Perinatal Mood and Anxiety Disorders (PMADs) describe a group of symptoms that can affect women before pregnancy, during pregnancy, and in the postpartum period. These symptoms disrupt functioning and make it difficult to enjoy life. Mood disorders, such as depression and bipolar disorder, often include symptoms of sadness, loss of pleasure, feelings of guilt, and mood swings. Anxiety disorders, such as generalized anxiety, panic disorder, and obsessive-compulsive disorder, include symptoms like excessive worry, irritability, and obsessive or scary thoughts. Often women will share that they aren’t feeling like themselves or that they are not enjoying parenthood like they thought that they would. All of these symptoms and feelings can interfere with a mother’s emotional wellness, her ability to bond with her infant, and her overall functioning.

Perinatal Mood and Anxiety Disorders can be easily missed because many of the symptoms overlap with changes that we come to expect during the postpartum period. Here is what you need to know. Everything in the perinatal period is treatable. Our biggest concern is not that a person will become depressed or anxious during the perinatal period, but rather that they won’t seek help and stay depressed or anxious during the perinatal period. See below for more specific descriptions of what is to be expected during or after childbirth and when you need additional support.

Typical Adjustment to a New Baby

• I am in love with my baby, but sometimes when he cries in the middle of the night I feel a sense of dread

• I fantasized about having a baby, but now I am doubting my abilities as a parent

• I sometimes feel resentful that I have no time for anything or anyone, except for this new baby

• I don’t know if I am feeling all of the things that you are supposed to feel during pregnancy

Becoming a new parent is stressful, and some difficulty adjusting to your new role and to your new baby is to be expected. The physical, emotional, and hormonal changes; and let’s not forget about the disruption in sleep, cause feelings to range from joy and excitement to exhaustion, stress, guilt, and moodiness. Those physical, psychological, and emotional changes you go through after the birth of your child have a name: matrescence. Matrescence is the process of becoming a mother. Adjusting to such a big change doesn't happen overnight so give yourself some time. However, if your symptoms are interfering with your normal coping abilities, functioning or parenting then something more serious might be going on. 

Baby Blues

• I have recently had a baby and I am feeling so sad, irritable, and exhausted

• I don’t have the time or desire to take care of myself.

• I find myself crying more than usual and I feel isolated from my partner, they just can’t relate to me anymore

• I feel like I can’t catch a break and I am wondering if this happens to everyone, or just me

80% of women experience what is described as the “Baby Blues” or feelings of exhaustion, irritation, and moodiness shortly after giving birth. This happens because after delivery your hormones are rapidly changing and you are up with your new baby and getting less sleep than you’re typically used to. Often moms describe feeling more tearful or irritable than usual; however, the overall mood is still joyful. These symptoms usually begin one to three days after delivery and may last between one to two weeks. The key with Baby Blues is both the severity of symptoms and the timeline of symptoms. If these symptoms do not lessen after two weeks, contact a professional as you may be experiencing something more serious than baby blues. 

Depression During Pregnancy & Postpartum Depression

• Everyone tells me that I should be happy, but I am crying all the time and feeling guilt, shame, and hopelessness; no one in the world understands what I am going through

• I am not coping well with this new baby and all the new demands placed on me, maybe I wasn’t cut out to be a mother. Does this make me horrible?

• Sometimes, I have thoughts that my baby and family would be better off if I wasn’t here

Depression during and after pregnancy occurs more often than people think so you are not alone if you are experiencing this. More than 15% of women experience depression following childbirth, perhaps more given that many women who are experiencing these feelings do not seek help. Symptoms include low mood or depressed mood; sadness and excessive crying; loss of interest or pleasure in doing things; agitation and irritability; anxiety and constant worry; difficulty concentrating; disturbances in appetite and/or sleep; loss of energy; feeling of guilt, shame or hopelessness; feeling like you are not doing a good job as a parent; difficulty bonding with your baby; and/or possible thoughts of harming yourself or your baby. Someone suffering from depression may experience some or all of these symptoms. Women are vulnerable to postpartum depression up to one year following delivery.

If you or someone you know is experiencing these symptoms, help is available. Call or email to find out more. 

Anxiety During Pregnancy & Postpartum Anxiety

• I can’t turn my brain off, my mind is constantly racing and I have a dreaded feeling that something bad is going to happen

• Maybe I would feel better if I could sleep, but there is so much to worry about, I couldn’t possibly get to sleep

• If I told anyone about all the thoughts I was having, they would judge me; sometimes my thoughts even scare me

• I am experiencing physical symptoms that feel like I am having a heart attack—maybe I am having one?

Many new mothers and parents experience some anxiety and worry after the birth of a new baby. But if your feelings of anxiety are interfering with your functioning, then you might be experiencing postpartum anxiety. Approximately one in every ten women experiences this kind of anxiety after giving birth and 6% of women experience anxiety while still pregnant. Anxiety symptoms often include, constant worry; feeling like something bad might happen to your or your baby; racing or intrusive thoughts; disturbances in sleep and appetite; difficulty sitting still or concentrating; and physical symptoms like dizziness, hot flashes, racing heart, and nausea.

If you or someone you know is experiencing these symptoms, help is available. Call or email to find out more. 

Postpartum Obsessive-Compulsive Disorder 

• I have never had OCD before, but suddenly I feel like if I don’t check things multiple times or make sure everything is perfect then something really horrible will happen

• I am experiencing persistent and repetitive thoughts or images of something bad happening to my baby, if I told anyone they would think that I was nuts or take away my baby

• I desperately want to be a good mother and keep my baby to be safe, and I am afraid to be left alone with my baby

• I find myself washing bottles or pump parts over and over again; no one can help because no one else does it right

Mothers who experience postpartum obsessive-compulsive disorder (OCD) may never have had a diagnosis of anxiety or OCD before, but suddenly cannot escape their intrusive, irrational, and upsetting thoughts (obsessions) unless they engage in a repetitive act (compulsions); such as cleaning constantly, checking things many times or counting and reordering over and over. You do not have to be diagnosed with OCD to experience these common symptoms of perinatal anxiety. It is estimated that as many as 5% of new mothers and new fathers will experience these symptoms. The repetitive and intrusive thoughts and images can be scary and feel like they come out of nowhere. 90% of moms have intrusive thoughts and 81% of dads and partners. Sometimes normalizing these thoughts and knowing that there is a name for what you are experiencing can be helpful. It is important to know that moms with postpartum OCD know that their thoughts are bizarre and are usually disturbed or upset by them; therefore, they are more likely to avoid what triggers them rather than do any harm to their babies. 

We understand that these thoughts can be distressing. If you or someone you know is experiencing these symptoms, help is available.

If you or someone you know is experiencing these symptoms, help is available. Call or email to find out more. 

Postpartum Bipolar Disorder

• After having my baby I am experiencing periods of a severely depressed mood followed by a period where I feel better than usual

• I do not need to sleep, yet I have a ton of energy, I am really talkative and feel overconfident in my abilities

• I am having racing thoughts and difficulty concentrating, my family is noticing my pressured speech

To meet the criteria for bipolar disorder, symptoms must last longer than four days and interfere with functioning and relationships. The up and down cycles and emotional states are more than moodiness common in pregnancy and postpartum. In pregnant and postpartum women, a bipolar disorder can look like severe depression or anxiety followed by elevated mood; rapid speech; decreased need for sleep; continuous energy; racing thoughts; overconfidence; delusions; impulsiveness or poor judgment; grandiose thoughts and inflated sense of self-importance. A personal or family history of bipolar disorder, pre-existing mental health conditions, traumatic birth experiences, and sleep deprivation could be potential risk factors. For other women, the postpartum period might be the first time that she realizes she has bipolar mood cycles.

If you or someone you know is experiencing these mood symptoms, help is available. Consider consulting with a psychiatrist for better management of mood symptoms. Call or email to find out more. 

Postpartum Psychosis

• I am experiencing delusions and beliefs that others might think are strange, but they feel real to me

• I am hearing things that other people do not hear or see things that others do not see

• Sometimes I think that other people might know what I am thinking, which makes me feel suspicious and paranoid

If you are hearing things others are not; feeling like others are out to get you or your baby; or if you are having highly unusual thoughts or strange delusions, you may be experiencing postpartum psychosis. While postpartum psychosis is rare, it is a serious disorder and requires immediate medical attention.

Women suffering from postpartum depression may do things they might not otherwise do given their altered state. Postpartum psychosis is temporary and treatable with professional help, but it is an emergency and it is essential that you receive immediate help. Please call 911 if you or someone you know is experiencing postpartum psychosis.

Do I need therapy?

If you are not sure that what you are going through is normal, you might feel better just by reaching out. It is possible that you will get initial relief from just one phone call. I can help you decide if you should come in for an evaluation and further support.

CONSIDER THESE REASONS TO ENGAGE IN THERAPY:  

• The sooner you get professional help, the sooner you will start feeling better. Therapy provides you with a frame of reference that will help you build a healthier perspective on some of your unwanted thoughts and feelings.

• If you are so overwhelmed that adding therapy to your already full plate doesn’t feel plausible, remember that therapy can help you minimize those overwhelmed feelings and also decrease depression and anxiety with resources and clinical skills. If getting out of the house is too much of a barrier, consider teletherapy. With new and emerging technologies, you can engage in therapy from the comfort of your very own home.

• Maybe you are not worried about how you are feeling right now, but you have a history of depression or anxiety—which can be a risk factor for postpartum depression or postpartum anxiety. Remember that any kind of support during this period is extremely valuable.

• While relying on friends and family is wonderful, everyone benefits from an outside perspective. A therapist comes with a different understanding that your friends and family may not have. Therapy might be the very place you need to express yourself freely and without judgment.

• As a parent or caregiver, your mental and overall health is just as important as your child’s. Treatment is available and it works. Call or email to find out more. 

What happens if I need therapy?

I understand that you are too tired, too distracted, and too overwhelmed with your new baby to think about yourself or your own mental health. I also know how important it is to get you back to feeling like yourself again and as quickly as possible. As a therapist who specializes in the treatment of perinatal mood and anxiety disorders, Nurture Therapy has the experience and knowledge to help you navigate this inherently complicated time. Together, we will come up with a plan for symptom relief and get you in and out of the office as soon as you start feeling better.  

Get the help you and your family need

Every disorder listed here is temporary and treatable. Seeking support from professionals is the first step toward healing. Nurture Therapy understands how difficult it can be to reach out, but it is important to find someone you trust and let them know how you are feeling.

If you are worried about your partner, your sister, your daughter, or your best friend, let her know that help is available. It is important that you find good, accurate information about Perinatal Mood and Anxiety Disorders. Let her know that this is not her fault and that help is available. With her permission, you can call Nurture Therapy and our expert staff will guide you through the initial difficult steps of reaching out for help.