What is a PMAD?

For too long, the media has used postpartum depression as a blanket term used to encompass all perinatal mood and anxiety disorders (PMADs). We are pleased to see the increased use of the term “PMAD” rather than using one maternal mental illness to define a whole category. However, for many, there is still a great lack of understanding regarding the different types of perinatal mood and anxiety disorders as well as their symptoms. Failure to identify, define and share information about these different disorders perpetuates the stigma around maternal mental health and may also make a mom who is suffering feel isolated, alone and afraid to share or ask for help. The fact is that 1 in 7 women get postpartum depression (or another perinatal mood or anxiety disorder); in low socioeconomic communities, that number rises to 1 in 4. For these reasons, we wanted to dedicate a post to explaining the different perinatal mood and anxiety disorders and their symptoms. Please note that symptoms can start anytime during pregnancy or within the first year postpartum.

WHAT IS POSTPARTUM DEPRESSION?

Depression during pregnancy (antepartum or prenatal depression) as well as postpartum depression are more common than many realize. While postpartum depression often becomes the scapegoat for nearly all postpartum mental health issues, there are some hallmark symptoms that are used to identify this illness including the following:

  • Feelings of anger, irritability or rage
  • Regret of becoming a mother or feeling as though you’ve made the wrong decision to have a baby
  • Lack of interest in the baby
  • Loss of interest, joy or pleasure in things you used to enjoy
  • Feeling disconnected or numb
  • Crying and sadness
  • Eating too much or too little
  • Insomnia
  • Feelings of guilt, shame or hopelessness
  • Fear that you will never be yourself again and things will never get better
  • Possible thoughts of harming the baby or yourself.

It is important to recognize that postpartum depression is NOT the “baby blues” which is typically a few days to two weeks of mild ups and downs and weepiness. The key is to ask yourself how often have you been feeling this way, for how long and to what extent are these symptoms affecting your ability to function in your daily life?

WHAT IS POSTPARTUM ANXIETY?

Pregnancy or postpartum anxiety can be present on its own or in addition to postpartum depression. While most moms experience some anxiousness or worry during pregnancy or after giving birth, postpartum anxiety is more severe and impacts a mom’s ability to function and/or bond with her baby. Some symptoms of postpartum anxiety include:

  • Constant worry
  • Feeling as though something bad is going to happen
  • Racing thoughts that are difficult to slow down
  • Feeling like your to-do list is never done or that your work is never good enough
  • Sleep and/or appetite disturbances
  • Feeling as though you can’t sit still, restlessness
  • Physical symptoms such as dizziness, nausea or diarrhea

In addition to generalized anxiety, a mom may also suffer from postpartum panic disorder with which she will likely experience extreme nervousness and recurring panic attacks. These attacks may include dizziness, shortness of breath, chest pain, heart palpitations and numbness or tingling in the extremities. These symptoms are not life threatening and will subside after the attack passes.

WHAT IS POSTPARTUM-OCD?

Anxiety may also present as pregnancy or postpartum obsessive compulsive disorder or postpartum-OCD. This disorder is known for causing intrusive thoughts that are unwanted and terrifying to the mom who is experiencing them. You might be suffering from postpartum-OCD if you are experiencing some of the following:

  • Worried constantly no matter what others might say to reassure you
  • Disturbed by dark, unwanted thoughts – possibly about harm coming to your baby
  • Afraid to be alone with your baby
  • Spending hours Googling or researching in an attempt to decrease your anxiety
  • Avoiding potentially harmful things such as the stove, stairs, knives or bathtub
  • Obsessed with checking things such as locked doors or your baby’s breathing
  • Sleep and/or appetite disturbances
  • Afraid that if you share what you’re experiencing with loved ones or a doctor, that your baby will be taken from you

A professional who has not been properly trained in perinatal mood and anxiety disorders may confuse postpartum-OCD with postpartum psychosis. Therefore, many moms experiencing intrusive thoughts are afraid to be honest with family, friends or providers. The key differentiating factor is that a mom with postpartum-OCD experiences thoughts that are ego-dystonic or thoughts and/or impulses that are distressing and inconsistent with the person she identifies herself to be.

WHAT IS POSTPARTUM PTSD?

Several events can contribute to a mom experiencing postpartum PTSD. These may include prolapsed cord, an unplanned c-section, alternative means to deliver the baby, feelings of powerlessness or lack of support during delivery or a baby who needs to spend time in the NICU. Symptoms of postpartum PTSD may include, but are not limited to the following:

  • Flashbacks
  • Nightmares
  • Avoidance of stimuli associated with the perceived traumatic event
  • Difficulty sleeping
  • Anxiety and/or panic attacks

We want to stress that trauma is subjective. Your labor, delivery or postpartum period may not be deemed traumatic from a medical perspective. However, if you are experiencing symptoms of postpartum-PTSD, know that your feelings are valid and you deserve to be taken seriously. Please reach out to a provider you can trust.

WHAT IS POSTPARTUM PSYCHOSIS?

Postpartum psychosis is a rare but extremely serious condition that requires immediate medical attention. Approximately 1 or 2 out of 1,000 moms will experience postpartum psychosis. Hyperbolic media depictions have greatly contributed to the inaccurate assumptions about the disorder. While you may have been lead to believe that all moms experiencing postpartum psychosis harm themselves or their children, the reality is that 5% of moms with postpartum psychosis commit suicide and 4% commit infanticide. Those statistics are still far too great for a condition that is treatable.

A mom who is suffering from postpartum psychosis experiences a break from reality. In her psychotic state, her hallucinations, delusions and beliefs make perfect sense to her. As opposed to postpartum-OCD, a mom with postpartum psychosis experiences thoughts that are ego-systonic or thoughts that are acceptable to her sense of self.

It’s important to note that many survivors of postpartum psychosis never harm themselves or anyone else, nor do they experience delusions that give them violent commands. However, because a mom with postpartum psychosis is experiencing irrational thinking and judgement, it is imperative that she be evaluated, treated and carefully monitored by a perinatal mental health professional. Please seek immediate medical attention if you or someone you know is experiencing any of the following:

  • Feeling paranoid or suspecting that others are out to get you
  • Seeing and/or hearing things that no one else does
  • Experiencing thoughts of harming yourself or others that you want to act on
  • You are unable to sleep and have more energy than you’ve ever had before
  • You are irritated by the fact that those around you don’t seem to understand you

In conclusion, the message we’d like to give regarding ALL perinatal mood and anxiety disorders is that they are temporary and treatable with the right, professional help. In no way are you at fault for the symptoms you are experiencing nor do they make you a bad person or a bad mother. Help is available and recovery is possible.

There is no one size fits all when it comes to perinatal mood and anxiety disorders. However if you find that you, or someone you know, is experiencing symptoms of a PMAD, please reach out to a healthcare provider you can trust. If local to the milwaukee area, you can contact Moms Mental Health Initiative by email at mmhimke@gmail.com. You may also contact us via Facebook or learn more by visiting our website, www.momsmentalhealthmke.org. You can also learn more about additional resources near you by visiting Postpartum Support International’s website at http://www.postpartum.net/  or by calling their warm-line at 800-944-4773. Finally, if you are thinking of harming yourself or your baby, get help right away by calling the National Suicide Prevention Lifeline at 800-273-8255, or dialing 911. You are not alone.

-Written by Alexis Bruce

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