Bringing new life into the world is a transformative experience, but the journey through pregnancy can also be fraught with unexpected challenges. Perinatal Mood and Anxiety Disorders, or PMADs, are a spectrum of mental health conditions specific to the perinatal period (or the time before and after giving birth) that can present several complex challenges for new parents.[1] From the nuances of prenatal depression to the overwhelming nature of postpartum psychosis, PMADs can affect individuals from every background and significantly impact the well-being of both parents and their newborns.
These conditions, ranging from heightened anxiety to debilitating mood disorders, underscore the importance of recognizing and addressing mental health in the perinatal context. In today’s blog, Clear Behavioral Health will continue our examination of PMADs, working to cultivate more understanding and compassion around these disorders to navigate them with greater resilience and increased empathy.
What are PMADs?
PMADs refer to a group of mental health conditions that can occur either during pregnancy or in the postpartum period (after giving birth). These disorders encompass a range of mood and anxiety symptoms that can affect individuals who are pregnant, have recently given birth, or are in the process of adopting a child.
These disorders can manifest with symptoms like severe or mild mood changes, feelings of sadness, anxiety, intrusive thoughts, changes in sleep and appetite, difficulty concentrating, and in severe cases, hallucinations or delusions. PMADs can impact both mothers and fathers, as referenced in our last blog, and often require timely intervention for effective management.
Specific kinds of PMADs can include:[2]
- Perinatal Depression: Perinatal depression is a mood disorder characterized by persistent feelings of sadness, hopelessness, or a lack of interest or pleasure in activities. When less severe, it is common to be referred to as “baby blues”. It can occur during pregnancy or after childbirth (postpartum)
- Prenatal and Postpartum Anxiety Disorders: Anxiety disorders, such as generalized anxiety disorder or specific phobias, can also manifest during the perinatal period
- Perinatal Obsessive-Compulsive Disorder (OCD): Some individuals may experience intrusive, repetitive thoughts and engage in compulsive behaviors, which can be exacerbated during the perinatal period.
- Post-Traumatic Stress Disorder (PTSD): For some individuals, traumatic or frightening childbirth experiences can lead to symptoms of PTSD.
- Postpartum Psychosis: While rare, postpartum psychosis is a severe condition that can involve hallucinations, delusions, and extreme mood swings. It requires immediate medical attention.
How Common are Perinatal Mood and Anxiety Disorders?
Perinatal mood and anxiety disorders are relatively common and can affect individuals during pregnancy and in the postpartum period. The prevalence rate of PMADs varies, but research estimates suggest that around 20 to 25% of women may experience some form of mood or anxiety disorder during the perinatal (prenatal and postpartum) period.[3]
Around one in seven women can develop postpartum depression (PPD).[4] According to a 2009 study, as many as half of PPD cases in new mothers will go undiagnosed due to privacy concerns and feelings of shame.[5]
Can PMADs Occur Before and After Pregnancy?
Yes, PMADs can occur both before and after pregnancy, encompassing the entire perinatal period. Symptoms can appear at any time during pregnancy and up to a year after delivery of the child.[6]
What Causes PMADs?
PMADs encompass a spectrum of mental health conditions influenced by biological, psychological, and environmental factors.[7] One key contributor is hormonal changes experienced during the perinatal period, involving substantial fluctuations in estrogen and progesterone levels. These hormonal shifts can impact neurotransmitters in the brain, contributing to the manifestation of mood disturbances associated with PMADs. Understanding the intricate interplay of these hormonal factors is crucial for comprehending the physiological basis of perinatal mental health challenges.
Genetic factors also play a significant role in predisposing individuals to PMADs, with a family history of mood or anxiety disorders identified as a notable risk factor. The influence of genetics adds a layer of complexity to the understanding of susceptibility, highlighting the importance of recognizing familial mental health histories in assessing the risk of PMADs.
Additionally, psychological factors contribute significantly to the development of PMADs. Personal and family histories of mental health issues, coupled with experiences of trauma, heighten the risk. Stressors such as life events, relationship difficulties, and a lack of social support further compound the psychological complexities associated with PMADs.
It’s important to recognize that each individual’s experience is unique, and not everyone with risk factors will develop PMADs. Prompt identification and intervention, including support from healthcare professionals, counseling, and, if necessary, medication, can significantly improve outcomes for individuals experiencing PMADs.
How Long Can PMADs Last?
The duration of perinatal mood and anxiety disorders can vary widely among individuals and depends on several factors, such as the severity of symptoms, the type of disorder, the timing of any therapeutic interventions, and the effectiveness of the treatment.[8] PMADs can resolve on their own for some individuals, while others may require professional help for an extended period.
In addition to individual variability, the duration of PMADs is also influenced by the presence of ongoing stressors and the level of social support. High levels of stress, whether related to ongoing life events, relationship challenges, or other external factors, can prolong the course of PMADs. Conversely, robust social support networks, including understanding family and friends, can contribute significantly to the recovery process. Early intervention and consistent follow-up with healthcare professionals play pivotal roles in managing the duration of PMADs. Timely access to appropriate treatments, such as therapy or medication, can help individuals navigate and overcome the challenges posed by perinatal mood and anxiety disorders more effectively.
Who Is At-Risk for PMADs?
While any expecting parent can develop PMADs, there are several known risk factors for their potential development within the perinatal period:[9]
- A previous history of mental health conditions: Individuals with a history of depression, anxiety, bipolar disorder, or other mental health conditions are at an increased risk of developing PMADs
- Family history: A family history of mood or anxiety disorders, especially during the perinatal period, may elevate the risk for an individual
- Previous personal history of PMADs: If a person has experienced PMADs during a previous pregnancy or postpartum period, they are at a higher risk of recurrence in any subsequent pregnancies
- Stressful life events: Significant life stressors during the perinatal period, such as financial difficulties, relationship issues, or other major life changes, can increase the risk of developing PMADs
- A lack of social support: Limited support from family, friends, or a partner can contribute to increased feelings of isolation and stress, both of which may factor into the development of PMADs
- Complications experienced during the pregnancy or birth: Medical complications during pregnancy, difficult childbirth experiences, or having a child with health issues can contribute to the development of PMADs
- Unplanned or unwanted pregnancy: The emotional impact of an unplanned or unwanted pregnancy may increase the risk of PMADs in expecting parents
- Hormonal changes: Fluctuations in hormone levels during pregnancy and the postpartum period can contribute to mood disturbances and increase vulnerability to PMADs
- Sleep disruptions: Sleep disturbances are common during pregnancy and after childbirth. Lack of sleep or disrupted sleep patterns can be a risk factor for PMADs
- Substance abuse: Substance abuse, including alcohol and drug use, can contribute to the development or exacerbation of PMADs
Treatment Options for PMADs
Thankfully, PMADs can be effectively treated, with several therapeutic options available.[10] The choice of treatment depends on the severity of your symptoms, your individual preferences, and the recommendations of healthcare professionals. The most effective treatment often involves a combination of therapeutic approaches tailored to the individual’s needs. Early intervention is always key to achieving positive outcomes, and ongoing support can contribute to long-term well-being.
Navigating the treatment for PMADs involves a range of supportive approaches tailored to individual needs. Engagement in counseling can offer valuable insights and coping strategies. Cognitive-Behavioral Therapy (CBT), a structured approach, aids in identifying and transforming negative thought patterns and behaviors, has been proven effective for managing perinatal depression and anxiety.[11]
In certain cases, prescribed medication may be beneficial as well. Antidepressants like Selective Serotonin Reuptake Inhibitors (SSRIs) and Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs) act as mood balancers, while anti-anxiety medications such as benzodiazepines and specific antidepressants may be prescribed for intense anxiety. Open communication with your healthcare providers is essential, especially considering potential impacts on breastfeeding.
Support groups for new parents can create a space for individuals to share experiences and coping strategies. Family or couples therapy involves partners or family members in the therapeutic process, fortifying communication and support systems. Exercise and physical activity also contribute to increasing your overall well-being, with mind-body practices like mindfulness, yoga, and meditation act as effective stress-busters, promoting a sense of calm.
Hospitalization or participation in intensive treatment programs is considered in instances where the severity of PMADs poses significant risks to the individual’s safety and well-being. These interventions provide a structured and closely monitored environment, offering round-the-clock care from a multidisciplinary team of professionals. During hospitalization or intensive programs, individuals can receive specialized treatments, therapeutic interventions, and support tailored to the severity of their condition. This level of care ensures a comprehensive approach to address the complex and challenging aspects of PMADs, fostering a path toward stabilization and recovery. It’s important to note that these interventions are reserved for cases where outpatient care may not provide the necessary level of support and where the immediate safety of the individual is a priority.
Get Help and Support for Perinatal-Related Challenges
Addressing perinatal mental health challenges can be incredibly difficult on your own. If you or a loved one is experiencing difficulties, then reaching out for help is an important first step on the path to healing.
Understanding the unique nature of perinatal mental health concerns, our dedicated team is committed to providing compassionate and effective care. We recognize that no two journeys are alike, and our approach is tailored to meet the diverse needs of individuals facing perinatal mental health challenges. From virtual program offerings that allow you to receive quality mental health treatment from the comfort of your own home to inpatient mental health services for more serious conditions and outpatient mental health programs that provide more support than weekly therapy, Clear Behavioral Health’s comprehensive services are designed to provide the treatment and guidance necessary for your healing journey. You don’t have to navigate this path alone, and we’re here to walk with you every step of the way.
The choice is clear—give us a call today to get the help and support you need.
References:
- Perinatal Mood and Anxiety Disorders (PMAD) | Orange County California – Health Care Agency. (n.d.). Ochealthinfo.com. Retrieved November 24, 2023, from https://ochealthinfo.com/services-programs/pregnancy-and-parenting/perinatal-mood-and-anxiety on November 22nd, 2023
- Johnson Rolfes, J., & Paulsen, M. (2021). Protecting the infant-parent relationship: special emphasis on perinatal mood and anxiety disorder screening and treatment in neonatal intensive care unit parents. Journal of Perinatology. https://doi.org/10.1038/s41372-021-01256-7 on November 22nd, 2023
- Shklarski, L., & Kalogridis, L. (2022). Promotion and Prevention of Perinatal Mood and Anxiety Disorders: Doulas’ Roles and Challenges. The Journal of Perinatal Education, 31(2), 82–93. https://doi.org/10.1891/jpe-2021-00058 on November 23rd, 2023
- Mughal, S., Azhar, Y., & Siddiqui, W. (2022, October 7). Postpartum Depression. National Library of Medicine; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK519070/ on November 23rd, 2023
- Zauderer, C. (2009). Postpartum Depression: How Childbirth Educators Can Help Break the Silence. Journal of Perinatal Education, 18(2), 23–31. https://doi.org/10.1624/105812409×426305 on November 23rd, 2023
- Perinatal Mood and Anxiety Disorders. (n.d.). Www.health.ny.gov. https://www.health.ny.gov/community/pregnancy/health_care/perinatal/perinatal_depression.htm on November 24th, 2023
- National Institute of Mental Health. (2021). Perinatal Depression. National Institute of Mental Health. https://www.nimh.nih.gov/health/publications/perinatal-depression on November 24th, 2023
- The Children’s Hospital of Philadelphia. (2018, October 19). Perinatal or Postpartum Mood and Anxiety Disorders | Children’s Hospital of Philadelphia. Chop.edu. https://www.chop.edu/conditions-diseases/perinatal-or-postpartum-mood-and-anxiety-disorders on November 24th, 2023
- Ghaedrahmati, M., Kazemi, A., Kheirabadi, G., Ebrahimi, A., & Bahrami, M. (2017). Postpartum depression risk factors: A narrative review. Journal of Education and Health Promotion, 6(60), 60. https://doi.org/10.4103/jehp.jehp_9_16 on November 24th, 2023
- Meltzer-Brody, S., & Jones, I. (2015). Optimizing the treatment of mood disorders in the perinatal period. Dialogues in Clinical Neuroscience, 17(2), 207–218. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4518703/ on November 24th, 2023
- Postpartum Depression and Anxiety | Fact Sheet. (2021, March 10). ABCT – Association for Behavioral and Cognitive Therapies. https://www.abct.org/fact-sheets/postpartum-depression-and-anxiety/ on November 24th, 2023
