INTRODUCTION TO

PERINATAL MOOD & ANXIETY DISORDERS

 Objectives
Define PMADs
Understand the importance of appropriate
diagnosis & consequences of untreated PMADs
Review subtypes of PMADs and their symptoms
Identify risk factors for PMADs
Learn what screening tools are appropriate
Recognize useful treatment options and
resources
Overview of PMADs
‘Perinatal’ refers to the period
during pregnancy and the first year
after the baby is born
Can occur days, weeks, or even months
after childbirth
PMADs can occur whether a first-
time mother or previous
pregnancies with no symptoms
PMADs can affect women from all
socioeconomic statuses, ethnicities,
religions, education levels, etc.
 Estimated to impact 1 in 4 mothers
 Also impacts 1 out of 10 dads
 Risk Factors for PMADs
 If you or anyone in your family has a
history of mental illness or depression
Bipolar dx or previous psychotic episodes =
greater risk of PPP
 Perceived lack of support from partner,
family, or others
 If pregnancy was unplanned or
unwanted
 Unrealistic expectations of motherhood
 Delivery or birth trauma
 Sharp hormone changes after delivery
 If baby is born prematurely
 Consequences of Untreated PMADs
 Long term attachment issues
Increased risk of mental, behavioral, emotional issues for child

 Increased risk of abuse for father

Relationship issues, divorce, more likely to experience MH disorder

 Increased risk to child due to untreated health issues or

neglect
Substance use, risky behaviors (not using appropriate car seat or
bed safety, less baby well-visits, missing vaccinations), corporal
punishment
 More likely to use substances to cope

(WHO, 2009)
 Forms of PMADs
Postpartum Depression
Postpartum Anxiety
Postpartum Panic
Postpartum Post Traumatic Stress Disorder
Postpartum Obsessive-Compulsive Disorder
Postpartum Psychosis

*Note that although I’ll refer to these as postpartum,

these disorders can also occur during pregnancy*
 Baby Blues
Baby blues are normal and not considered a PMAD
Affects ~80% of women experience baby blues
Symptoms include: mood swings, sadness, difficulty
sleeping, irritability, appetite changes, and
concentration problems
Starts after birth, but lasts no more than 2-3 weeks
 Postpartum Depression
Affects ~15-20% of new mothers
Many mothers feel ashamed and do not
disclose their thoughts or feelings
Often interferes with mother’s ability to
care for herself and/or baby
Symptoms include: Feelings of anger or
irritability, lack of interest in baby,
appetite and sleep disturbances, crying
and sadness, feelings of guilt, shame, or
hopelessness, loss of interest in things
once enjoyed, possible scary thoughts of
harming the baby or yourself
Postpartum Anxiety & Panic
Affects 6% of pregnant women, 10%
postpartum women
May be experienced on its own or in
addition to depression
Symptoms include: constant worry,
feeling something bad is going to
happen, racing thoughts,
sleep/appetite disturbances, inability
to sit still, or physical effects such as
dizziness, hot flashes, and nausea
Postpartum panic disorder is a form of
anxiety, includes feeling very nervous
and having frequent panic attacks,
which often may feel like a heart
attack or that she is dying
 Postpartum Post-Traumatic Stress
Disorder (PTSD)
Affects 9% of new mothers
Caused by a real or perceived trauma during delivery or
postpartum
May include: prolapsed cord, unplanned c-section, use of extractor or
forceps, baby in NICU, feelings of powerlessness, poor
communication/lack of support during delivery, previous trauma hx
including prior rape/sexual abuse as well as those who experienced severe
complications related to pregnancy or childbirth
Symptoms include re-experiencing traumatic event,
flashbacks, nightmares, avoidance of stimuli associated,
irritability, difficulty sleeping, hypervigilance, exaggerated
response, panic attacks, and detachment from reality
 Postpartum Obsessive-
Compulsive Disorder (POCD)
Most misunderstood and misdiagnosed of
the perinatal disorders
Affects 3-5% of new mothers
Obsessions or intrusive thoughts:
Persistent, repetitive thoughts related to
the baby
Frightening, low risk of being acted on (ego
dystonic)
Compulsions: Actions that are repeated to
reduce fears and obsessions
Other symptoms may include sense of
horror about obsessions, fear of being left
alone with infant, hypervigilance about
protecting baby
 Egosyntonic vs. Egodystonic
Thoughts
Egosyntonic
Thoughts that are
consistent or in harmony
with the needs & goals of
ego
Can occur in psychosis
where thoughts of
harming self/infant feels
like the right thing to do
“The world is evil and trying
to cause the family harm, so
killing the baby is in the
baby’s best interest.”
Egodystonic
Thoughts are not
consistent with needs &
goals of ego
Individuals with OCD
struggle with disturbing
intrusive thoughts
Results in compulsions
Does not feel like the right
thing to do
Envisioning baby dying due
exposure to germs; therefore
excessively cleaning and
avoiding others
 Postpartum Psychosis (PPP)
Rare, but most severe, occurs .1-.2% of births
Onset is sudden, within two weeks postpartum
Symptoms include: delusions or strange beliefs,
hallucinations, irritable, hyper active, insomnia, paranoia, rapid
mood swings, and difficulty communicating
Most women that experience PPP do not harm themselves or
others
Those that do believe delusions are reality and are left untreated could
hurt themselves or the baby
Immediate treatment is critical, which can include
hospitalization, psychotherapy, and medication
 Clinical Tools for Screening
Edinburgh Postnatal Depression
Scale (EDPS)
10 questions, self-administered
Cut off score of 12 or higher
Reliable & valid for dads too

Postpartum Distress Measure

10 questions, self-administered
Used to get a sense of constellation
of sxs
PHQ-9 & GAD-7 are also
appropriate
Inquiring about past hx of MH and
trauma
 How are PMADs treated?
MH counseling can help for mild to moderate symptoms
Individual, groups, CBT, DBT, psychoeducation, involving collaterals

Medication can also treat moderate to severe symptoms

Untreated sxs may be more detrimental than effects of medication
on fetus/newborn
There are medications that are safe during pregnancy and
compatible with breastfeeding
Mothertobaby.org, Motherisk.org, LactMed, aafp.org, infantrisk.org

Inpatient typically required to stabilize postpartum

psychosis due to delusions and hallucinations
Combination of counseling, medication, and social
support results in the most effective treatment outcomes
 Resources for PMADs
Postpartum Support International
www.postpartum.net, chat with an expert, information, trainings
for professionals, warmline (800) 994-4773
The Postpartum Stress Center
www.postpartumstresscenter.com, information for clients,
trainings for professionals
Postpartum Progress
www.postpartumprogress.com, blogs, articles, resources

Seleni Institute
www.seleni.org, blogs, articles, trainings for professionals

NorthShore MOMS Line

866.364.MOMS(6667), 24/7 hotline for individuals struggling with
PMADs, staffed by trained PMAD professionals
 References
Glezer, A. (n.d.). Intrusive Thoughts and OCD Postpartum. Mind Body Pregnancy
by Anna Glezer, MD. Retreived from www.mindbodypregnancy.com/ocd-
postpartum.
Kleiman, K. (2017). For Professionals. The Postpartum Stress Center. Retrieved
from www.postpartumstress.com.
Kripke, K. (n.d). Normal Postpartum Adjustment and PMADs: Understanding the
difference. Postpartum Wellness Center of Boulder. Powerpoint presentation.
(n.a.). Learn More. (2017). Postpartum Support International. Retrieved from
www.postpartum.net.
Stewart, D.E., Robertson, E., Dennis, C-L., Grace, S.L., & Wallington, T. (2003).
Postpartum depression: Literature review of risk factors and interventions.
Retrieved from
www.who.int/mental_health/prevention/suicide/lit_review_postpartum_depressi
on.pdf.
World Health Organization. (2009). Women and Health: Today’s Evidence,
Tomorrow’s agenda. Retrieved from
http://apps.who.int/iris/bitstream/10665/44168/1/9789241563857_eng.pdf.