PMAD | What You Need to Know

Let’s start by defining PMADs:

Perinatal or postpartum mood and anxiety disorder (PMAD) is the term used to describe distressing feelings that occur during pregnancy (perinatal) and throughout the first year after pregnancy (postpartum).

This is different from baby blues. Around 50 percent to 80 percent of new mother's experience mood swings during the first two to three weeks after giving birth. This is referred to as the “baby blues”.

Symptoms of a perinatal or postpartum mood disorder occur daily for more than two weeks. If you believe you are experiencing PMADs please reach out to a healthcare provider or, if necessary, call 911 for emergency help.

Symptoms of a mood disorder:

• Feeling intense anger or irritability
• Trouble falling asleep or sleeping too much
• Trouble concentrating or remembering things
• Trouble making decisions
• Loss of interest in doing things you used to enjoy
• Withdrawing socially from family or friends
• Negative feelings about your baby
• Complete lack of energy
• Loss of interest in caring for yourself
• Loss of appetite or overeating
• Inability to carry out everyday tasks
• Frequent crying spells or feeling teary
• Showing too much or not enough concern for your baby
• Feelings of guilt or worthlessness
• Possible thoughts of harming the baby or yourself
• Seeing or hearing things that aren’t there, or having thoughts that don’t make sense

Types of PMADs: 

Perinatal or postpartum anxiety disorder:

10 percent of pregnant and postpartum women experience significant anxiety symptoms.

           Symptoms include

• Constant worry, feeling that something bad is going to happen, racing and intrusive thoughts, trouble falling asleep or sleeping too much, loss of appetite or overeating (weight loss or gain), restlessness or inability to sit still, physical symptoms like dizziness, nausea, headaches, racing heartbeat and breathing fast, and feelings of fear or uneasiness.

Perinatal or postpartum psychosis:

One in 1,000 suffers a rare and severe form of a mood disorder called perinatal or postpartum psychosis. Those who have been diagnosed with bipolar disorder, schizophrenia, or other psychiatric challenges may have a higher risk of developing this form of mood disorder. Women who have experienced perinatal or postpartum psychosis in the past have a 30 percent to 50 percent recurrence risk.

Symptoms include:

• Extreme confusion, hopelessness, inability to sleep (even when exhausted) or excessive energy and not needing to sleep, refusing to eat, distrusting other people, seeing things or hearing voices that are not there, and thoughts of hurting yourself, your partner or your baby.

Perinatal or postpartum obsessive-compulsive disorder (OCD):

OCD is an often misunderstood and misdiagnosed disorder that affects as many as 3 percent to 5 percent of new mothers (and even many new fathers). Risk factors include a personal or family history of anxiety or OCD. More than 38 percent of women with OCD also struggle with an underlying mood disorder. Intrusive thoughts and images are the most common symptoms. Research has shown that these images are driven by anxiety and not psychosis.

Other symptoms include:

• Compulsive behaviors in an effort to reduce fears and obsessions (e.g., cleaning, checking, counting, reordering things), a sense of horror and/or disgust about the obsessive thoughts, fear of being left alone with the baby, and heightened alertness and preoccupation with protecting the baby

PMAD Statistics:

• Depression/Anxiety in Pregnancy: It is estimated that 15-21% of pregnant women experience moderate to severe symptoms of depression or anxiety (Wisner KL, Sit DKY, McShea MC, et al. JAMA Psychiatry 2013).
• Postpartum Depression: Approximately 21% of women experience major or minor depression following childbirth. (Wisner KL, Sit DKY, McShea MC, et al. JAMA Psychiatry 2013) Low-income women and teens have rates up to 60% (Earls, M. Pediatrics 2010).
• Perinatal Panic Disorder: This is a form of anxiety that occurs in up to 11% of new mothers. (Wenzel A. 2011).
• Perinatal Obsessive-Compulsive Disorder: This is the most misunderstood and misdiagnosed of the perinatal disorders. It is estimated that as many as 11% of new mothers will experience this (Miller ES. J Reprod Med 2013).
• Postpartum Posttraumatic Stress Disorder: An estimated 9% of women experience PTSD following childbirth (Beck C, et al Birth 2011). Perinatal Bipolar Disorder: Over 70% of women with bipolar disorder who stop medication when pregnant become ill during the pregnancy. (Wisner KL, Sit DKY, McShea MC, et al. JAMA Psychiatry 2013).
• Postpartum Psychosis: occurs in approximately 1 to 2 of every 1,000 deliveries (Sit, et al, 2006). There is a 5% suicide rate and 4% infanticide associated with postpartum psychosis.

Effects on baby:

If left untreated, PMADs adversely affect parental cognitions and beliefs, attachment to the infant, and the growing caregiver-infant relationship. PMADs affect the early developmental outcomes of infants including neurosynaptic development, regulatory development, and developmental milestones. PMADs can lead to premature birth, risk of SIDs, and a need for neurodevelopmental or neurobehavioral support. Research shows that depressed and anxious parents often smile less, talk less, and are less likely to touch or engage with their newborns throughout the first year of life. Children of parents with depression and anxiety may develop learning, attention, or behavioral difficulties as they grow older. Older children may also suffer from the loss of maternal/paternal attention and support, and they may become depressed or anxious as teenagers.

Endocannabinoids and PMADs:

Endocannabinoids are responsible for helping regulate various processes, such as pain, memory, mood, immunity, and stress. The endocannabinoid system is known to have positive effects on depression. One way to improve mental health is exercise. Intense exercise increases circulating endocannabinoids. Including exercise in your routine can help combat PMADs and baby blues. A study published in the British Journal of Sports Medicine found that endurance exercise increases the level of endocannabinoids in the body. These substances have an effect similar to the active ingredient in marijuana.

Another way to reinforce endocannabinoids is through food. Endocannabinoid reinforcing foods include Hemp seeds and oil, chia seeds, walnuts, flax seeds and oils, eggs, sardines, and anchovies. Essential fatty acids, chocolate, herbs, spices, and tea can also naturally stimulate the endocannabinoid system (ECS).

The ECS is involved in reconsolidation and extinction of the fear memory in the fear memory paradigms as well as in anxiety. Endocannabinoid signaling may ensure an appropriate reaction to stressful events.

Including ECS reinforcement in your postpartum plan could be extremely beneficial!

Disparities in PMADs:

African American women have a higher risk of developing perinatal depression compared to white women, and Latina women also have a higher risk. Current research from the Icahn School of Medicine at Mount Sinai found that 44% of African Americans reported depressive symptoms two weeks after delivery, compared to 31% percent of white women.

Are they rising? Yes, but why?

NY Times says:

“Postpartum depression and the larger group of maternal mental health conditions called perinatal mood and anxiety disorders are caused by neurobiological factors and environmental stressors. Pregnancy and the postpartum period are already vulnerable times for women due in part to the hormonal fluctuations accompanying pregnancy and delivery, as well as the sleep deprivation of the early postpartum period. Now, fears about the health of an unborn child or an infant and the consequences of preventive measures, like social distancing, have added more stress.”

Isolation is a huge factor in mental health struggles. Isolation during the pandemic may be a factor increasing PMADs, along with the new fears that the pandemic has instilled in families.

Studies show social media plays a role in varying mental health stability. So many new parents have unrealistic expectations because of what they see other people share, but other people only share the good (usually). The discouraged parents are experiencing results in unhealthy feelings of blame and guilt or shame that they are not the best parent.

In reality, we could be using social media to spread more awareness and create a better understanding of what so many people go through in pregnancy and postpartum.

Another way to decrease PMADs effects on a family is to increase postpartum appointments and include a PMAD screening at prenatal and postpartum visits. Prevention is so important and a key part of preventing PMADs is increasing support. Parents should try to put support plans in place before the baby arrives. This could include a meal train, family members visiting, a babysitter, etc.

Resources:

• Postpartum Support International, 1-800-944-4773
• Postpartum Education for Parents, 1-805-967-7636
• National Women’s Health Information Center, 1-800-994-9662
• National Postpartum Depression Hotline, 1-800-PPD-MOMS
• National Suicide Prevention Lifeline, 1-800-273-8255 (TALK)
• Suicide Prevention Hotline, 1-800-SUICIDE
• S. Department of Health and Human Services free booklet on depression during and after pregnancy

References:

Anonymous. (2018, March 16). My postpartum exercise addiction - seleni - maternal mental health institute. Seleni. Retrieved May 11, 2022, from https://www.seleni.org/advice-support/2018/3/16/my-postpartum-exercise-addiction

Heyman E, Gamelin FX, Goekint M, Piscitelli F, Roelands B, Leclair E, Di Marzo V, Meeusen R. Intense exercise increases circulating endocannabinoid and BDNF levels in humans--possible implications for reward and depression. Psychoneuroendocrinology. 2012 Jun;37(6):844-51. doi: 10.1016/j.psyneuen.2011.09.017. Epub 2011 Oct 24. PMID: 22029953.

Kozhimannil, K. B., Trinacty, C. M., Busch, A. B., Huskamp, H. A., & Adams, A. S. (2011). Racial and ethnic disparities in postpartum depression care among low-income women. Psychiatric services (Washington, D.C.), 62(6), 619–625. https://doi.org/10.1176/ps.62.6.pss6206_0619

Lakshmin, P. (2020, May 27). Experts fear increase in postpartum mood and anxiety disorders. The New York Times. Retrieved May 6, 2022, from https://www.nytimes.com/2020/05/27/parenting/coronavirus-postpartum-depression-anxiety.html

Ruehle, S., Rey, A. A., Remmers, F., & Lutz, B. (2012). The endocannabinoid system in anxiety, fear memory and habituation. Journal of psychopharmacology (Oxford, England), 26(1), 23–39. https://doi.org/10.1177/0269881111408958