Talking about perinatal mood and anxiety disorders

Having a baby can be one of the most magical times in a person’s life, but it can also lead to some of the most challenging times. While not always discussed and often untreated, perinatal (the period of time after birth) mood and anxiety disorders are very real and affect close to 1 in 5 new parents.

Perinatal mood and anxiety disorders (PMAD) include depression, anxiety, mood shifts and — in severe cases — thoughts of self-harm or harm to your baby. This includes suicide or infanticide during pregnancy or after childbirth.

About 15% to 21% of all mothers experience some degree of perinatal mood and anxiety disorder. While PMAD can affect any new parent, you are at higher risk if you’ve had PMAD in the past or have a history of depression, anxiety or other mental illness.

Contrary to popular belief, an equal number of fathers and partners may also develop PMAD. What’s more, you may be surprised to learn that it’s not uncommon for PMAD to begin during pregnancy.

“Most parents don’t realize that postpartum depression can start even before their child is born,” says Veronica James, a clinical social worker at Sharp Mary Birch Hospital for Women & Newborns and facilitator of the hospital’s Postpartum Support Group. “Parents may wonder why they aren’t excited about a pregnancy that was very much planned and wanted, or why they are constantly feeling anxious when nothing appears to be wrong.”

Recognizing symptoms of PMAD

Symptoms of PMAD during pregnancy might include a lack of motivation, feelings of hopelessness, constant worry, frequent crying and obsessive thinking. Sadly, these contrast significantly with the feelings of giddy anticipation, joy and boundless love parents may have expected to feel.

These symptoms may continue after birth, with the addition of negative thoughts toward baby and other symptoms that may be more subtle, such as:

• Anger or irritability that you and your loved ones may chalk up to fatigue

• Angst over breastfeeding

• Overly intense behaviors, such as not being able to separate from your new baby

• Fleeting thoughts of abandonment or thoughts of worthlessness

Moms experiencing PMAD often project their own feelings of inadequacy onto their baby. Some may even believe their baby feels negatively about them.

“I’ve had parents tell me they feel like a bad parent because they are having breastfeeding problems," James says. "Parents find themselves so anxious about breastfeeding to the point of not taking care of themselves, not eating or losing sleep because of constant worry."

When it's time to seek help

According to James, the distinction between normal worry and clinical anxiety is the intensity and duration of the experiences. To what degree do the symptoms impact your daily life, ability to function and relationships?

If you are experiencing PMAD, many treatment options are available. As with regular depression and anxiety, the best form of treatment is usually a combination of medication and counseling. It's important to talk with your health care provider about what might be right for you.

Sharp Mary Birch offers a maternal mental health program in partnership with Sharp Mesa Vista. This intensive outpatient program provides comprehensive, specialized care for people who are pregnant or have recently given birth and are experiencing moderate to severe mental health conditions that are affecting their daily lives.

“Pregnancy and postpartum life are often depicted as wonderful times of bonding with your baby,” says Sandra Reynaga, a licensed marriage and family therapist from the program. “While that can be the case, there are also times when parents struggle deeply with their mental health, and they need all the support they can get."

Treatment to relieve symptoms include assessment by a specialized psychiatrist and nurse practitioner, individualized mental health support, education and group therapy, all of which the maternal mental health program offers. “We provide therapy sessions in person and virtually,” Reynaga says.

If you suspect a loved one might be suffering from PMAD, James says you can play an important role by offering support and concern. Using phrases such as, “I love you and I’m worried about you,” or “I want you to feel better, I think we should call your doctor,” are the best way to approach a loved one about getting help, she advises.

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