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Hormones run amok during pregnancy and postpartum. The body is adjusting to being pregnant, growing a human, no longer being pregnant, adjusting to lactation needs, far less sleep, likely less adequate nutrition, the responsibility of caring for a newborn, relationship adjustments, reimagining of self as a parent (“matrescence”), and shifts in community support. Just as your body is changing and adjusting, your brain undergoes changes that can lead to known perinatal mood and anxiety disorders. It’s a lot to handle in a year! 1 in 5 birthing people experience some form of perinatal mood and anxiety disorders, and likely higher as it is often underreported.

WHAT ARE PMADS?

Perinatal mood and anxiety disorders can develop during pregnancy and at any point in the first year after birth. It encompasses more than perinatal depression and can range from anxiety postpartum symptoms to OCD to psychosis. PMADs are more than the “baby blues”, a common feeling of sadness, irritation, and exhaustion occurring in the first two weeks after birth. The concern for feelings of sadness beyond 2 weeks is when a conversation with a health care or mental health professional may be helpful.

Understanding where the line is between common emotional woes and perinatal mood and anxiety disorders is key. As with other emotional problems that affect people that have nothing to do with birthing, understanding when you might be experiencing perinatal mood and anxiety disorders can be extremely helpful in dealing with them.

Perinatal Mood and Anxiety Disorder Symptoms

DEPRESSION:

  • Low mood, sadness, tearfulness
  • Loss of interest, joy, or pleasure in things you used to enjoy
  • Agitation or anxiety
  • Lack of energy or feeling slowed down physically
  • Difficulty concentrating
  • Appetite or sleep disturbance
  • Feelings of guilt, shame, or hopelessness
  • Possible thoughts of harming the baby or yourself

While abdominal separation is common, it can be minimized with proper care and trained support people. If you’re experiencing one or multiple of these perinatal mood and anxiety disorder symptoms it might be good to reach out.

ANXIETY:

  • Constant worry
  • Feeling that something bad is going to happen
  • Feeling like you can’t turn your brain off
  • Disturbances of sleep and appetite
  • Physical Symptoms like dizziness, heart palpitations, and nausea

Feeling like a worried mama bear can be a common response in new parenthood. The urge to protect your baby goes into hyperdrive. Concern arises if the feelings are intrusive and interfere with your ability to function. 10% of newly postpartum people experience anxiety and 6% experience anxiety while pregnant. Again one of the key differences is if these issues are affecting your ability to function, this is when we cross into the realm of perinatal mood and anxiety disorders.

OCD:

  • Obsessions, also called intrusive thoughts, which are persistent, repetitive thoughts or mental images regarding the baby. These thoughts are very upsetting
  • Compulsions, where the mom may do certain things over and over again to try to reduce her fears and obsessions. This may include things like needing to clean constantly, checking things many times, counting or reordering things.
  • A sense of horror about these obsessions
  • Fear of being left alone with the infant
  • Hyper-vigilance in protecting the infant

3-5% of postpartum people experience symptoms of OCD, even with no prior history of OCD. This can be a strong indication of perinatal mood and anxiety disorders.

PSYCHOSIS:

  • Delusions or strange beliefs that feel real
  • Hallucinations (seeing or hearing things that aren’t there)
  • Feeling confused
  • Feeling disconnected from reality
  • Decreased need for or inability to sleep
  • Paranoia and suspiciousness
  • Difficulty communicating at time

While occurring very rarely, only 0.1-0.2% of postpartum people, psychosis is very serious and requires immediate medical attention. Very rarely do people experiencing postpartum psychosis harm themselves or their babies but does require urgent medical care. Call 911 or seek immediate care from a hospital or doctor if you or someone you know is exhibiting symptoms. This is one of the more drastic forms of perinatal mood and anxiety disorders.

    WHO IS AT RISK?

    Anyone. There is no single factor causation for PMADs. People who have never experienced any form of depression, anxiety or OCD may develop perinatal mood and anxiety disorders during the perinatal period. People of every socioeconomic status, race, sexuality, gender identity may experience PMADs. No matter how you gave birth or how you feed your baby will inoculate you from potential postpartum depression and anxiety.

    Keeping an eye on your postpartum mental health is something that you should keep in mind whenever you’re seeing something affect you more than it normally would. However, each of these things may attribute to stress, anxiety, fears, breaks in support that can be risk factors to developing a perinatal mood and anxiety disorder.

    Common triggers for PMADs can be financial insecurity, previous loss, fertility challenges, past personal or family history of depression or anxiety, substance abuse, relationship challenges, unstable housing, inadequate emotional support from partners or family, anxiety about the well being of the baby. Even if you have any of these factors, there is no way to predict who will experience a PMAD.

    SUPPORT AND CARE

    Understanding symptoms and how common PMADs are can help in seeking support, treatment and reducing stigma. The more we know about these common disorders, the more likely those experiencing these very treatable and temporary conditions can improve their quality of life and experience of parenthood. It is important for partners to know the signs as well since it can be challenging to recognize them on your own when you are in a difficult emotional state. No one wants to be on the giving or receiving end of postpartum mood swings so having the right people around you is always a great thing.

    Oftentimes your baby’s pediatrician may be the only medical professional that you see regularly. Don’t be afraid to speak up if you are recognizing signs of a PMAD. You can also reach out to your own OB or midwife, do not wait until the 6 week postnatal visit if you are concerned about your well being. If you do not feel comfortable speaking to the pediatrician or your OB, there are many resources available for therapists, many of whom now do virtual sessions. Talk therapy, medication, and other forms of treatment can be effective in treating PMADs. Other methods such as  exercise can be a very helpful method for some.

    If you, or someone you know, may be experiencing symptoms of a PMAD, there is help. You are not alone, you are not a bad parent, and it can be improved upon

    RESOURCES?

    The Motherhood Center (NYC, virtual)

    Seleni Institute 

    Postpartum Support International

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