Understanding Perinatal Mood and Anxiety Disorders

With specializing working with women, one of the areas I focus on is working with new and expectant mothers in the perinatal mental health realm. Therapists who work in the perinatal mental health realm, can have a variety of specialities, with some including pregnancy or infant loss, non-birthing parents/fathers, infertility, surrogacy, adoption, and NICU families. In this newsletter, I hope to provide psychoeducation around symptoms of a perinatal mood and anxiety disorder, and the myths around mental health in motherhood.

In recent years, the understanding of experiencing mental health struggles in motherhood, has shifted from the diagnosis of Postpartum Depression to Perinatal Mood and Anxiety Disorders (PMADs). Research found that the variety of symptoms that an expectant or new mother may experience is very varied, and therefore symptoms could not always meet the diagnostic criteria for depression.

A PMAD can begin any time during pregnancy or within one year postpartum (baby being born).  Also, a PMAD can be triggered after a miscarriage or stillborn birth of a baby. PMAD symptoms can consist of agitation, anxiety, anger, rage, insomnia, persistent sadness, crying, feeling overwhelmed, irritability, appetite changes, mood swings, apathy, exhaustion, mania, hyper-vigilance around the baby, and drug and alcohol dependence. Also, more serious conditions such as postpartum psychosis, PTSD, Bipolar, and suicidal ideation can be triggered while experiencing a PMAD as well, and need to be acutely addressed.

Through research we know a PMAD can be triggered with the physical and hormonal changes a woman undergoes during pregnancy and after birth that can increase risk to mental health challenges. Other factors that put women at risk are psychological factors of not having enough support, a personal history of mental health struggles, and strong ideal/perfectionist expectations with how transitioning to parenthood should progress. Other concurrent stressors that predispose women to experiencing a PMAD are sleep deprivation, struggling to attach to their baby, poor nutrition, and interpersonal stress.

Being a PMAD informed therapist, a lot of work with new mothers is working through the social myths of parenthood and the shame that can be triggered when a mother is struggling.

There is a lot of pressure in Western society for women to always present “happy, put together and thriving” in new motherhood. However, we know the reality that though there can be “positive” experiences in early motherhood, there are, or sometimes more challenging experiences that a woman endures during this season. 

Holding space, that just because you are struggling in motherhood, does not mean you are a bad mother or not “grateful” for your child.  Allowing space for “all feelings” in motherhood to be validated, and acknowledging that areas of grief may need to be worked through, often helps mothers feel relieved in finding support. It is also important for mothers and caregivers to understand, that like any mental health condition, a perinatal mood and anxiety disorder can come in cycles for months or years, after a baby or the perinatal trauma occurred, whether that be a miscarriage, stillbirth, traumatic pregnancy or labor/delivery. Birthdays or anniversaries of the trauma can trigger seasons of relapse, and increasing awareness, compassion, and support during these times are important for getting back on track.

If interested in learning more about the Perinatal Mood and Anxiety Disorders, or looking for a resource for yourself, loved one, or friend who may be experiencing one, Postpartum Support International (PSI) is a reputable organization with a variety of resources from free call lines, support groups, connecting with regional coordinators in your city, and variety of training and volunteer opportunities for individuals to get involved with.