Treatment for Perinatal Mood & Anxiety Disorders (PMADS) – The Basics

By Anna Thomas, PhD

What are PMADs?

Perinatal Mood & Anxiety Disorders (PMADs) describe symptoms of depression and/or anxiety that occur after childbirth and have been identified across all cultures and ethnicities. The term “perinatal” refers to the period during pregnancy and for the first year postpartum. PMADs are the most common complication of childbirth (affecting about one in five women) yet are highly treatable. 

What does treatment look like?

One of the first steps in treatment is to undergo an evaluation of symptoms . Some doctors offices will administer a questionnaire when you are in-office (for example your Ob-Gyn or pediatrician), but you can always reach out to them directly if you are experiencing symptoms before or after your next visit. They will likely discuss your symptoms with you to make a treatment plan or refer you to a mental health professional.  You can also connect directly with a mental health professional. I recommend moms consult the Postpartum Support International website for information on trained providers in their area (www.postpartum.net or call 1-800-944-4773). 

Once you have had an evaluation, your provider will make treatment recommendations. Treatment for PMADs can range depending on the severity of the condition (e.g., whether your symptoms are mild, moderate or severe). If your symptoms are mild or moderate, your provider may recommend you begin counseling (also sometimes called psychotherapy). Your provider will likely use an approach which is short-term and solutions-oriented to get you relief quickly. You may discuss self-care methods and positive coping strategies and work together with your therapist to understand where you can find more practical support. Some patients discontinue therapy once they feel better for a sustained amount of time. Other patients may find that therapy helps them for longer-term treatment. In our office, we allow patients to bring their babies if they are not able to come alone. We also encourage patients to consider embracing new technologies such as telehealth. There are also options for group support such as a postpartum support group, which is appealing for some moms. 

In more moderate or severe cases of PMADs, we typically treat patients with medication. The medications that are best understood during pregnancy and postpartum are called selective serotonin reuptake inhibitors (also called SSRIs). These are antidepressants and you may have heard of them before (Zoloft, Lexapro, Celexa and Prozac are most typical for treatment in pregnant/postpartum women). As psychologists, we don’t prescribe these directly but often work with Ob-Gyns who are comfortable prescribing these medications as well as psychiatrists who specialize in reproductive psychiatry. I would like to emphasize that we typically use a collaborative approach to make this decision (team approach including patient, their spouse if relevant, and doctors). We also emphasize that no decision is without risk. That means that while there may be small risks to taking these medications, there is also risk to having untreated mood & anxiety symptoms during pregnancy and postpartum.  In very rare cases, we may consider escalating a patient’s care to an inpatient option or program if we cannot manage one’s severe symptoms through medication and therapy alone. 

Why is it important to get treatment? 

PMADs are unfortunately underdiagnosed and they are typically accompanied by feelings of shame or loneliness. I always want to emphasize how common and treatable these conditions are. They can affect women who have never had mood or anxiety concerns before. They can also actually affect partners as well. Treatment will help a patient understand what is going on, emphasize that they are not alone and can make someone feel better sooner. Oftentimes it is important to undergo treatment as soon as someone notices they do not feel right to shorten the duration 

As I mentioned earlier, there are some concerns with untreated PMADs. Depression, anxiety, and stress can have adverse effects on the fetus. Additionally, they can have negative effects on maternal-infant attachment. Therefore we heavily encourage new moms and their families to “say something if they see something” to get someone treated quickly. 

I know in some cases the treatment options can seem stressful, but I encourage you to consider the recommendations and expertise of your treatment providers. It may be helpful to understand that no short-term treatment decision must have long-term implications (e.g., “Will I have to take medication forever?”)  I hope that you find some relief if you have been struggling or know what options exist should you start to experience symptoms in the future. Be well!