It Isn’t Always Postpartum Depression – Perinatal Mood and Anxiety Disorders: Components of Perinatal Mental Health

Postpartum depression (PPD) is probably the first thing that comes to mind for most people when we talk about perinatal mental health, seconded closely by Postpartum Anxiety (PPA). While it is great that PPD and PPA have become relatively well known, they are not the only two mood disorders that can occur during or after pregnancy.

Slowly but surely, the term “PMADs” is gaining traction. PMADs stands for “Perinatal Mood and Anxiety Disorders,” where perinatal refers to the entire pregnancy journey and up to one year after baby is born. I know, I know – vocabulary lessons are boring, but in this case, the distinction is important. What you’re experiencing may not be postpartum depression, and it may not even be occurring during the postpartum phase of your perinatal journey. To get proper help that actually addresses your symptoms, people need to know and understand proper terminology – in this case, PMADs. Because it isn’t always PPD, and it doesn’t always happen exclusively during the postpartum period.

If it isn’t Postpartum Depression, what could it be?

There is a range of PMADs that can occur anytime from the start of pregnancy through the postpartum period. Forgive me if this list reads like a textbook, but there isn’t really a fun way to list symptoms, is there?

Perinatal/Postpartum Depression (PPD). Low mood, sleep disturbances, loss of interest or enjoyment, appetite and eating pattern change, fatigue, feelings of worthlessness, excessive guilt, possible suicidal thoughts or thoughts of hurting self/others.

Perinatal/Postpartum Anxiety (PPA). Excessive worrying, racing thoughts, intrusive thoughts, unable to sleep due to worried thoughts, agitation and irritability, somatic symptoms such as muscle tension, shortness of breath, etc.

Perinatal/Postpartum Obsessive-Compulsive Disorder (PP-OCD). PP-OCD stands out because the individual experiences compulsive urges or thoughts, and tries to neutralize those urges/thoughts through an action (compulsion).

Perinatal/Postpartum Post Traumatic Stress Disorder (PP-PTSD). PP-PTSD can occur if the person experienced something traumatic related to pregnancy, labour, or birth. Symptoms include flashbacks (unwanted intrusive memories of the traumatic event), avoiding anything that could trigger memories or thoughts of the event, and isolating self. PP-PTSD is often confused with PPD because the symptoms may look similar, but the distinction is very important for treatment.

Perinatal/Postpartum Bipolar Disorders. There are two types of Bipolar Disorders – type 1 and type 2. Bipolar 1 is characterized by having episodes of mania and episodes of depressive symptoms (the classic high and low of bipolar that we see on TV). Bipolar 2 is more subtle and often missed – it is characterized by “hypomania,” where the person has chronically elevated mood and irritability. There is an increase in activity level, but it doesn’t present the way that typical mania does, so it is easily missed.

Perinatal/Postpartum Psychosis. Perinatal psychosis is a medical emergency! Women experiencing Perinatal Psychosis are at a much greater risk of hurting themselves, or their baby. The symptoms include extreme insomnia, excessive energy, hallucinations, hearing voices, and extreme paranoia. If you think you or a loved one is experiencing Perinatal/Postpartum Psychosis, please head straight to the emergency room.

Conclusion

Whether you’re experiencing PPD, PPA, or a less commonly known PMAD, it is important to seek help. Counsellors with training in perinatal mental health (like me!) are trained to recognize symptoms of PMADs and to properly support the person. Your medical provider can also prescribe medication that is safe to take while pregnant or breastfeeding. You are important and your mental health matters. When your mental health suffers, so do your important relationships, your enjoyment of life, and your self-esteem. Don’t wait to reach out for support.

Disclaimer: The content of this blog is for informational purposes only. It is not meant to substitute the advice or diagnosis of a medical doctor, psychiatrist, psychologist, or therapist. If you are concerned that you may have Perinatal/Postpartum Depression, or another Perinatal Mood or Anxiety Disorder, please contact a doctor or public health unit for assessment.