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Name it to Tame it: Why “PMAD” is Replacing Postpartum Depression

By: Alexandra Sacks M.D.

The scope of emotional issues that women experience during pregnancy and after giving birth is much broader than just depression — that’s why the medical community is beginning to use the term “Perinatal Mood And Anxiety Disorder” (PMAD) to address the spectrum of mood changes that may occur during or after pregnancy, rather than simply applying the term “Postpartum Depression” (PPD) as a catch-all.

This shift in language will help with diagnosis and treatment for mothers who are going through a wide range of experiences that may be specific to their biology or individual stressors. Many of the women who suffer from these conditions actually begin to experience symptoms during pregnancy; this is why the term “perinatal” is more inclusive than “postpartum.” Research from the World Health Organization suggests that PMADs impact 10 to 15 percent of women around the world, with rates highest in developing countries. However, some theories suggest that because symptoms may be underreported or unrecognized, the incidences may be even higher.

CDC research shows that women in their childbearing years experience anxiety and depression at roughly two times the rate as men. Economic inequality, sexual/domestic violence, and sociocultural factors like workplace discrimination and poor access to healthcare may also factor in and even increase during pregnancy.

The emotional, physical, and hormonal shifts around pregnancy and postpartum may also increase stress in a way that can trigger anxiety and depression. Pregnancy is often a high risk time for women with a history of mental health issues because many go off their medication or stop prior treatment when they get pregnant, or they might stop activities that are stress-relieving, like exercise, or feel socially isolated because they’re not going out with friends or participating in hobbies or rituals that are important to them, the way they used to.

Some women are more sensitive to hormonal fluctuations than others during pregnancy and the postpartum. Women with a history of severe mood changes around their menstrual cycles or when on hormonal birth control may be more sensitive to hormonal shifts and therefore more predisposed to developing a PMAD. Some theories suggest that postpartum depression is a form of general depression that occurs during pregnancy and in the postpartum period, perhaps made worse by stress and hormonal shifts but is not a different disease than the type of clinical depression people may experience at other times of life.

Other risk factors for developing a PMAD include: past depression or anxiety, especially around a prior pregnancy, recently stopping your treatment for anxiety or depression, family history of mental illness (especially PMAD.) Social isolation from family or friends, single motherhood, intimate partner conflict, low self esteem, financial stress (including stress around childcare), prior pregnancy loss, birth trauma, medical complications for a mother or baby, struggling with breastfeeding, and sleep deprivation may all be contributing factors.

Alexandra Sacks M.D. (left) is a reproductive psychiatrist, coauthor of What No One Tells You: A Guide to Your Emotions from Pregnancy to Motherhood and host of Motherhood Sessions podcast.

All women need to find a balance between giving and taking in order to treat PMADs and stay well.  In the throes of emotional shifts, it may be hard to remember the things that used to make you happy. If you’re physically able, going to a yoga class (even lying on the mat) and other forms of exercise like a walk around the block or gentle stretching at home may help. Studies show that meditation also helps with depression and anxiety.

Remember that sleep and rest are like medicine for your mental and physical wellness. This means that you may need to ask someone else to do one of the baby’s feedings while you get a longer stretch of rest (easier said than done, but at a certain point becomes essential).

Seeing an old friend may help you feel connected to your old self. Social isolation is a classic symptom of  anxiety and depression, but even women without these symptoms tend to stay hush-hush about the negative stuff of new motherhood for fear of being judged. Pretending nothing is wrong and hiding your feelings can cause your despair to deepen, and it can isolate you from other new moms who feel the same way you do.

Ask your healthcare provider for a referral to a mental health professional or find one through Postpartum Support International. Talk therapy helps, and it’s a misconception that all psychiatric medications are harmful during pregnancy and breastfeeding. Scientific data now shows that ignoring psychiatric illness during pregnancy and postpartum is not only bad for the mom, it may be bad for her baby’s health too. Experts can walk you through a risk/benefit analysis that compares the effects of the medication with the effects of the untreated illness. Mother to Baby has great resources for learning more about medication safety during pregnancy and breastfeeding.

You can learn more about how to prevent and treat PMADs and how to tell the difference between “matrescence” (the natural body, mind, hormone and relationship transitions of pregnancy and new motherhood) and PMAD in What No One Tells You: A Guide to Your Emotions from Pregnancy to Motherhood.