Before having a baby, I was warned about the “baby blues.” This refers to the time postpartum when hormones settle and re-assert themselves after giving birth. Many moms feel a bit weepy, sad, irritable, and overwhelmed.1 And boy, did I feel it! I didn’t want to leave the house. I was worried about my tiny, new human being out in a big, wide world. And I was exhausted — bone shatteringly so. But after a few days, the feelings abated. However, I was left with the exhaustion (nearly five years of exhaustion and counting!).
PMADs: What You Should Know
Baby blues has a lot to do with hormones, adjustment, and lack of sleep. It will usually resolve naturally (or after some postpartum self-care and time to adjust) in a couple of weeks. 50-80% of all new mothers report feeling physically and emotionally overwhelmed.1
However, perinatal or postnatal mood and anxiety disorders (PMADs) are not the “baby blues.” They can appear before giving birth, after birth, and persist well beyond a couple of weeks. In some cases, they can occur up to one year after giving birth.1 That’s right! Contrary to popular belief, PMADs don’t necessarily appear in the immediate days and weeks after birth.1 Here’s what you need to know about them:
What Are PMADs?
PMADs encompass several conditions: depression, anxiety, obsessive-compulsive disorder, post-traumatic stress disorder, and postpartum psychosis, the most common of which are symptoms of depression and anxiety.2 Research suggests that 15-21% of women experience a PMAD in the year (12 months) after their child’s birth.2,5 The most common presentations are associated with post/perinatal depression (PND) and post/perinatal anxiety (PNA), with some research indicating that around 15-21% of women may experience minor or major depression or anxiety after birth.5
Post/Perinatal Depression (PND)
The typical symptoms of PND might include:1,2,3,4
- Anger or irritability
- Trouble falling or staying asleep
- Sleeping too much
- Feeling guilty or worthless
- Lack of interest in doing things you used to enjoy
- Difficulty concentrating
- Socially isolating yourself from family or friends
- Not caring for yourself (this includes activities of daily living, like washing yourself or getting dressed)
- Over- or under-eating
- Feeling weepy or crying often
- Showing too much or not enough concern for your child
- Having negative feelings about your baby
- Feeling like harming yourself or the baby (if you experience these thoughts, please seek immediate help from a trained professional or emergency services in your area)
Post/Perinatal Anxiety (PNA)
The typical symptoms of PNA might be:1,2,3,4
- Constant worry
- Feeling like something bad is going to happen
- Racing and intrusive thoughts
- Trouble falling asleep or sleeping too much
- Loss of appetite or overeating (weight loss or gain)
- Restlessness or an inability to sit still
- Physical symptoms like dizziness, nausea, headaches, racing heartbeat, and breathing fast
- Feeling fearful or uneasy
Other PMADs
PND and PNA are the most common disorders following childbirth.11,12 However, PMADs can also include other less common disorders – which can be just as impactful or serious despite being less known. These can include:2
1. Perinatal Panic Disorder
A diagnosis of panic occurs within a category of anxiety disorders, and up to 11% of new mothers can experience it. Key symptoms to be on the lookout for include:6
- Recurring panic attacks
- Shortness of breath
- Heart palpitations
- Chest pain
- Feeling nervous
- Having excessive worries or fears
2. Perinatal Obsessive-Compulsive Disorder
This can occur in up to 11% of women and can result in experiences or symptoms broken down under either obsessions (persistent or intrusive thoughts related to their baby), compulsions (actions or behaviors repeated over and over to try to reduce the fear associated with obsessions) or both. It’s coupled with intense fear or horror related to these thoughts and, often, avoidance of triggers or feared stimuli.7
3. Postpartum Post-Traumatic Stress Disorder
Postpartum post-traumatic stress disorder occurs in an estimated 9% of women following childbirth. Symptoms to look out for include:8
- A traumatic birth experience (or other birth/health/infant-related event)
- Re-experiencing the birth/experience (repetitive thoughts, dreams)
- Avoiding things that remind them of the experience (places, people, thoughts, feelings)
- Increased arousal (being hypervigilant, difficulty sleeping, feeling irritable, easily or exaggerated startle)
4. Perinatal Bipolar Disorder
For women who are experiencing postpartum depression, around 22% of them are experiencing bipolar depression.5 Bipolar disorder refers to someone experiencing depression as well as periods of mania. The symptoms of depression are the same as those described in PND. Symptoms of mania include:9
- Increased energy
- Overactivity
- Racing thoughts and speech
- Being reckless (taking risks, spending too much)
- Increased sex drive
- Irritability
- Reduced sleep
- Having grandiose ideas (feeling an exaggerated sense of importance, power, or knowledge)
- For some, experiences of psychosis (hallucinations or delusions)
5. Postpartum Psychosis
According to studies, postpartum psychosis occurs in approximately 1-2/1,000 women after delivery.2,13 Typically, symptoms begin suddenly and occur within the first four weeks after delivery. Symptoms include:2
- Hallucinations and/or delusions
- Hyperactivity
- Irritation
- A decreased need for sleep
- Poor decision-making
- Irritation
- Significant shifts in mood
It’s important to know that there’s a 5% suicide rate and a 4% infanticide rate linked with postpartum psychosis.2 If you notice any of these symptoms, you must seek immediate support from your local hospital or emergency service.
Many of these symptoms of PMADs are normal. If your child becomes a non-sleeping, breastfeeding machine at night, of course you’re going to feel tired. Due to hormones and significant adjustments to your life, many of these other feelings can be very typical. But you should pay attention when these symptoms last (consistently) for more than a couple of weeks, become more severe, or start affecting the quality of your life.1 In particular, if you’re having thoughts of harming yourself, your baby, or anyone else, you should immediately contact emergency services or go to your local hospital.
Who Gets PMADs?
We know little about why mental health conditions impact one person but not another. It’s thought to be a combination of genetics, biology, and personal history/experiences. The following are some life circumstances that occur before and during pregnancy that are associated with a higher likelihood of PMADs:1,3
- A history of mental health conditions
- Substance use (alcohol and other drugs)
- Trauma or violence
- Lack of social support
- A traumatic birth or significant medical intervention post-birth
While these factors might increase the likelihood of experiencing PMADs, remember to watch for the symptoms rather than assume you or someone you know isn’t likely to get a PMAD. They can occur in women having their first child or even their fourth, fifth, etc. Women with no medical interventions can experience them, as well as mothers whose babies had to be in the NICU (neonatal intensive care unit) or who required medical support themselves. Recent research has also found that fathers can experience PMADs, too.1
Treatment for PMADs
There are several treatment options available to help address PMADs. These include:10
- Certain medications (can only be discussed and prescribed via appropriate healthcare providers)
- Therapy (particularly cognitive behavioral therapy or other therapies that focus on self-compassion)
- Making lifestyle changes where possible (improving sleep, exercising, focusing on nutrition and eating a balanced diet, and using stress reduction strategies)
- Connecting with social supports
Remember, each person and their circumstances are unique, so you’ll need to explore what treatment options best suit your needs.10
Seek Help as Soon as You Can
There seem to be a lot of unrealistic expectations around motherhood that it will be a fluffy, rosy, beautiful experience with a snuggly, perfect baby (social media has a fair bit to answer for here). But motherhood certainly isn’t perfect. I have yet to meet a perfect parent. It’s these expectations that can make it hard to seek help.
You may feel like everyone else has it together or that a “good parent” would handle things better. But mental health conditions don’t discriminate. They don’t care how beautiful your nursery is or how closely you stuck to your birth plan. Being a parent is messy, challenging, and the most beautiful thing we’ll ever do. However, it’s essential to seek support if you (or someone you love) are struggling or experiencing any of these symptoms. Seeking help is a sign of strength, not weakness. If this article has brought up anything for you, please seek the support of a trusted health professional or emergency services in your area.
