Understanding PMADs, Postpartum Depression and Postpartum Psychosis
Recent headlines have sparked difficult but important conversations about maternal mental health. While their stories involve very different circumstances, they have led many women, partners and family members to ask questions about postpartum depression, anxiety, intrusive thoughts and postpartum psychosis.
At Pine Rest, we welcome these conversations because knowledge saves lives. When people better understand the signs and symptoms of Perinatal Mood and Anxiety Disorders (PMADs), they are more likely to recognize when they or a loved one need support.
The most important thing to know is this: PMADs are common, treatable medical conditions. They are not a sign of weakness, a character flaw or a reflection of how much someone loves their child.
Quick Answers About PMADs
What Are Perinatal Mood and Anxiety Disorders (PMADs)?
Perinatal Mood and Anxiety Disorders, commonly called PMADs, are mental health conditions that can occur during pregnancy and through one to two years postpartum. PMADs include depression, anxiety, obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), bipolar disorder and postpartum psychosis.
How Common Are PMADs?
Nearly 1 in 5 women experience a PMAD during pregnancy or after childbirth, making it the most common complication of childbirth. PMADs can also affect women who have experienced pregnancy loss, and even non-birthing partners can experience depression and anxiety during this period.
Can PMADs Start During Pregnancy?
Yes. Despite the common use of the term “postpartum depression,” symptoms can begin during pregnancy, immediately after birth or up to two years later.
Are PMADs Treatable?
Absolutely. Effective treatment options include therapy, medication management, support groups, intensive day programs and inpatient care when needed. Early intervention can make a significant difference in recovery.
PMAD Is More Than Postpartum Depression
Many people assume maternal mental health concerns begin and end with postpartum depression. In reality, PMADs exist on a spectrum, and symptoms can look very different from one woman to another.
Some women feel overwhelming sadness. Others experience intense anxiety, panic attacks or intrusive thoughts. Some struggle to sleep even when their baby is sleeping. Others find themselves consumed by worry, irritability, guilt or fear.
Understanding the different diagnoses can help women recognize when what they’re experiencing is more than the normal stress of adjusting to parenthood.
Signs of Postpartum Depression
While all new parents experience ups and downs, postpartum depression involves symptoms that persist and interfere with everyday life.
Common postpartum depression symptoms may include:
- Persistent sadness or feelings of emptiness
- Frequent crying
- Loss of interest in activities once enjoyed
- Difficulty bonding with the baby
- Feelings of guilt, shame or worthlessness
- Hopelessness
- Fatigue beyond expected sleep deprivation
- Changes in appetite
- Difficulty concentrating
- Thoughts of self-harm or suicide
Many mothers describe feeling as though they “should be happy” but cannot understand why they continue to struggle. These feelings can be isolating, but they are also highly treatable.
Signs of Postpartum Anxiety
Postpartum anxiety often receives less attention than depression, yet it can be equally disruptive.
Women experiencing postpartum anxiety may include:
- Worry excessively about their baby’s health or safety
- Feel unable to relax
- Experience racing thoughts
- Constantly anticipate worst-case scenarios
- Have panic attacks
- Feel restless or on edge
- Struggle to sleep even when exhausted
- Experience physical symptoms such as nausea, dizziness or rapid heartbeat
Many women with anxiety appear to be functioning normally on the outside while privately battling intense fear and distress.
Intrusive Thoughts and Perinatal OCD
One of the most frightening symptoms women report is the presence of intrusive thoughts.
These thoughts may include unwanted images or worries about accidental harm coming to the baby. Some mothers describe feeling shocked or horrified by what enters their mind.
It is important to understand that intrusive thoughts do not mean a mother wants to harm her child. In fact, women experiencing perinatal OCD are typically deeply distressed by these thoughts and often go to great lengths to avoid situations they fear could be dangerous.
Perinatal OCD can also involve:
- Repeated checking behaviors
- Excessive cleaning or sanitizing
- Seeking constant reassurance
- Avoidance of certain activities
- Time-consuming rituals intended to reduce anxiety
Understanding that these symptoms are part of a treatable illness can be life-changing for women who believe they are alone.
Understanding Postpartum PTSD
Some women develop symptoms of post-traumatic stress disorder following a difficult pregnancy, traumatic birth experience, medical complications, NICU stay or concerns about an infant’s health.
Postpartum PTSD symptoms may include:
- Flashbacks or unwanted memories
- Nightmares
- Hypervigilance
- Avoidance of reminders of the event
- Emotional numbness
- Increased anxiety or panic
These experiences are more common than many people realize and deserve compassionate, specialized care.
Understanding Bipolar Disorder in the Perinatal Period
Pregnancy and postpartum hormonal changes can complicate existing bipolar disorder or, in some cases, contribute to the first recognition of symptoms.
Potential bipolar disorder signs include:
- Significant mood swings
- Periods of high energy with little need for sleep
- Racing thoughts
- Impulsivity
- Irritability
- Depressive episodes
Because symptoms sometimes overlap with anxiety and depression, accurate diagnosis is essential to ensuring women receive appropriate treatment.
What Is Postpartum Psychosis?
The recent attention surrounding the Lindsay Clancy trial has increased public awareness of postpartum psychosis and prompted many questions about this condition. While 1 in 5 women experience a PMAD during pregnancy or after childbirth, experts estimate the rate of postpartum psychosis is somewhere between 1 to 3 in every 1,000.
Postpartum psychosis is a psychiatric emergency that differs significantly from postpartum depression and anxiety. Anyone experiencing symptoms of psychosis should receive immediate medical evaluation and treatment.
Postpartum psychosis symptoms can include:
- Hallucinations
- Delusions or fixed false beliefs
- Severe confusion
- Extreme mood disturbances
- Disorganized thinking
- Loss of contact with reality
Although postpartum psychosis receives substantial media attention because of its severity, depression and anxiety remain far more common experiences for pregnant and postpartum women.
When Should You Seek Help?
Many women wait until they feel completely overwhelmed before reaching out. The reality is that support is most effective when symptoms are recognized early.
Consider seeking professional help if symptoms:
- Last more than two weeks
- Interfere with daily functioning
- Make it difficult to care for yourself
- Affect bonding with your baby
- Cause significant distress
- Include intrusive thoughts that are frightening or disruptive
- Include thoughts of self-harm
- Include hallucinations, delusions or confusion
You don’t need to have a specific diagnosis to benefit from support.
Many women wonder whether what they’re experiencing is “serious enough” or whether their symptoms fit neatly into depression, anxiety, OCD or another PMAD. The truth is that if you’re struggling, feeling overwhelmed or not feeling like yourself, that’s reason enough to reach out. You don’t need to wait until symptoms worsen or have all the answers before seeking help. Sometimes simply needing support is enough.
Specialized Treatment for PMADs at Pine Rest
For some women, weekly outpatient appointments provide enough support. For others, symptoms become so overwhelming that a higher level of care is needed.
The Mother & Baby Program
Pine Rest’s Mother & Baby Program was created specifically for women experiencing significant symptoms of PMADs and remains the only program of its kind in Michigan. It is also one of only a few specialized perinatal psychiatric day treatment programs in the United States.
The Mother & Baby Program provides:
- Intensive group therapy
- Psychiatric care
- Medication management
- Peer support
- Family education
- Skills training
- Support for mother-baby bonding
One unique feature is that mothers can bring infants up to eight months old with them to treatment. A staffed nursery helps remove barriers such as childcare concerns, separation anxiety and feeding challenges while also supporting healthy attachment and bonding.
Since opening in 2012, the program has served more than 1,700 mothers and their families, helping women reduce symptoms of depression and anxiety while building confidence in caring for themselves and their children.
Outpatient therapists specializing in PMAD
Not every woman needs intensive treatment, but many benefit from working with a therapist who understands the unique challenges of pregnancy and the postpartum period. Pine Rest offers outpatient therapy with clinicians who have specialized training in perinatal mental health and experience treating PMADs. These providers understand how symptoms of depression, anxiety, OCD, trauma and other PMADs can appear during pregnancy and after childbirth, and they provide compassionate, evidence-based support tailored to each woman’s needs.
If you’re seeking therapy, let us know that you’re pregnant or postpartum when scheduling so we can help connect you with a clinician who has expertise in maternal mental health.
You Are Not Alone
Stories in the national news can raise awareness, but they can also leave women feeling worried or uncertain about their own symptoms. The reality is that maternal mental health conditions exist on a wide spectrum, and most women who experience PMADs recover with proper support and treatment.
If you’re pregnant or postpartum and struggling with anxiety, depression, intrusive thoughts or other changes in mood, reaching out is a sign of strength, not weakness. Help is available, healing is possible and you do not have to navigate it alone.
Written by Pine Rest Staff. Reviewed by Sarah DeYoung, LMSW, PMH-C.
Learn More About Treatment for PMADs at Pine Rest
You are not alone! Perinatal Mood & Anxiety Disorders are the #1 complication of pregnancy. Pine Rest has innovative, proven programs to help you feel like yourself again.
