What are Perinatal Mood and Anxiety Disorders (PMADs)?

Perinatal Mood and Anxiety Disorders(PMADs) describe a group of symptoms that can affect women during pregnancy and up to one year postpartum. These symptoms disrupt day to day functioning and make it difficult to enjoy life. Mood disorders, such as postpartum depression (PPD) and bipolar disorder, often include symptoms of sadness, loss of pleasure, guilt, mood swings, and difficulty bonding with the baby. Anxiety disorders, including generalized anxiety, panic disorder, and obsessive-compulsive disorder, include symptoms such as excessive worry, irritability, and obsessive or negative thoughts. All of these symptoms can interfere with a mother’s emotional wellness, her ability to form a healthy attachment with her baby, and overall functioning. PMADs can be easily missed because many of the symptoms overlap with changes that we expect from new moms during the postpartum period. In addition, screenings/assessments for PMADs can be inconsistent and under-utilized.

Depression During and After Pregnancy

Depression that occurs during pregnancy or within a year after delivery is called postpartum depression. According to research, depression is one of the most common complications during and after pregnancy. Factors that may increase the likelihood of depression during or after pregnancy can include a history of depression or substance abuse, family history of mental illness, inadequate support from family and friends, anxiety about the baby, problems with a previous pregnancy or birth, miscarriage, marital or financial problems, young age (of mother or newborn). It is natural for women to experience changes in their feelings and mood during pregnancy, such as feeling more tired, irritable, or worried. However, while mild mood changes during pregnancy are common, mood symptoms can sometimes become severe enough to require treatment from a health care provider.

Symptoms of Depression During Pregnancy

  • Feeling sad, depressed, and/or crying often
  • Diminished interest in becoming a mother
  • Feeling worthless or guilty
  • Sleep problems
  • Low energy
  • Feeling restless or irritable
  • Loss of or increase in appetite or weight
  • Trouble focusing, remembering things, or making decisions
  • Anxiety, tension, and/or fear either about the baby or other things
  • Headaches, chest pains, heart palpitations, numbness, or hyperventilation
  • Suicidal thoughts

Typical Adjustment to a New Baby

Becoming a new parent, while exciting, can also be daunting and stressful—some difficulty adjusting to parenthood and to your new baby is to be expected. Please remember that adjusting to such a significant change does not happen overnight—be patient with yourself and with your partner, give yourselves plenty of grace, and rest when possible.

Baby Blues and Postpartum Depression (PPD)

Many new moms experience the “Baby Blues” within the first three weeks after the baby’s birth. This happens because, after delivery, the mom’s hormones are rapidly changing as she is adjusting to her new role—this transition feels overwhelming. Common symptoms include mood instability, weepiness, sadness, irritability, anxiety, lack of concentration, and feelings of dependency. These symptoms usually subside on their own within two weeks from onset. It is important to note that the baby blues are often self-limited and are to be distinguished from postpartum depression (PPD), which has increased severity and duration of symptoms. Depression after childbirth is a serious illness that can have a significant and lasting impact on the patient, infant, and the family unit.

If symptoms persist for a minimum of two weeks and interfere with your daily functioning or parenting, please seek professional care to prevent symptoms from worsening. Postpartum depression occurs in up to 10% of births and it may happen at any time during the baby’s first year of life.

Symptoms of Postpartum Depression

  • Feeling sad, depressed, and/or crying often
  • Intense anxiety, such as rumination and/or obsessions
  • Loss of interest in usual activities
  • Feelings of guilt, worthlessness, or incompetence
  • Fatigue, irritability, sleep disturbance
  • Change in appetite
  • Poor concentration
  • Feeling inadequate as a parent
  • Excessive worry about the baby’s health
  • Suicidal thoughts

Postpartum Anxiety Disorders

Postpartum anxiety disorders such as generalized anxiety disorder, panic disorder, and obsessive-compulsive disorder appear to be as common as postpartum depression and may even coincide with PPD. Perinatal anxiety symptoms include panic attacks, hyperventilation, excessive worry, restless sleep, and disturbing, reoccurring thoughts.

Postpartum Psychosis

Another form of postpartum depression is postpartum psychosis. Postpartum psychosis is a serious illness that can be severe and life-threatening. Psychotic symptoms include delusions (thoughts that are not based in reality), hallucinations (hearing or seeing things that are not there), or disorganized thinking. Often mothers who develop postpartum psychosis are having a severe episode of a mood disorder, such as bipolar(manic depression) disorder with psychotic features. It is essential for women who are suffering from these symptoms to seek care, evaluation, and treatment immediately.

Pregnancy Loss

Experiencing miscarriage at any point in pregnancy can be a shocking and devastating event. Many women struggle with physical and emotional pain and grief that is powerful and overwhelming. Miscarriage can leave women feeling numb, helpless, and isolated from others. Common reactions to miscarriage are sadness, anger, guilt, and depression.


Infertility occurs in 10-15% of couples of reproductive age. Investigation of the causes of infertility and treatment can bring on a “life crisis” that can tax a couple’s existing problem-solving resources, threaten the achievement of life goals, and awaken unresolved past difficulties.

There is Hope

PMDAs are treatable and seeking support from a professional is the first step towards healing. If you are worried about yourself, your partner, your sister, your daughter, colleague, or best friend, let them know that help is available.

What happens if I need therapy?

Moms and Dads—At ITW, we understand that you might feel too tired, too distracted, or too overwhelmed with your new baby to think about yourself or your own mental health. We challenge you to rethink this—prioritizing yourself and adding a therapist to your support system can have a positive impact on your recovery and your transition as a family. We will meet you where you are, find a comfortable pace, and provide you with the care you deserve to help you recover well and thrive. We have the desire, the experience, and the knowledge to help you navigate through this inherently complex life transition.