Perinatal or Postpartum Mood and Anxiety Disorders

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). Feelings can be mild, moderate or severe. Without treatment, symptoms may last a few weeks, several months or even years, depending on the severity. In all cases, help is available.

This information focuses on recognizing symptoms of a PMAD and how they differ from the "baby blues," and explains strategies for getting you or your loved one professional help. Note, this information is not a substitute for personal medical advice, clinical diagnosis or treatment. If you have questions or concerns about your emotional health or that of your loved one, please consult your healthcare professional.

Baby blues

There is a period of normal adjustment after having a baby when women may feel physically and emotionally overwhelmed. Approximately 50 percent to 80 percent of new mothers experience mood swings and weepiness during the first two to three weeks after giving birth. This is often called a period of postpartum “baby blues.” The baby blues are not the same as a perinatal or postpartum mood and anxiety disorder.

With time, patience, good self-care (sleeping, eating, hydrating, etc.), and the positive support of family and friends, symptoms will often fluctuate and usually disappear within a few days or weeks after birth.

If they do not disappear, it may be a sign of a bigger problem and you should seek medical attention. If you are unsure of whether or not you are experiencing baby blues or something more, please ask your healthcare provider.

Signs of baby blues

  • 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

What is a PMAD?

A PMAD occurs when baby blues symptoms last beyond a two- to three-week period and become worse or begin to interfere with everyday living. There are a number of reasons why parents may become depressed or anxious. As a mother, your body undergoes many changes during and after pregnancy. You may experience mood swings. A new baby will change parents’ sleeping schedules and lifestyles. In addition, there are many stressors to having a baby who has undergone surgery and an ICU hospitalization after birth.

Perinatal or postpartum mood and anxiety disorders affect 1 in 7 women and can happen even before your baby is born. These feelings get in the way of doing activities of everyday living, particularly caring for yourself and your baby. Symptoms such as feeling overly tired, experiencing appetite changes and poor sleep are often dismissed as “just part of being pregnant” or “being a new parent,” but if the things you do every day are affected, you should consider seeking help.

The changes that your body and emotions go through during and following pregnancy are very real and so are the risks for a PMAD. It is a serious illness, just like diabetes or heart disease, and it can be treated.

Types of PMADS

  • Perinatal or postpartum mood disorder
  • Perinatal or postpartum anxiety disorder
  • Perinatal or postpartum psychosis
  • Perinatal or postpartum obsessive-compulsive disorder (OCD)

Read more about the four different types of PMADs.

What causes a PMAD?

There is no single cause for a PMAD. It can affect any man or woman — regardless of age, race, income, culture or education. Yes, even men can experience perinatal or postpartum challenges. In fact, more than 10 percent of men who have a partner who is depressed during pregnancy or after birth also report experiencing similar depressive symptoms.

PMADs affect both women who breastfeed and those who do not. PMADs affect both women with healthy babies and those with medical challenges. PMADs affect both first-time parents and those with more than one child. Women and their partners who have experienced a difficult pregnancy or who have had a baby treated in the ICU after birth are at highest risk for experiencing emotional challenges in the postpartum period.

Changes in hormones during pregnancy and after birth may trigger a worsening of symptoms. A personal or family history of depression or anxiety may also put a woman at risk. A history of alcohol or drug abuse and/or ongoing stressful life events may also lead to a PMAD. Childbirth itself may be a stressful event, as well as having a baby requiring hospitalization or multiple medical interventions during the first year of life. Research also suggests that a lack of social support can put women and men at heightened risk.

How long does a PMAD last?

Every person is different and will have a different experience during pregnancy and throughout the postpartum period. Some parents may begin to feel better within a few weeks, while others may feel depressed or anxious for many months or even years. Remember that with treatment, you can get better.

What effects can a PMAD have if left untreated?

When a PMAD goes untreated, it can have unwanted and negative effects on your family. 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.

Babies, in turn, may experience more colic, feeding, sleeping and developmental challenges as a result. 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.

An untreated PMAD may place the entire family under stress, as your partner and other loved ones may feel disconnected from you in their attempts to help and comfort you.

Getting help for a PMAD

Only a trained healthcare or mental health professional can tell you whether you have a perinatal or postpartum mood and anxiety disorder. If you or your loved one continue to have difficulty during this time, it may be helpful for you to contact a mental health professional for additional support. Read more about getting help for a PMAD.

Additional resources

Podcast: Postpartum Depression in Dads and Partners

In this podcast episode, David Levine, MD, pediatrician and board member, Postpartum Support International, discusses PMADs in dads, partners, and adoptive parents. Among the topics: prevalence and risk factors for postpartum depression and other mood issues in dads and partners; cultural attitudes, including factors that keep dads from asking for help and the lack of public role models for struggling dads; how to include dads and partners in screening during obstetric or newborn care; how postpartum depression in dads may affect bonding with the infant; what to do if you suspect postpartum depression in a dad or partner; and more. Listen here.

Next Steps
Pregnant Mom and Toddler

Wood Center for Fetal Diagnosis and Treatment

The Wood Center for Fetal Diagnosis and Treatment cares for women carrying babies with known birth defects, from diagnosis to fetal surgery to care after birth.

Pregnancy and Zika virus

Garbose Family Special Delivery Unit

CHOP’s Special Delivery Unit is the world’s first birth facility in a pediatric hospital specifically designed for healthy mothers carrying babies with known birth defects.