack of judgement and insight which can lead to devastating consequences and safety concern.
● She may start to believe things are happening when in fact they are not and act paranoid.
● She can be occupied with strange ideas and suspicions.
● There may be strange beliefs focused on about the baby, self and others.
● She may hear or see things which others could not see or hear, such as voices, shadows images of people or things.
● There may be grandiose thoughts about doing things that are not reasonable.

Women may present with on and off confusion, rambling speech, being severely withdrawn or
acting high/ elated with excessive mood swings, excessive activity or agitation. It is critical to
get her help immediately with an emergency psychiatric evaluation. This is typically done
in a hospital ER or mental health or crisis service center. Lack of treatment can lead to
suicidal or homicidal thoughts or attempts.