Perinatal Mood and Anxiety Disorders (PMADS)

---

Did you know perinatal mental health conditions are the #1 complication of pregnancy and childbirth. According to current data, 1 in 5 Moms and 1 in 10 Dads report experiencing symptoms of depression or anxiety in the postpartum period. Perinatal Mental Health conditions can occur anytime during the perinatal period, including pregnancy, post-loss, and postpartum. These conditions are common, treatable, and can affect anyone regardless of prior mental health history.

Perinatal depression is a depressive disorder that develops during pregnancy, after a pregnancy loss, or within 1 year after childbirth. It involves persistent changes in mood, thinking, behavior, and functioning that go beyond the expected emotional adjustments of pregnancy or new parenthood.

Common symptoms may include:

• Persistent sadness, emptiness, or feeling emotionally numb
• Loss of interest or pleasure in activities that were previously enjoyable
• Feelings of guilt, shame, worthlessness, or hopelessness
• Feeling as though you are not a good mother
• Irritability, anger, or rage
• Fatigue or feeling physically and emotionally depleted
• Frequent crying episodes
• Significant changes in sleep or appetite
• Difficulty concentrating or making decisions
• Feeling disconnected from others, feeling alone, or isolating yourself
• Having difficulty bonding with the baby
• Thoughts of death, suicide, or harming oneself or the baby (this is a medical emergency and requires immediate support and intervention)

Perinatal anxiety refers to significant anxiety that develops during pregnancy, after a pregnancy loss, or the postpartum period. It may involve excessive and difficult-to-control worry, fear, physical symptoms of anxiety such as panic attacks, or a persistent sense that something bad is going to happen. Anxiety may center on the pregnancy, your birth, the health and safety of your or your baby, parenting, or your relationships.

Common symptoms may include:

• Excessive or uncontrollable worry
• Persistent fears about something bad happening
• Feeling on edge, restless, or unable to relax
• Racing thoughts or difficulty concentrating or quieting the mind
• Irritability or feeling overwhelmed
• Repeatedly seeking reassurance
• Avoidance of situations that trigger anxiety
• Difficulty sleeping, even when your baby is sleeping
• Physical symptoms such as rapid heartbeat, dizziness, nausea, trembling, or shortness of breath (not related to another medical cause)
• Panic attacks

Perinatal OCD is OCD that develops or becomes significantly worse during pregnancy or the postpartum period. It is characterized by obsessions—recurrent, unwanted, intrusive thoughts, images, or urges—and compulsions, which are behaviors or mental rituals performed in an attempt to reduce anxiety or prevent a feared outcome.

Perinatal OCD commonly involves fears related to the health and safety of your pregnancy or baby, contamination, illness, or accidental or intentional harm. Having intrusive images or thoughts is another common component of perinatal OCD. These intrusive images or thoughts are typically unwanted, frightening, and inconsistent with the person's values. You may take steps to avoid triggers to these images or thoughts because they are so upsetting. Importantly, having intrusive thoughts about harming a baby does not mean that a person wants to harm the baby or is likely to act on the thought.

Common symptoms may include:

• Intrusive, unwanted thoughts, images, or urges
• Fears of accidentally or intentionally harming the baby
• Excessive concerns about contamination, illness, or safety
• Excessive cleaning or washing
• Repeated checking of the baby
• Excessive reassurance-seeking
• Avoiding being alone with or caring for the baby
• Repeatedly researching symptoms, illnesses, or safety information
• Mental rituals, rumination, counting, reviewing, or "neutralizing" thoughts
• Rigid routines intended to prevent something bad from happening

Perinatal PTSD is PTSD that occurs in connection with pregnancy, childbirth, the postpartum period, or a previous trauma that becomes activated during the perinatal period. It may follow a traumatic or frightening birth experience, pregnancy complication, medical emergency, pregnancy or infant loss, or other trauma.

Common symptoms may include:

• Intrusive memories or distressing thoughts about the traumatic event
• Nightmares, flashbacks, or feeling as though the event is happening again
• Intense emotional or physical distress when reminded of the trauma
• Avoidance of people, places, conversations, medical care, or other reminders
• Hypervigilance or feeling constantly "on guard"
• Increased startle response
• Difficulty sleeping or concentrating
• Feelings of fear, helplessness, guilt, shame, or emotional numbness
• Feeling disconnected from your body, baby, partner, or the birth experience

Perinatal bipolar disorder involves episodes of depression and episodes of mania or hypomania occurring during pregnancy or the postpartum period. These episodes impact a person’s mood, thinking and behavior for weeks to months at a time. Research shows that 50% of women with bipolar disorder are first diagnosed in the postpartum period.

There are two phases of a bipolar mood disorder: the lows and the highs. During the lows, you may experience a sad, depressed or irritable mood and a combination of symptoms including low energy, sleep problems (too much or too little), appetite changes (poor appetite or overeating), poor concentration, and thoughts of death. The highs, called mania or hypomania, are characterized by feeling exceptionally happy, creative, or productive. You may be active and talkative and need very little sleep. A person can also experience a mixed bipolar episode, which is experiencing the lows and the highs at the same time. This kind of episode is most worrisome.

Most individuals with bipolar disorder need regular medication to help manage symptoms. There are a variety of medications that can be used to treat bipolar disorder and many of them can be used during pregnancy and/or lactation. When the episode is severe (one has delusions or hallucinations, is suicidal or homicidal, or is making very unsafe decisions) hospitalization may be needed. 

• Periods of severely depressed mood
• Elevated, expansive, or unusually irritable mood
• Increased energy or activity
• Decreased need for sleep without feeling tired
• Rapid or excessive speech
• Racing thoughts
• Increased confidence or feelings of grandiosity
• Increased distractibility
• Poor judgment
• Impulsive or risky behavior
• In severe episodes, delusions or hallucinations, or thoughts of harming yourself or others are present. This is a psychiatric emergency and requires immediate help.

Perinatal or postpartum psychosis is a uncommon and is a psychiatric emergency involving a significant loss of contact with reality. It most commonly begins within the first two weeks after childbirth, although onset can up to one year postpartum, and, more rarely, during pregnancy or following a pregnancy loss. It is strongly associated with bipolar-spectrum illness, although it can occur without a known history of bipolar disorder.

Common symptoms may include:

• Delusions or beliefs that are not based in reality (often religious or governmental in nature)
• Hallucinations, such as hearing or seeing things others do not
• Paranoia or extreme suspiciousness
• Severe confusion or disorganized thinking
• Rapid speech, flight of ideas, difficulty communicating
• Extreme agitation or unusual changes in behavior
• Dramatic or rapidly changing moods
• Mania or unusually high energy
• Severe depression or emotional withdrawal
• Markedly decreased need for sleep or inability to sleep
• Disorientation or difficulty distinguishing reality from imagination

Perinatal psychosis requires immediate psychiatric evaluation and treatment. It is different from perinatal OCD: a person experiencing OCD generally recognizes intrusive thoughts as unwanted and distressing, whereas psychosis may involve fixed false beliefs, hallucinations, or impaired reality testing. 

If you or someone you know is experiencing a psychiatric emergency, especially thoughts of suicide or harming someone else, hallucinations, delusions, severe confusion, or a loss of contact with reality, seek immediate help. Do not wait for symptoms to resolve on their own or wait for a regularly scheduled appointment.

• Call 911 or go to the nearest emergency department 
• If possible, do not leave the person alone 
• Tell emergency personnel that the person is pregnant or recently gave birth and describe any psychiatric symptoms, medications, substance use, sleep deprivation, or recent changes in behavior.

Call or text 988 to connect with the Suicide & Crisis Lifeline. The service provides 24/7, confidential crisis support for people experiencing suicidal thoughts, emotional distress, or other mental health crises. If there is an immediate threat to life or safety, call 911 rather than relying solely on a crisis line.

Perinatal mental health conditions are common and treatable, and early support can make a meaningful difference. You do not need to have a diagnosis before reaching out for support. You may benefit from talking to your doctor, seeing a therapist, or contacting the following resources if you are feeling unlike yourself, overwhelmed, persistently anxious or depressed, experiencing frightening intrusive thoughts, struggling after a difficult birth, or having difficulty functioning day-to-day.

Postpartum Support International (PSI) is a national organization dedicated to supporting individuals and families experiencing perinatal mental health concerns.

PSI offers:

• PSI HelpLine: 1-800-944-4773 (4PPD) for support, information, and referrals
• Online support groups and peer to peer support
• Chat with an expert sessions
• Educational resources
• A directory for finding perinatal mental health professionals

National Maternal Mental Health Hotline: Call or text 1-833-TLC-MAMA (1-833-852-6262)

This is a free, confidential, 24/7 resource for pregnant and postpartum individuals and their families. The hotline connects callers with trained counselors who can provide emotional support, information, and referrals to local or telehealth mental health providers and other resources.  

PEACE for Moms Provider Consultation Line: 470-977-3223 

Provides free, confidential perinatal psychiatric consultation to Georgia prescribing providers and can assist with diagnostic questions, medication considerations, treatment planning, and community referrals. If you are considering medication, you can ask your primary care doctor or OB/GYN to contact the consultation line for guidance on which medication may be best for you.