I’ve never heard of PMAD…

Perinatal or Postpartum Mood and Anxiety Disorders (PMAD) is the new and more inclusive label for the formally known Postpartum Depression (PPD). Hormonally and environmentally, having a baby creates drastic changes in our bodies and in our lives. Often these changes begin to impair our daily functioning in various areas of life beyond just inconvenience. That is the signal that maybe something more serious is going on. More often than we think, many birthing people and parents experience the clinical effects of these changes. In fact, about one in every five to seven women is forced to deal with a PMAD. Some may be surprised to hear that even parents who are not pregnant or giving birth are still at risk for PMAD. Perinatal and postpartum mood and anxiety disorders include the following: 

• Perinatal/Postpartum Depression

• Perinatal/Postpartum Anxiety

• Perinatal/Postpartum Bipolar I and II

• Perinatal/Postpartum Obsessive Compulsive Disorder (OCD)

• Perinatal/Postpartum Post-Traumatic Stress Disorder (PTSD)

• Perinatal/Postpartum Psychosis (A TRUE MEDICAL EMERGENCY)

How do I know if it is Baby Blues or PMAD?

The “Baby Blues” is an extremely common experience for birthing people. Directly after giving birth, it is common to feel emotionally dysregulated and unlike your usual self. About 80% of people who give birth find themselves feeling more extreme highs and lows in their moods and often paired with major overwhelm. This effect is the direct result of the hormonal rollercoaster that birthing people face after delivery. The level of estrogen and progesterone in the body has a sudden decrease which leads to a variety of reactions throughout the body. 

The symptoms of baby blues and PMAD have a large overlap. It can be a blurry line which makes it all the more difficult to self-diagnose and all the more necessary to lean on a professional for confirmation and support. Some symptoms to look out for include:

• Excessive worry or nervousness

• Feelings of anger, fear and/or guilt

• Lack of interest in the baby

• Loss of appetite 

• Sleep disturbance 

• Difficulty concentrating/making decisions

• Thoughts of harming the baby or oneself

• Delusions and/or hallucinations

• Panic attacks

• Hypervigilance 

• Recurring traumatic memories

The biggest clues that differentiate baby blues from PMAD are onset and duration. Baby blues only occur directly after birth and only last up to two weeks post-delivery. If symptoms begin during pregnancy or last beyond two weeks after delivery, it is an indicator that professional help is necessary.

Where did my PMAD come from?

There are two sides to this coin. On one hand, there is no clear way to identify exactly what causes each person’s PMAD. Everyone’s experience with PMAD is so unique which makes it all the more difficult for researchers and medical professionals to pinpoint the origin for each PMAD case. However, so much research has been done over the last 100 years. Birthing people of all backgrounds, cultures, and genders have revealed evidence to support consistent risk factors for PMADs. 

People with a history of mental illness have a higher probability of experiencing different perinatal mood and anxiety diagnoses. If there is a traumatic birth experience and/or pregnancy, it is important to be mindful of any PMAD symptoms that may present itself. Another predictor of PMAD includes a lack of sleep. While this is an expectation that most all new and expecting parents can anticipate, the effects that limited sleep has on the human body can have detrimental effects. Environmental risk factors include systemic racism, substance use, financial stress, grief, and big life changes. 

How long will I have to deal with my PMAD?

The length of time someone’s PMAD is present is determined by the type of PMAD, severity, and how early treatment and intervention begins. Birthing people and partners are at risk for enduring symptoms for months or even years, specifically if gone untreated. Like all mental health challenges, healing takes time and varies based on the individual and level of support they receive. 

Do I really have to treat it?

PMADs do not go away on their own. If not treated appropriately, the effects will begin to impair more areas of your normal functioning. The baby and parent bond and developmental attachment is at risk when a PMAD goes untreated. Babies are sensitive and rely on nurture and connection from their parent. This effort and authentic contact cannot be properly built if the parent is disconnected from their own self. When babies do not have these needs met, they may experience impairments of long term physical, emotional, and mental development. Families, work environments, and ones overall self concept are threatened by the changes that a PMAD brings into the room. It is imperative that PMADs are treated by a trained healthcare or mental health professional.

What will others think?

“Everyone else has had a baby with no problems.” “I am sure this will pass.” “What will my friends, family, or partner think if I tell them I need help?” “Why do I want to hurt my baby?” “I am not a good parent…”

These are only a few of the thoughts that birthing people and partners all around the world face around the time of having a child. There is heavy shame and stigma around asking for help with PMAD symptoms which only perpetuates the problem. 

Unfortunately, PMADs do not discriminate and they impact people of all cultures and genders. Research shows that an average of 35.1% of BIPOC women in American communities experience clinical postpartum mental health issues. Between 17-59% of Hispanic women in America faced the same problems. For Alaskan Natives and American Indians, the prevalence lies between 14-29.7%. 

For individuals who are experiencing intrusive thoughts about harming their baby - you are not alone and there is nothing wrong with you. Help is possible. Many individuals think by sharing this experience their child will be taken away from them. If it is any reassurance, often times parents with PMADs who have thoughts about hurting their children will not actually do it, although it is still extremely distressing to deal with alone. Mental health professionals, healthcare professionals, and any social support out there does not want to tear apart any families. The main priority is to keep everyone safe, healthy, and thriving. 

How can I help myself?

The beauty of PMADs being so common is that there are professionals that are specially trained to support birthing people and partners overcome the hurdle. Whether medication or hospitalization is necessary, or if therapeutic support is sufficient on its own, Flourish Mindset works collaboratively with your care team to provide the best support possible. Flourish Mindset offers counseling services for individuals looking for perinatal and postpartum anxiety and depression therapy in Los Angeles and providing telehealth services to all of California. Individual counseling, couples counseling, and even group counseling can all support individuals looking to tend to their PMAD symptoms. Explore Flourish Mindset services here . Sometimes it just takes one foot in the door to start the healing journey. Contact Flourish Mindset to schedule a free 20 minute consultation call and explore the options that work best for you or your loved one.

About the Author:

Savannah Jaouhari, M.A., APCC, NCC, is supervised by Hanna Stensby, LMFT. She is a Gottman Trained Therapist and registered provider, and advocate with the Postpartum Support International, and supports parents who are struggling with Postpartum Blues and PMAD (perinatal mood and anxiety disorders). She helps couples find healthy ways to move through conflict, create shared meaning, and stay connected despite facing life challenges.

Sources:

Goodman, S. H., & Tully, E. C. (2009). Recurrence of depression during pregnancy: psychosocial and personal functioning correlates. Depression and anxiety, 26(6), 557–567. https://doi.org/10.1002/da.20421

Yonkers, K. A., Ramin, S. M., Rush, A. J., Navarrete, C. A., Carmody, T., March, D., Heartwell, S. F., & Leveno, K. J. (2001). Onset and persistence of postpartum depression in an inner-city maternal health clinic system. The American journal of psychiatry, 158(11), 1856–1863. https://doi.org/10.1176/appi.ajp.158.11.1856