Frequently Asked Questions About Perinatal Mood and Anxiety Disorders

What is a Perinatal Mood and Anxiety Disorder (PMAD)?

PMAD is an umbrella term used to describe mental health conditions that occur during pregnancy and the postpartum period. PMADs include depression, anxiety, obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), bipolar disorder and postpartum psychosis. These conditions are common, treatable and affect nearly 1 in 5 women during pregnancy or after childbirth.

What is the difference between postpartum depression and postpartum psychosis?

Postpartum depression and postpartum psychosis are very different conditions.

Postpartum depression is relatively common and may involve symptoms such as sadness, hopelessness, excessive guilt, fatigue, anxiety and difficulty bonding with a baby. Women experiencing postpartum depression generally remain grounded in reality, even when symptoms are severe.

Postpartum psychosis is considered a psychiatric emergency. Symptoms may include hallucinations, delusions, severe confusion, extreme mood changes and a loss of contact with reality. Immediate medical evaluation is necessary when psychosis is suspected.

Can postpartum depression become postpartum psychosis?

Postpartum psychosis is generally considered a distinct condition rather than a progression of typical postpartum depression. However, mental health symptoms can change over time, and some individuals with underlying bipolar disorder or other serious psychiatric conditions may be at higher risk for developing psychosis during the postpartum period. Any significant worsening of symptoms should be evaluated by a qualified healthcare professional.

What are the warning signs of postpartum psychosis?

Warning signs may include:

• Hallucinations, such as hearing or seeing things others do not
• Delusions or strongly held false beliefs
• Severe confusion
• Extreme agitation or mood changes
• Disorganized thinking or behavior
• Paranoia
• Inability to distinguish reality from non-reality

Postpartum psychosis occurs at a significantly lower rate than postpartum depression and anxiety but requires immediate emergency evaluation and treatment.

How common is postpartum psychosis?

Postpartum psychosis receives considerable media attention because of its severity, but it is rare. By comparison, depression and anxiety are far more common and affect a much larger percentage of pregnant and postpartum women. Most women experiencing PMADs are dealing with depression, anxiety, OCD or related conditions rather than psychosis.

Can medication trigger or worsen psychiatric symptoms after childbirth?

The postpartum period is a time of significant biological, hormonal and emotional change. Mental health providers carefully evaluate many factors when symptoms worsen, including underlying diagnoses, medication responses, sleep deprivation, medical history and life stressors. Because each person’s situation is unique, women should always discuss concerns about medications and symptom changes with their psychiatric and medical providers.

How should partners support someone experiencing PMAD symptoms?

Partners and loved ones often play a critical role in recovery. Helpful steps include:

• Listening without judgment
• Encouraging professional support
• Helping with baby care and household responsibilities
• Watching for worsening symptoms
• Attending appointments when appropriate
• Reminding the mother that she is not alone

Just as importantly, partners should pay attention to their own mental health. Anxiety and depression can affect non-birthing parents as well.

Why do mothers sometimes delay seeking help?

Many women delay treatment because they believe what they are experiencing is “just part of being a new mom.” Others fear judgment, worry about being perceived as a bad parent or assume they should be able to manage symptoms on their own.

Unfortunately, waiting often allows symptoms to worsen. Seeking help early can improve outcomes for both mother and baby.

Are current postpartum mental health screenings effective?

Screening tools are an important first step and help identify many women who may need additional support. However, no screening tool is perfect. Open communication between patients, families and healthcare providers remains essential, especially when symptoms are changing or becoming more severe.

How do providers distinguish between anxiety, depression, OCD, PTSD, bipolar disorder and psychosis during the perinatal period?

Mental health professionals evaluate a combination of factors, including symptoms, severity, duration, personal and family history, sleep patterns, thought processes, traumatic experiences and overall functioning. Because many Perinatal Mood and Anxiety Disorders (PMADs) share overlapping symptoms, a comprehensive assessment is essential to ensure an accurate diagnosis and effective treatment plan.

For example:

• Depression often centers on persistent sadness, hopelessness, guilt, low energy and a loss of interest in activities that were once enjoyable. Women may also have difficulty bonding with their baby or feel overwhelmed by everyday responsibilities.
• Anxiety is marked by excessive worry, fear, racing thoughts, physical tension and difficulty relaxing. Many women report constantly anticipating worst-case scenarios related to their baby’s health or safety.
• Obsessive-Compulsive Disorder (OCD) involves distressing intrusive thoughts and compulsive behaviors intended to reduce anxiety. Common examples include repeatedly checking on a sleeping baby, excessive cleaning or seeking constant reassurance.
• Postpartum PTSD is linked to a traumatic pregnancy, childbirth experience, pregnancy loss, medical complication or infant health crisis. Symptoms often include flashbacks, nightmares, avoidance of reminders of the event, hypervigilance and intense emotional or physical distress when recalling the trauma.
• Bipolar disorder includes episodes of depression as well as periods of elevated, expansive or irritable mood. During elevated mood states, individuals may experience decreased need for sleep, increased energy, racing thoughts, impulsivity or unusually high confidence.
• Psychosis involves a loss of contact with reality and may include hallucinations, delusions, severe confusion or disorganized thinking. Postpartum psychosis is rare but requires immediate medical attention.

It is also important to recognize that women can experience more than one PMAD at the same time. For example, a mother may have postpartum depression and anxiety, or PTSD and depression following a traumatic birth experience. Because symptoms can overlap and change over time, specialized assessment by clinicians experienced in perinatal mental health is often the best way to identify the underlying condition and determine the most appropriate treatment

What treatment options are most effective for severe PMADs?

Treatment depends on the individual’s symptoms and needs but may include:

• Individual therapy
• Medication management
• Support groups
• Family education
• Intensive outpatient or hospital day (or partial hospitalization) programs
• Inpatient psychiatric care when safety concerns exist

For women requiring more intensive support, Pine Rest’s Mother & Baby Program provides specialized perinatal psychiatric treatment while allowing mothers with infants eight months and younger to bring their babies to treatment.

What is the most important message for mothers to remember?

If you’re struggling during pregnancy or after the birth of a child, you are not alone. PMADs are common, treatable medical conditions, and effective help is available. Seeking support is not a sign of weakness. It is one of the most important steps you can take for yourself, your baby and your family.

Written by Pine Rest Staff. Reviewed by Sarah DeYoung, LMSW, PMH-C.