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What Are PMADs?

Anxiety and/or depression during pregnancy and the first year after giving birth affect up to 1 in 5 new or expectant mothers and their families.  These illnesses – also known as perinatal mood and anxiety disorders, or PMADs — are the #1 complication of pregnancy and childbirth.

Women of every culture, age, income level, and race can develop PMADs.  Symptoms can appear anytime during the two-year span from conception through baby’s first birthday.  Onset of symptoms may be gradual or sudden.  Perinatal mood and anxiety disorders are caused by changes in biology, physiology, environment, and expectations.

 

Note:

  • Perinatal includes pregnancy and the first year after giving birth.
  • Antepartum or prenatal refers to pregnancy.
  • Postpartum refers to the first year after giving birth.

 

Perinatal mood and anxiety disorders (PMADs) are temporary and can be treated with a combination of self-care, social support, talk therapy, and medication if necessary.

 

Baby Blues are a period of normal adjustment and are not considered a perinatal mood and anxiety disorder.  Up to 80% of women experience the Baby Blues, which usually last 2-3 weeks and resolve without medical intervention.

 

Depression.  A woman experiencing depression during pregnancy or the first year postpartum might have feelings of anger, sadness, irritability, guilt, lack of interest in the baby, changes in eating and sleeping habits, trouble concentrating, and thoughts of hopelessness and sometimes even thoughts of harming the baby or herself. 

 

Anxiety.  A woman with anxiety may experience extreme worries and fears, often over the health and safety of the baby. Some women have panic attacks and might feel shortness of breath, chest pain, dizziness, a feeling of losing control, and numbness and tingling.

 

Obsessive-Compulsive Disorder (OCD).  Women with OCD can have repetitive, upsetting and unwanted thoughts or mental images (obsessions), and sometimes they need to do certain things over and over (compulsions) to reduce the anxiety caused by those thoughts. These moms find these thoughts very scary and unusual and are very unlikely to ever act on them.

 

Panic Disorder.  This is a form of anxiety in which the sufferer feels very nervous and has recurring panic attacks.   During a panic attack, she may experience shortness of breath, chest pain, claustrophobia, dizziness, heart palpitations, and numbness and tingling in the extremities.  Panic attacks seem to go in waves, but they are temporary and resolve without assistance.

 

Post-Traumatic Stress Disorder (PTSD) is often caused by a traumatic or frightening childbirth, and symptoms may include flashbacks of the trauma with feelings of anxiety and the need to avoid things related to that event.

 

Psychosis.  Individuals experiencing psychosis sometimes see and hear voices or images that others can’t, called hallucinations. They may believe things that aren’t true and distrust those around them. They may also have periods of confusion and memory loss, and seem manic. This severe condition is dangerous so it is important to seek help immediately.  Postpartum psychosis is a very serious emergency and requires immediate medical help. If you or someone you know may be experiencing postpartum psychosis, call a doctor or go to the nearest hospital emergency room.  Women with severe postpartum psychosis may require hospitalization and medication.

 

Treatment

Each woman’s treatment plan and path to wellness will differ slightly, but the most successful plans include:

  • A complete medical examination (some medical conditions, such as a thyroid imbalance and anemia, are fairly common in the postpartum period and can contribute to feelings of depression and lethargy)
  • A psychiatric evaluation
  • Self-help techniques
  • Participation in a support group
  • Talk therapy with a psychologist or counselor
  • Medication and/or hospitalization when necessary

 

Self-care recommendations

New or expectant mothers need to be “mothered” during pregnancy or recovery from childbirth. Being a new mother, caring for a newborn, and maintaining home and family are challenging, especially if the mother feels anxious or depression.  Important self-care steps include:

  • Sleep.  Getting 4-5 hours of uninterrupted sleep is the most effective, least expensive thing a new mother can do to start feeling better.  Brainstorm with partner, friends, and family how to maximize sleep.  Note: sleeping too much or not being able to sleep when baby sleeps may be signs of more serious depression or anxiety.
  • Nutrition.  New moms should eat every time baby eats.  Water and a high-protein snack (yogurt, cheese stick, nuts) are good mini-meals.
  • Exercise.  Gentle exercise – such as a walk around the block – can have terrific benefits.  The combined effect of change of scenery, fresh air, Vitamin D from the sun, and endorphins released in the body can have a positive impact on mood.
  • Time off.  No other job is so demanding, requiring being on duty 24 hours/day, 7 days/week.  New moms need time off to recharge and rejuvenate, especially if feeling overwhelmed.  The challenge is to identify and meet those needs, whether it’s taking a shower, reading the newspaper, or talking with an old friend.
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