Perinatal Mood & Anxiety Disorder and Postpartum Depression(PMAD): Exploring the Differences, Signs & Causes

The World Health Organization estimates that around 13% of people worldwide who have recently given birth, experience a mental health disorder, most commonly depression.This figure is even higher in the developing world at 19.8%. For pregnant people, 10% worldwide experience depression and in developing countries, the rate is 15.6% (1). 

At the Prenatal Yoga Center, we believe in bringing a much-needed awareness to this topic so that those who are pregnant or postpartum can understand the signs of Perinatal Mood and Anxiety Disorders (PMADS) and get the help that they need. We believe that it is essential that childbirth educators, maternity care specialists, clinicians and psychiatrists continually have a conversation about how to better help and assist pregnant and postpartum folks who experience a perinatal mental health disorder.

We will explore some of the different diagnoses given to various perinatal mental health disorders which in the past have generally been classed as “postpartum depression”. We will also examine how to spot the signs of a PMAD and what can potentially cause this disorder. I also will share a dear friend’s story about her experience dealing with perinatal depression.

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The Difference Between Postpartum Depression and Perinatal Mood & Anxiety Disorder (PMAD) Difference between Perinatal Depression & Baby Blues Nicole’s Story Signs and Symptoms of Perinatal Mood and Anxiety Disorder Other symptoms of PMADs Facts About Perinatal Depression Causes How to Get Help For Perinatal Mood and Anxiety Disorder Society’s Expectations and Stigma

The Difference Between Postpartum Depression and Perinatal Mood & Anxiety Disorder (PMAD)

You may be wondering how Perinatal Mood and Anxiety Disorder differs from Postpartum Depression. The main difference is that the field of psychiatry in recent years has recognized that depression and mental health disorders can often occur during pregnancy as well as the postpartum period (i.e. during the perinatal period which includes pregnancy and up to 12 months postpartum). Some may use the term postpartum depression interchangeably with perinatal mood and anxiety disorder, however postpartum depression is exclusively used to refer to depression during the postpartum period whereas perinatal can include both pregnancy and postpartum.

What’s more, perinatal mood and anxiety disorder encompasses a range of different perinatal mental health disorders as well as depression. For example, perinatal anxiety disorder, perinatal psychosis and perinatal obsessive compulsive disorder (OCD) all are considered a type of PMAD.

Difference between Perinatal Depression & Baby Blues

While we are exploring the differences between terms it is important to note that perinatal depression can often be mistaken for baby blues, however there is a key difference between the two. Baby blues happens for a few days to a few weeks after giving birth and is generally considered to be driven by hormones whereas perinatal depression is considered more severe and can go on for months to even years.

Additionally, baby blues is seen as a universal issue among birthing parents. For example, it’s normal for new parents to cry, feel overwhelmed and maybe experience sadness due to hormonal shifts in the body. However, if a feeling of sadness or depression lasts longer than the normal baby blues period of two to three weeks after giving birth then a perinatal depression or PMAD diagnosis may be given.

Nicole’s Story

Not long ago, I was speaking with a friend about her experience right after her babies were born. She confided in me that she suffered from postpartum depression and started to tell me her story. I asked her if she would be willing to share what she endured so that other parents can learn from her struggle.

Here is my brave friend Nicole’s story.

Please describe your postpartum experience

The postpartum experience for me was shocking. It really had no idea what was wrong with me and it didn’t occur to me for several weeks that it could actually be postpartum depression. I was walking around for weeks in a perpetual fog and funk. I was of course tired and overwhelmed after giving birth to twins, but what stood out was that I couldn’t seem to shake the “gloomies” and had a very hard time bonding with my babies. To say I was not myself was an understatement. 

People would describe me as a girl who was always “up” and looked at things “glass half full.” I could barely pull myself out of bed in the morning and I dreaded the rigors that would lie ahead for me each day. I took absolutely no joy in being a new mother. I was so convinced that I had made a huge mistake in having children that if my doctor had come to me and assured me that I was a good person, that he knew I meant well but clearly I was not cut out to be a mother, I think I would have let him take my kids away.

It is very hard for me to look back on those first couple of months, I feel guilty and ashamed about how I felt. The person that I was at the time was a complete stranger to me. As bad as I felt, I am thankful for the fact that never once did I think about harming myself or harming the children, I just wanted to run away.

When/how did you recognize that you were experiencing postpartum depression?

I felt the “doom and glooms” from day one. I had experienced HELLP syndrome when delivering the babies which caused my blood pressure to skyrocket and kept me in intensive care for a few days. I had to see my OB a few days after coming home from the hospital and mentioned that I was feeling bad – feeling like I wasn’t myself and I couldn’t “hold it together” but he wrote it off as being overwhelmed and the stress of the HELLP and the delivery. But help arrived on the day I took the girls for their 8 week check up at the pediatrician’s office.

We saw the physician’s assistant, Dr. Gardiner for the check-up. I immediately liked her, she had such a calm and reassuring way about her. She took one look at me and asked me very gently how I was feeling. When I told her how sad and lost I felt (my husband was with me at the time and was obviously so worried about me), she immediately recognized the symptoms and was at least able to give me a reason and a name for what I was feeling.

While it didn’t help my depression it at least allowed me to realize that what was happening wasn’t my fault and I wasn’t going crazy!

What measures did you take to help relieve the situation?

Dr. Gardiner discussed medication with me and was very reassuring that it would help and I wouldn’t have to take it forever. I have always had a phobia about taking medication (I don’t even like to take Advil!) so I was reluctant.

I kept thinking the next day would be better, that I would “pull myself out of the fog” and get back to being my old upbeat self. Somehow just knowing that it was a chemical issue and not me losing my mind really helped. I knew that my darkest times were when I was alone so I began to reach out to every friend, family member, neighbor and acquaintance to keep me occupied and the upside was they could help me with the babies. I didn’t wind up taking any medication but it’s a decision that quite honestly I regret. There was no reason I had to suffer the way I did when medication could have helped.

I look back on it now and realize it was such a shame that I wasted precious months with the girls crying and feeling worthless and like a terrible mother/person when if I had at least tried the medication I could have enjoyed being on maternity leave and loving and appreciating my new family.

What measures best worked for you?

The only thing that really worked was time and honestly going back to work. It seems strange that going back to work helped cure me because the thought of returning to my job while I was home made me unbearably depressed each day. I felt so awful and knew that each day was slipping away – I became obsessed with the fact that each day I felt sad was one less happy day I was going to have with the kids.

It became like this doomsday countdown in my mind knowing that each day my maternity leave was closer to being over. But somehow when I was forced to get up in the morning, take a shower, put on makeup and nice clothes and get back to the reality I knew prior to the babies, I felt rejuvenated.

Having a little time to myself made me whole again and it allowed me to appreciate every waking moment I had with the girls when I was home. I became so much more patient and loving, I finally felt like a new mother was supposed to feel. Luckily I only had to go back to work three days a week so I really felt like I was having my cake and eating it too!

Did you feel like you could discuss what you were feeling with other people ie- partner, friends etc?

I felt like I could talk about it with my husband and my best friend and sisters but no one could understand what I was going through. They would try everything from sympathizing to “tough love” but no one really got it. I was so relieved when Dr. Gardiner was able to recognize my symptoms – for the first time I felt like I wasn’t going crazy and someone really knew (at least from a clinical point of view) what I was going through.

A couple of years later when I read Brooke Shield’s book, “Down Came the Rain”, I cried (with sadness and relief) through every chapter. It brought back all the raw and painful emotions I felt each day and it made me so happy that someone with fame and notoriety was able to share such a personal story that was bound to help thousands of women. My only wish is that it had come out before I had my kids, not after. Since she had taken the medication, I think it would have given me the courage to do the same.

I am tempted to go and see Brooke Shields in The Adamms Family and wait outside the stage door after the play in the hopes of telling her how much that book meant to me.

Do you have any advice for other parents that may be experiencing postpartum depression?

My advice would be to try and recognize your symptoms early and to talk about it with your doctor. My biggest mistake was thinking that I could will the sadness away, that mind over matter would help me to persevere – instead the hormones won and I wasted 4 months feeling like there was a rain cloud above my head that followed me everywhere.

It’s also important to take time for yourself. Don’t be afraid to take people up on their offers to help (another of my many mistakes) and get out and do something slightly indulgent like meet a friend for lunch or get your nails done. Don’t waste precious free time doing mindless errands like food shopping and Duane Reade runs, try and let others help you with it.

Most of all I would say that you have to remember you are powerless against this force of nature – it is not your fault and you just can’t help it. It was such a waste of energy for me to carry the shame and the sadness that I did. Be very vocal with your doctor, let them help you whether it’s taking medication or connecting you with a support group – just putting a name to the issue will help the healing process.

Signs and Symptoms of Perinatal Mood and Anxiety Disorder

There are a number of different symptoms of PMAD that can indicate a mental health disorder. We believe it is crucial for those who have recently given birth to be aware of the signs and symptoms should they need help. 

Some symptoms include:

Feeling restless or moody Feeling sad, hopeless, and overwhelmed Crying a lot Having no energy or motivation Eating too little or too much Sleeping too little or too much Feeling “not good enough” as a parent Having trouble focusing or making decisions Having memory problems Feeling worthless and guilty Losing interest or pleasure in activities you used to enjoy Withdrawing from friends and family Having headaches, aches and pains, or stomach problems that don’t go away Problems bonding with the baby

It is normal to see a change in mood and desires postpartum, especially considering the huge hormonal shift your body experiences after birth and sleep deprivation. However, if you are experiencing any of the symptoms of depression listed above (2) for more than two weeks, it is best to consult with your care provider. Your doctor can figure out if your symptoms are caused by depression or something else.

In a conversation with Karen Kleiman on our podcast Yoga|Birth|Babies, she shared that it’s not just about the symptoms that one feels, it’s the intensity and frequency of them as well the resilience of the parent. All these factors come into play when diagnosing a PMAD. In fact, she explains that it is up to the parent to decide at which point they need the help of a professional. She believes if a parent doesn’t like the way that they feel and decide they need help, then it is important that they trust their gut instinct and get that help.

You can listen to this podcast episode where we discuss Perinatal Depression in depth here.

Other symptoms of PMADs

Slightly more worrying symptoms of a PMAD that could indicate a more serious condition such as perinatal psychosis, perinatal anxiety or perinatal obsessive compulsive disorder but are not exclusive to these disorders are:

Intrusive or violent thoughts Thoughts of self harm or harming the baby Hypervigilance over the baby Feelings of regret for having children Severe anxiety Not wanting to leave the house or want to avoid social situations Panic attacks Delusions or hallucinations

Facts About Perinatal Depression

For half of birthing parents diagnosed with PMAD, this is their first episode of depression.
About half of new parents who are later diagnosed with PMAD may have begun experiencing symptoms during pregnancy so it’s important to seek help early! Perinatal depression can occur at any time after birth, but it most commonly starts 1-3 weeks after delivery.

Causes

It is impossible to pinpoint what may be the cause of one’s perinatal mood and anxiety disorder. There are several reasons that can contribute to PMAD, but not one single reason often leads to this disorder.

Some causes could include:

Infant temperament and maternal anxiety and depressed mood in the early postpartum period. (3) Isolation Expectations of what parenthood would be like, what the baby would be like  Lack of support Overcoming a difficult birth (If you experienced a challenging birth, you may be interested in the article, Birth Trauma) Ambiguous feeling about the pregnancy – may have been an unplanned pregnancy Loss of freedom and personal identity Body image issue- loss of pre-pregnancy body More prone to experiencing PMAD if there is a history of depression or mental illness pre-pregnancy or family history of depression or mental illness. Stress from marital problems or financial problems

How to Get Help For Perinatal Mood and Anxiety Disorder

Even the idea of reaching out for help may seem overwhelming. If you need, start small, maybe your partner can make a phone call or two to get the ball rolling for additional support. Here are some additional ways you can get help:

Seek professional help LifeNet Call Center – Listening Service for people in crisis, including substance abuse. 800-543-3638 Get support from partner, family and friends Practice self-compassion Sleep! Sleep deprivation can really wear on the mind and body!! Find a New Parent’s Support Group in your area. (PYC often offers on going support groups!) Try to get some time away from your baby, even if that is just going outside and walk around the block a couple times. Supplements: Omega-3 polyunsaturated fatty acid supplementation in prevention and treatment of maternal depression: Putative mechanism and recommendation

It may be that you need to try different things to help yourself to feel better. This may include medication or seeing a mental health professional. However, like Nicole, the solution may be doing something that helps you to rediscover your identity such as going back to work. Each case of PMAD is different and so should the solution be. Talk to friends, family and professionals to discover what the solution might be for you.

Society’s Expectations and Stigma

From my own experience, I believe a new parent may feel a certain amount of pressure to “get it right.” Many people said to me, “You seem to be doing great!” While it was nice to have the encouraging support and feedback, there was a part of me that felt, if the outsider thinks I am doing a great job, why don’t I? Was there even room for me not to be doing so great when everyone believed (and maybe expected) I was?!

I clearly remember one difficult Wednesday afternoon when Shay was about 2 1/2 weeks old. All the family had left and our postpartum doula was not in that day. At this time, our pediatrician wanted Shay to eat every two hours. I had been up with him since 6am and managed to get him down for a few rounds of feeding. But the successful cycle of eat, change him and put him down for a nap stopped abruptly.

He had gone straight through three feeding and no nap. He was tired and irritable and I was exhausted. I tried every position and trick I had learned in my few weeks of motherhood. We bounced on the birth ball, I swaddled him, rocked him, sang to him, Shh’d him. Around 3 pm that afternoon, I called my husband asking him when he was going to come home. He said soon. I hung up the phone and just started crying. Fifteen minutes later, my husband entered the apartment to find me sitting in our bedroom, rocking on the ball with the baby in my arms and tears streaming down my face. He gave me a kiss and took our child. After a few minutes, he said, “Thank you for calling me. Now please go to sleep.” I had never been so grateful for the opportunity to rest and for help to arrive.

As Nicole explained in her story, it may be challenging and disappointing to face that one cannot “pull themselves” out of the funk they are feeling by themselves. Some people may even be at a level of embarrassment or shame that goes along with experiencing perinatal mood and anxiety disorder and needing medication. Even though pharmaceutical drugs are very prevalent in our society, some may still feel stigmatized for taking SSRIs (Selective Serotonin Reuptake Inhibitors).

A close friend of mine talked to me about how she was finally able to accept taking medication. She said she could acknowledge that if she had diabetes and needed insulin, there would be no doubt that she would take the medication. So she was able to rationalize, taking medication for her mental health was no different than taking medication for her physical health.

No matter what level of depression or anxiety one feels, there is always a way to find support and feel better.

If you are looking to join a community of parents who have recently given birth, then consider joining one of our postnatal yoga classes! Click the button below to view our class schedule.

FAQs

What are the risks of untreated PMADS?

Elizabeth Cox explains in ‘Women’s Mood Disorders’ that when not addressed during pregnancy, perinatal mood and anxiety disorders (PMADs) can create various negative outcomes for the mother, infant, and their relationship. The risks of untreated symptoms must be balanced against the risks associated with treatment during pregnancy and breastfeeding. (4)

We believe that the risks of untreated PMADs depend on the severity of the case and the symptoms of the individual. For example, if a parent isn’t able to care for the baby due to their PMAD, then medication and professional help is strongly recommended.

There is also a risk that if PMADS aren’t addressed, that they may last for years and get progressively worse.

Sources

(1) The World Health Organization: https://www.who.int/teams/mental-health-and-substance-use/promotion-prevention/maternal-mental-health#:~:text=Section%20navigation&text=Worldwide%20about%2010%25%20of%20pregnant,trained%20non%2Dspecialist%20health%20providers.

(2) http://womenshealth.gov/publications/our-publications/fact-sheet/depression-pregnancy.cfm
(3) http://www.ncbi.nlm.nih.gov/pubmed/21391161

(4) ‘Women’s Mood Disorders’ by Elizabeth Cox https://link.springer.com/chapter/10.1007/978-3-030-71497-0_5#:~:text=Untreated%20PMADs%3A%20Effects%20on%20the,low%20birth%20weight%20%5B47%5D.

American Psychological Association
http://www.acog.org/publications/patient_education/bp091.cfm
http://www.womenshealth.gov/faq/depression-pregnancy.cfm