PMADS: Perinatal Depression:Signs and Where to Get Support

During pregnancy and postpartum women are particularly vulnerable to anxiety and depression. The perinatal period (conception-1 year delivery) is a time of significant hormone and identity change. While worry and anxiety is common; significant anxiety during pregnancy is related to higher rates of postpartum depression and comes with some lasting effects for mothers, infants, and families.

Pre-pandemic rates of a women experiencing a PMAD (Perinatal Mood and Anxiety Disorder) was estimated at about 1 in 5. However, research during the pandemic has find much higher rates. Rates of anxiety and depression during pregnancy have been found to more than double in the COVID-19 pandemic.

A study by Sandford University found rates of depression during pregnancy almost doubled https://news.stanford.edu/2021/06/01/stress-pregnancy-doubled-pandemic/. More than half of the pregnant women in the study reported high depression symptoms (51%) compared to a matched pre-pandemic group who had 25% rate. Another study conducted in the UK found that rates of depression for pregnant women went from 17% to 47% and anxiety jumped from 37% to 60% (https://www.sciencedaily.com/releases/2022/01/220131110457.htm).

With approximately half of pregnant women now found to be experiencing high anxiety and depression symptoms, it is important to help increase awareness of signs and spread the word about available resources.

Why is this so important?

Depression in pregnancy or during the first 12 months after delivery is one of the most common medical complications for mothers. Postpartum depression has even been identified as the most under-diagnosed obstetric complication in the United States.

Many women do not recognize the signs and symptoms of a PMAD. Relatively few women get screened for anxiety or depression during pregnancy and receive adequate support during this time. Yet, there are potential serious negative outcomes for women, infants, and families when perinatal anxiety and depression is left untreated. AND. There are evidence based-research supported therapeutic services that can successfully reduce and help effective manage symptoms for depression and anxiety.

What are Risk Factors for Perinatal Depression?

Risk factors for anxiety during pregnancy include financial challenges, low social support and poor support from a partner / spouse. A history of anxiety or depression also increases the chance that a mother will experience anxiety during the perinatal period. See the list of risk factors below: (From https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2018/11/screening-for-perinatal-depression)

Depression during Pregnancy:

• Maternal anxiety
• Life stress
• History of depression
• Lack of social support
• Unintended pregnancy
• Medicaid insurance
• Domestic violence
• Lower income
• Lower education
• Smoking
• Single status
• Poor relationship quality
• Postpartum depression:
• Depression during pregnancy
• Anxiety during pregnancy
• Experiencing stressful life events during pregnancy or the early postpartum period
• Traumatic birth experience
• Preterm birth/infant admission to neonatal intensive care
• Low levels of social support
• Previous history of depression
• Breastfeeding problems

Signs of Perinatal PMADS: A PMAD is not the commonly experienced “baby blues”. While approximately 60% of new mothers experience the “baby blues” the first few weeks after giving birth, a PMAD lasts longer and can significantly negatively affect functioning in daily life.

“Baby Blues”

According to the Children’s Hospital of Philadelphia (CHOP) signs of “baby blues” include the following: (https://www.chop.edu/conditions-diseases/perinatal-or-postpartum-mood-and-anxiety-disorders)

• Crying often and not always for a reason
• Feeling very tired
• Having trouble falling asleep
• Having trouble staying asleep
• Having trouble thinking clearly, or feeling out of touch
• Feeling very nervous around the baby
• Becoming easily annoyed and/or angry and not understanding why
• Feeling that nothing will ever be the same
• Not feeling like yourself

Perinatal Depression

The University of North Carolina, Chapel Hill School of Medicine identified the following symptoms of depression during pregnancy and during the postpartum period: (https://www.med.unc.edu/psych/wmd/resources/mood-disorders/perinatal/)

Symptoms of Depression in Pregnancy:

• Feeling sad, depressed, and/or crying a lot
• Diminished interest in becoming a mother
• Feeling worthless or guilty, especially about not being a good mother
• Strong anxiety, tension, and/or fear either about your future child or other things
• Sleep problems (not being able to sleep despite feeling very tired or sleeping more than usual but not feeling rested)
• Thoughts of wanting to be dead or wanting to kill yourself
• Having low energy
• Loss of or increase in appetite or weight
• Trouble focusing, remembering things, or making decisions
• Feeling restless or irritable
• Having headaches, chest pains, heart palpitations, numbness, or hyperventilation

Symptoms of Postpartum Depression:

• • Feeling sad, depressed, and/or crying a lot
• • Intense anxiety; rumination, obsessions (See Postpartum Anxiety Disorders below)
• • Loss of interest in usual activities
• • Feelings of guilt, worthlessness or incompetence
• • Fatigue, irritability, sleep disturbance
• • Change in appetite
• • Poor concentration
• • Feeling inadequate to cope with new infant
• • Excessive worry about baby’s health
• • Suicidal thoughts

Where to Find Support

If you or someone you know is experiencing depression symptoms or wants additional support during pregnancy or after delivery, please talk with a physician or trained therapist. There are free screening instruments that can be completed and shared with an OBGYN, Primary Care Physician or Therapist. (See https://psychology-tools.com/epds/ for a free downloadable Edinburgh Postnatal Depression Screen (EPDS).

To find Providers in the US: Providers in Florida:

The Postpartum Support International (PSI) provider directory can be found at https://www.postpartum.net/get-help/provider-directory/

In Florida you can also search trained providers at: https://flmomsmhresources.org